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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]

Research and clinical interest in self-compassion has grown due to its associations with physical and mental health benefits. Widely used measures of self-compassion have conceptual and psychometric limitations that warrant attention. The purpose of this project was to develop a new self-compassion measure, the Brief Self-Compassion Inventory (BSCI), and test its psychometric properties. We developed items for the BSCI based on theory, prior research, and expert and cancer patient feedback. The BSCI was then tested with adults diagnosed with breast, gastrointestinal, lung, or prostate cancer (N = 404). Confirmatory factor analysis suggested a unidimensional structure, and internal consistency reliability was excellent. Construct validity of the BSCI was established through its correlations with psychological variables hypothesized to be related to self-compassion, such as mindfulness, acceptance of cancer, and other coping strategies. Furthermore, measurement invariance testing of the BSCI indicated that it could be used across patients of varying genders, cancer types, and stages of illness. In conclusion, the 5-item BSCI was determined to be psychometrically sound and suitable for use with adults of varying genders, cancer types, and stages of disease. The measure warrants testing with other medical and nonclinical populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Chinh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Students with ASD have some of the worst postsecondary outcomes when compared to other students with disabilities indicating transition planning may not be working effectively. One source of support for postsecondary planning is development of the transition Individualized Education Program (IEP). However, little research is available to describe the current contents of transition IEPs for students with ASD. This study aimed to describe IEP and postsecondary planning quality for students with autism in their final year of high school., Method: IEPs for 20 students with autism (M age = 18.2 years; SD = 1.1) from two mid-southern states were analyzed. Descriptive analyses were used to identify strengths and weaknesses of IEPs and postsecondary goals based on federal law requirements and best practice recommendations., Results: IEPs contained an average of 3.1 IEP goals and 1.6 postsecondary goals. IEP goals were most frequently related to academic, learning/work, or communication skills. All IEPs contained an employment postsecondary goal while less than half of the IEPs included an independent living postsecondary goal. Key findings include lack of goals related to social skills and the lack of alignment between present levels of performance, IEP goals, and postsecondary goals., Conclusions: IEPs for students with ASD in their final year of school do not consistently meet standards outlined by federal law or best practice recommendations necessary for successful transition from high school., Competing Interests: Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Lay Abstract: Little is known about factors impacting poor post-school outcomes for transition-age students with autism spectrum disorder. Guided by an implementation science framework that takes into account the multiple factors that influence transition outcomes, we sought to better understand the interdependent impacts of policy, organizational, provider, and individual factors that shape the transition planning process in schools, and the subsequent process through which transition plans are implemented as youth with autism spectrum disorder access services and gain employment after school. We conducted focus groups with individuals with autism spectrum disorder, parents, classroom teachers, school administrators, adult service providers, and state policymakers (10 groups, N  = 40). Participants described how core tenets of the individualized education planning process were not reliably implemented: planning was described by inappropriate goal-setting, ineffective communication, and inadequate involvement of all decision-makers needed to inform planning. After school, youth struggled to access the services specified in their transition plans due to inadequate planning, overburdened services, and insufficient accountability for adult service providers. Finally, a failure to include appropriate skill-building and insufficient interagency and community relationships limited efforts to gain and maintain employment. Diverse stakeholder perspectives illuminate the need for implementation efforts to target the provider, organizational, and policy levels to improve transition outcomes for individuals with autism spectrum disorder.

Although teachers reporting high teaching self-efficacy demonstrate positive teaching behaviors, minimal stress, and superior classroom management techniques, surprisingly few studies have demonstrated a relationship between teacher self-efficacy and student outcomes. This study explored self-efficacy specific to teaching students with autism spectrum disorder (ASD), and examined relationships with stress, teacher engagement, and student individualized education program (IEP) outcomes. Special education teachers ( N = 44) were recruited as part of a larger study examining a consultation intervention. Results indicated that self-efficacy for teaching students with ASD was significantly and positively correlated with teacher engagement and student outcomes, and negatively correlated with teacher stress. Furthermore, teachers who received the consultation intervention reported higher levels of self-efficacy for teaching students with ASD. This is the first study to report a direct association between teacher self-efficacy and student IEP outcomes and the potential positive impact of a teacher consultation intervention on the teacher intrapersonal factor of self-efficacy., Competing Interests: Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Evidence-based educational instruction includes teaching elements common across different approaches as well as specific elements of the chosen evidence-based practice. We were interested in evaluating the use and impact of common elements of teaching. Specifically, we adopted a model of elements of high quality teaching sequences and developed and tested an instructional quality index to capture evidence-based features within teaching sequences (Grisham-Brown & Ruble, 2014)., Method: The current investigation examined 29 special education teachers who received a consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple & McGrew, 2012) that results in personalized teaching plans for young students with ASD and embeds elements of evidence-based teacher coaching of self-reflection and performance-based feedback. We analyzed the teaching plans to understand which of the common elements were present, and if teachers demonstrated improved performance after coaching., Results: Analysis of the use of common elements during the first and fourth coaching session demonstrated that all teachers showed improvement. Most importantly, the use of common elements correlated with student goal attainment outcomes., Conclusions: These results suggest that common elements of teaching sequences which we view as core features of teaching quality, can be improved as a result of coaching, and most importantly, are associated with students' educational outcomes.

