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Structured Assessment of FEasibility (SAFE)

What is SAFE?

Structured Assessment of FEasibility (SAFE) is a measure designed to assess the feasibility of implementing a complex intervention within mental health services within the NHS. The measure is designed for reviewers and policy makers when assessing the evidence base for an intervention and for researchers developing an intervention to ensure they consider factors related to implementation. SAFE was developed as part of the REFOCUS programme at King’s College London.

SAFE reporting guidelines were also developed, to identify the information needed in intervention reports which will allow SAFE to be rated. These reporting guidelines are intended to be used by authors reporting an intervention, to make it possible for the feasibility of the intervention to be assessed.

Citing SAFE

The reference for SAFE is:

Bird V, Le Boutillier C, Leamy M, Williams J, Bradstreet S, Slade M (2014) Evaluating the feasibility of complex interventions in mental health services: standardised measure and reporting guidelines, British Journal of Psychiatry, 204¸ 316-321

Please cite this reference whenever using the measure.

Downloading SAFE

The above paper included SAFE Version 1.0 as an appendix. Subsequent evaluation identified the need for minor modifications (SAFE Version 1.1) and a rating manual to further improve the reliability of SAFE ratings.

SAFE Measure Version 1.1

SAFE Measure Version 1.1 rating manual

SAFE Version 1 reporting guidelines

Scoring SAFE

The measure can be completed by systematic reviewers, commissioners, managers and researchers. There are 16 questions in two sections. The first eight questions assess blocks to implementation, with the final eight questions assessing facilitators of implementation. Best practice recommends against using summary scores on assessments to categorise papers within a systematic review, since items within the scale may have unequal weight. Instead it is recommended that reviewers attend to the individual items of the scale when conducting sensitivity and sub-group analyses. This same approach has been adopted for scoring SAFE – the reviewer rates individual items, without providing an overall summary score.

As an example of using SAFE, it has been applied to evaluation of the feasibility of recovery interventions:

van der Krieke L, Bird V, Leamy M, Bacon F, Dunn R, Pesola F, Janosik M, Le Boutillier C, Williams J, Slade M (2015) The feasibility of implementing recovery, psychosocial and pharmacological interventions for psychosis: comparison study, Implementation Science, 10, 73.

Using SAFE

The SAFE Measure is distributed using an Attribution-NonCommercial-No Derivative Works 4.0 International Public Licence (CC BY-NC-ND 4.0), which means that it can be used without permission for clinical, educational or research purposes, providing no change is made to the content and no charge is made. You do not need to contact us for this permission.

If you wish to change the content then you need to contact us to obtain our permission.

If you wish to charge for use, either directly on a pay-per-use basis or indirectly by including it within a commercial product such as software or a book, then you will first need to contact us to obtain a commercial use licence granting an Attribution-No Derivative Works 4.0 International Public Licence (CC BY-ND 4.0).

Translating SAFE

You have permission to translate SAFE providing all these conditions are met:

a) The translation is clearly labelled in English, e.g. SAFE Measure (Italian).

b) The translation must be compatible with the original English measure. Item 14 can be modified to ensure cultural compatibility, but other elements (e.g. structure, number and focus of items, rating scale etc.) cannot be changed. We encourage but do not require the development of high-quality translations, for example by following a formal methodology for translation such as described here.

c) The following statement is made in English and the local language on your translation:

SAFE was developed by Victoria Bird, Clair Le Boutillier, Mike Slade and colleagues in the Section for Recovery, Institute of Psychiatry, King’s College London. Further information from researchintorecovery.com/safe. This translation was published in year by name and contact details of translator

d) Your translation is clearly labelled with, and distributed using, an Attribution-NonCommercial-No Derivative Works 4.0 International Public Licence (CC BY-NC-ND 4.0), which means that it can be used without permission for clinical, educational or research purposes, providing no change is made to the content and no charge is made. Please contact us if you receive a request for permission to change or charge for your translation.

e) You send us a PDF copy of your translation which we will make available as a download in our translations list.