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Objective: This study investigated the reliability and validity of a phone-administered fidelity assessment instrument based on the Dartmouth Assertive Community Treatment Scale (DACTS).Methods: An experienced rater paired with a research assistant without fidelity assessment experience or a consultant familiar with the treatment site conducted phone-based assessments of 23 teams providing assertive community treatment in Indiana. Using the DACTS, consultants conducted on-site evaluations of the programs.Results: The pairs of phone raters revealed high levels of consistency [intraclass correlation coefficient (ICC)=.92] and consensus (mean absolute difference of .07). Phone and on-site assessment showed strong agreement (ICC=.87) and consensus (mean absolute difference of .07) and agreed within .1 scale point, or 2% of the scoring range, for 83% of sites and within .15 scale point for 91% of sites. Results were unaffected by the expertise level of the rater.Conclusions: Phone-based assessment could help agencies monitor faithful implementation of evidence-based practices. [ABSTRACT FROM AUTHOR]

Although supported employment (SE) helps most individuals with mental illness find employment, many continue to face significant barriers to achieving their vocational goals. In this 12-month prospective study, consumer perceptions of illness-related (e.g., medication side effects) and common (e.g., transportation) barriers to employment were assessed in relation to work and rehabilitation outcomes. At the time of SE enrollment, endorsement of illness-related barriers correlated negatively with hopefulness and quality of life, whereas endorsement of common barriers correlated negatively with clinician ratings of independent functioning. Both total barriers and common barriers correlated negatively with later employment attainment. [ABSTRACT FROM AUTHOR]

Background. To help mitigate empirically-identified shortcomings in Supported Employment (SE) outcomes for consumers with severe mental illness in Indiana (e.g., few long-term placements), Vocational Rehabilitation Services (VRS) and the Indiana Division of Mental Health and Addictions (DMHA) proposed the implementation of a results-based funding (RBF) system, in which providers received payment only when clients successfully attained each of 5 employment milestones. The current study presents the results of a multi-site controlled trial of RBF vs. a traditional fee-for-service (FFS) model.Method. The sample included 122 (RBF=81, FFS=41) consumers of SE (52% schizophrenia, 35% mood disorder). Assessments of clinical and life outcomes were conducted quarterly across 12 months.Results. Those served in RBF were more likely to attain all milestones collectively, and to have a completed person-centered plan and attain 9-months of employment, specifically. There were few differences between those in RBF and FFS on non-milestone employment variables (e.g., job match, wages) or clinical measures (e.g., quality of life, functioning).Conclusions. RBF produces better overall vocational outcomes, specifically, higher rates of completion of a person-centered plan and retention of employment for 9 months. However, improvements with RBF were limited to those specified and did not generalize to vocational areas not targeted by the milestones (e.g., wages, benefits) or to changes in other life domains typically valued by psychiatric rehabilitation. [ABSTRACT FROM AUTHOR]