The current meta-analysis comprehensively reviewed group-design studies of interventions designed to improve ASD caregiver psychosocial outcomes and explored potential moderators of effectiveness. Forty-one unique studies targeting 1771 caregivers met inclusion criteria. Overall, the interventions had a small positive effect in improving psychosocial outcomes in caregivers of individuals with ASD (within-subjects: Hedges' g = .44; between-subjects: Hedges' g = .28). Most intervention approaches demonstrated some evidence of effectiveness. Acceptance and commitment therapy, mindfulness-based interventions, and cognitive behavioral treatments demonstrated the strongest impact in improving caregiver psychosocial outcomes in pre-post comparisons. Although the results provide preliminary support for the effectiveness of caregiver-focused interventions, more studies with larger sample sizes, rigorous research designs, and long-term follow-up assessments are needed.

The school, student and family factors underlying poor postsecondary outcomes of students with autism spectrum disorder (ASD) are not well understood. The potential impact of school [e.g., transition planning quality (TPQ)], family (e.g., parent activation), and student factors (e.g., adaptive functioning) and their interaction (e.g., parent-teacher alliance) on student outcomes were examined. Student IQ and adaptive behavior, TPQ, and alliance correlated with IEP progress, with postsecondary goal attainment generally and with student participation in training/education, specifically. However, only parent activation and student externalizing behavior correlated with employment. Families and students, rather than school personnel, were the primary persons in charge and in control of the implementation of postsecondary plans and required help across multiple coaching sessions to implement plans fully.

Purpose: Utilization of behavioral health treatment services among adolescents who have been detained or incarcerated within the juvenile justice system is poorly understood, with estimated utilization rates varying widely across studies. This meta-analysis was conducted to review and synthesize the literature on the prevalence of service utilization among this population., Methods: Data from 27 studies of 28 distinct samples were abstracted and coded. A meta-analysis was conducted to calculate individual prevalence estimates of behavioral health service utilization, which were combined using random effects models. A moderator analysis was also conducted., Results: Prevalence effect sizes (pr) for service utilization were low, with effect sizes pr = 33.1% for mental health services, pr = 27.95% for substance use-related services, and pr = 45.32% for unspecified services. The moderator analysis showed significant heterogeneity in prevalence of behavioral health service utilization., Conclusions: The findings suggest limited service utilization by adolescents who had been detained or incarcerated, whether assessed before, during, or after confinement. Future research should focus on assessing the quality of, and youth access to, behavioral health services within and outside of juvenile justice facilities. Improved programs to ensure consistent treatment for previously detained or incarcerated adolescents are warranted., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Implementation science provides guidance on adapting existing evidence based practices (EBPs) by incorporating implementation concerns from the start. Focus-group methodology was used to understand barriers and facilitators of transition planning and implementation for students with autism spectrum disorder (ASD) who often experience disparate postsecondary outcomes compared to peers. Results were used to modify an evidence-based consultation intervention originally applied to young students with ASD, called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple, & McGrew, 2012). Because consultation is a multilevel EBP, two existing implementation science frameworks were used to guide adaptation: the Framework for Evidence Based Implementation and Intervention Practices (Dunst & Trivette, 2012) and the Consolidated Framework for Implementation Research (Damschroder et al., 2009). The purpose of this article is to describe a process of adaptation of COMPASS that may be useful for other implementation science studies of consultation interventions, teacher acceptability, feasibility, and burden, and parent/student satisfaction with the adapted intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The postsecondary outcomes of individuals with autism spectrum disorder (ASD) are significantly worse than peers with other disabilities. One problem is the lack of empirically-supported transition planning interventions to guide services and help produce better outcomes. We applied an implementation science approach to adapt and modify an evidence-based consultation intervention originally tested with young children called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble et al., The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) and evaluate it for efficacy in a randomized controlled trial for transition-age youth. Results replicated findings with younger students with ASD that IEP outcomes were higher for COMPASS compared to the placebo control group (d = 2.1). Consultant fidelity was high and teacher adherence improved over time, replicating the importance of ongoing teacher coaching.

Although data-based decision making is an evidence-based practice, many special educators have difficulty applying the practice within daily routines. We applied the Theory of Planned Behavior (TPB) to understand the influences that promote or hinder early childhood special educators' intentions to collect data. We assessed three influences on behavioral intention to collect data derived from the TPB: (a) attitude toward collecting data, (b) social norms for collecting data, and (c) perceived behavioral control for collecting data. All three influences correlated positively with teachers' reported intention to collect data; however, only perceived behavioral control of barriers correlated positively with actual data collection. Additional measures of teacher self-efficacy and administrative support correlated positively with intention to collect data, but not with actual data collection behaviors. Perceived behavior control accounted for the most variance in actual data collection behavior. Implications of the findings for data collection practices in educational settings are discussed.

Consultation is essential to the daily practice of school psychologists (National Association of School Psychologist, 2010). Successful consultation requires fidelity at both the consultant (implementation) and consultee (intervention) levels. We applied a multidimensional, multilevel conception of fidelity (Dunst, Trivette, & Raab, 2013) to a consultative intervention called the Collaborative Model for Promoting Competence and Success (COMPASS) for students with autism. The study provided 3 main findings. First, multidimensional, multilevel fidelity is a stable construct and increases over time with consultation support. Second, mediation analyses revealed that implementation-level fidelity components had distant, indirect effects on student Individualized Education Program (IEP) outcomes. Third, 3 fidelity components correlated with IEP outcomes: teacher coaching responsiveness at the implementation level, and teacher quality of delivery and student responsiveness at the intervention levels. Implications and future directions are discussed. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Burnout is prevalent among mental health providers and is associated with significant employee, consumer, and organizational costs. Over the past 35 years, numerous intervention studies have been conducted but have yet to be reviewed and synthesized using a quantitative approach. To fill this gap, we performed a meta-analysis on the effectiveness of burnout interventions for mental health workers. We completed a systematic literature search of burnout intervention studies that spanned more than 3 decades (1980 to 2015). Each eligible study was independently coded by 2 researchers, and data were analyzed using a random-effects model with effect sizes based on the Hedges' g statistic. We computed an overall intervention effect size and performed moderator analyses. Twenty-seven unique samples were included in the meta-analysis, representing 1,894 mental health workers. Interventions had a small but positive effect on provider burnout (Hedges' g = .13, p = .006). Moderator analyses suggested that person-directed interventions were more effective than organization-directed interventions at reducing emotional exhaustion (Qbetween = 6.70, p = .010) and that job training/education was the most effective organizational intervention subtype (Qbetween = 12.50, p < .001). Lower baseline burnout levels were associated with smaller intervention effects and accounted for a significant proportion of effect size variability. The field has made limited progress in ameliorating mental health provider burnout. Based on our findings, we suggest that researchers implement a wider breadth of interventions that are tailored to address unique organizational and staff needs and that incorporate longer follow-up periods. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objective: This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations., Method: Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR., Results: Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p < .001, R2 = .248, R2 change = .05. Additionally, we found that higher levels of maladaptive coping at baseline were predictive of higher levels of adaptive coping at follow-up, F(2, 180) = 5.29, p < .02, R2 = .38, R2 change = .02. Evidence did not support additional predictors., Conclusions and Implications for Practice: Previously, consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Although associated with key recovery outcomes, stigma resistance remains under-studied largely due to limitations of existing measures. This study developed and validated a new measure of stigma resistance. Preliminary items, derived from qualitative interviews of people with lived experience, were pilot tested online with people self-reporting a mental illness diagnosis (n = 489). Best performing items were selected, and the refined measure was administered to an independent sample of people with mental illness at two state mental health consumer recovery conferences (n = 202). Confirmatory factor analyses (CFA) guided by theory were used to test item fit, correlations between the refined stigma resistance measure and theoretically relevant measures were examined for validity, and test-retest correlations of a subsample were examined for stability. CFA demonstrated strong fit for a 5-factor model. The final 20-item measure demonstrated good internal consistency for each of the 5 subscales, adequate test-retest reliability at 3 weeks, and strong construct validity (i.e., positive associations with quality of life, recovery, and self-efficacy, and negative associations with overall symptoms, defeatist beliefs, and self-stigma). The new measure offers a more reliable and nuanced assessment of stigma resistance. It may afford greater personalization of interventions targeting stigma resistance., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Successful implementation of evidence-based practices requires valid, yet practical fidelity monitoring. This study compared the costs and acceptability of three fidelity assessment methods: on-site, phone, and expert-scored self-report. Thirty-two randomly selected VA mental health intensive case management teams completed all fidelity assessments using a standardized scale and provided feedback on each. Personnel and travel costs across the three methods were compared for statistical differences. Both phone and expert-scored self-report methods demonstrated significantly lower costs than on-site assessments, even when excluding travel costs. However, participants preferred on-site assessments. Remote fidelity assessments hold promise in monitoring large scale program fidelity with limited resources.

Teacher stress and burnout have a detrimental effect on the stability of the teaching workforce. However, the possible consequences of teacher burnout on teaching quality and on student learning outcomes are less clear, especially in special education settings. We applied Maslach and Leiter's model (1999) to understand the direct effects of burnout on teaching in general and stress arising from interaction with a specific student on the IEP outcomes of young children with autism spectrum disorder. We also examined indirect effects through teaching quality and student engagement. The results indicated that one of the three components of burnout-teacher personal accomplishment-was directly related to IEP outcomes, a distal effect, whereas stress was directly related to teaching quality and student engagement, which were more proximal effects. Additionally, teacher stress, emotional exhaustion, and depersonalization had indirect effects on IEP outcomes through teaching quality and student engagement.

Provider competence may affect the impact of a practice. The current study examined this relationship in sixty-three providers engaging in Illness Management and Recovery with 236 consumers. Improving upon previous research, the present study utilized a psychometrically validated competence measure in the ratings of multiple Illness Management and Recovery sessions from community providers, and mapped outcomes onto the theory underlying the practice. Provider competence was positively associated with illness self-management and adaptive coping. Results also indicated baseline self-management skills and working alliance may affect the relationship between competence and outcomes.

Objective: To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence., Method: IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation)., Results: Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review., Conclusions and Implications for Practice: IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record, ((c) 2016 APA, all rights reserved).)

We applied the ABCX model of stress and coping to assess the association between child and family demands, school-based resources (i.e., parent-teacher alliance and COMPASS, a consultation intervention), and two measures of parent stress: perceptions of the demands of raising a child (Child domain) and reactions to those demands (Parent domain). Data were analyzed from seventy-nine parents of children ages 3-9 with ASD participating in two randomized controlled trials of COMPASS. Stronger parent-teacher alliance correlated with decreased Parent domain stress and participation in COMPASS correlated with decreased Child domain stress after controlling for baseline stress. The study indicates that school-based resources can help reduce parent stress.

Assertive community treatment is known for improving consumer outcomes, but is difficult to implement. On-site fidelity measurement can help ensure model adherence, but is costly in large systems. This study compared reliability and validity of three methods of fidelity assessment (on-site, phone-administered, and expert-scored self-report) using a stratified random sample of 32 mental health intensive case management teams from the Department of Veterans Affairs. Overall, phone, and to a lesser extent, expert-scored self-report fidelity assessments compared favorably to on-site methods in inter-rater reliability and concurrent validity. If used appropriately, these alternative protocols hold promise in monitoring large-scale program fidelity with limited resources.

Objective: Assertive Community Treatment (ACT) is an evidence-based practice for individuals living with serious mental illnesses. Although studies estimate that at least half of people with serious mental illnesses are parents, little is known about ACT policies and services for parent consumers., Method: Seventy-three ACT providers from 67 teams completed a survey about treatment services for parent consumers. Teams were divided into "parent-sensitive" and "nonsensitive" teams based on 3 indicators of parent-related services: identifying parental status, discussing parenting issues, and assisting with parenting needs. For each treatment indicator, teams were compared to determine factors that may contribute to parent-supportive services., Results: Providers from parent-sensitive teams that consistently identified consumers' parental status were more likely to talk with consumers about committed relationships and to assist consumers with parent-child communication. Parent-sensitive teams that frequently discussed parenting issues with consumers were less likely to be unsure of consumers' family plans, more likely to find out about parenting during goal setting, and more likely to assist with parent-related needs. Parent-sensitive teams that frequently provided assistance with parenting needs were more likely to serve minority consumers and consumers who want children, spend more time discussing parenting issues, and offer special programs for parent consumers., Conclusions and Implications for Practice: Findings suggest that simply identifying consumers as parents is not sufficient for ensuring consistent provision of parent-supportive services, whereas discussing parenting issues is associated with increased service provision. More intensive, evidence-based parent-supportive services are needed, as well as continued research on parents with serious mental illnesses and available treatment services. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

The extent to which explicit and implicit stigma are endorsed by mental health practitioners using evidence-based practices is unknown. The purposes of the current study were to a) examine implicit and explicit biases among Assertive Community Treatment (ACT) staff and b) explore the extent to which biases predicted the use of treatment control mechanisms. Participants were 154 ACT staff from nine states. Overall, the participants exhibited positive explicit and implicit attitudes toward people with mental illness. When modeled using latent factors, greater implicit, but not explicit, bias significantly predicted greater endorsement of restrictive or controlling clinical interventions. Thus, despite overall positive attitudes toward those with mental illness for the sample as a whole, individual differences in provider stigma were related to clinical care. Mental health professionals, and specifically ACT clinicians, should be educated on types of bias and ways in which biases influence clinical interventions.

It is encouraging that children with autism show a strong response to early intervention, yet more research is needed for understanding the variability in responsiveness to specialized programs. Treatment predictor variables from 47 teachers and children who were randomized to receive the COMPASS intervention (Ruble et al. in The collaborative model for promoting competence and success for students with ASD. Springer, New York, 2012a) were analyzed. Predictors evaluated against child IEP goal attainment included child, teacher, intervention practice, and implementation practice variables based on an implementation science framework (Dunst and Trivette in J Soc Sci 8:143-148, 2012). Findings revealed one child (engagement), one teacher (exhaustion), two intervention quality (IEP quality for targeted and not targeted elements), and no implementation quality variables accounted for variance in child outcomes when analyzed separately. When the four significant variables were compared against each other in a single regression analysis, IEP quality accounted for one quarter of the variance in child outcomes.

Background: The utility of an endophenotype depends on its ability to reduce complex disorders into stable, genetically linked phenotypes. P50 and P300 event-related potential (ERP) measures are endophenotype candidates for schizophrenia; however, their abnormalities are broadly observed across neuropsychiatric disorders. This study examined the diagnostic efficiency of P50 and P300 in schizophrenia as compared with healthy and bipolar disorder samples. Supplemental ERP measures and a multivariate classification approach were evaluated as methods to improve specificity., Methods: Diagnostic classification was first modeled in schizophrenia (SZ = 50) and healthy normal (HN = 50) samples using hierarchical logistic regression with predictors blocked by 4 levels of analysis: (1) P50 suppression, P300 amplitude, and P300 latency; (2) N100 amplitude; (3) evoked spectral power; and (4) P50 and P300 hemispheric asymmetry. The optimal model was cross-validated in a holdout sample (SZ = 34, HN = 31) and tested against a bipolar (BP = 50) sample., Results: P50 and P300 endophenotypes classified SZ from HN with 71% accuracy (sensitivity = .70, specificity = .72) but did not differentiate SZ from BP above chance level. N100 and spectral power measures improved classification accuracy of SZ vs HN to 79% (sensitivity = .78, specificity = .80) and SZ vs BP to 72% (sensitivity = .74, specificity = .70). Cross validation analyses supported the stability of these models., Conclusions: Although traditional P50 and P300 measures failed to differentiate schizophrenia from bipolar participants, N100 and evoked spectral power measures added unique variance to classification models and improved accuracy to nearly the same level achieved in comparison of schizophrenia to healthy individuals.

The purpose of the current study was to evaluate a new measure, the Autism Self-Efficacy Scale for Teachers (ASSET) for its dimensionality, internal consistency, and construct validity derived in a sample of special education teachers ( N = 44) of students with autism. Results indicate that all items reflect one dominant factor, teachers' responses to items were internally consistent within the sample, and compared to a 100-point scale, a 6-point response scale is adequate. ASSET scores were found to be negatively correlated with scores on two subscale measures of teacher stress (i.e., self-doubt/need for support and disruption of the teaching process) but uncorrelated with teacher burnout scores. The ASSET is a promising tool that requires replication with larger samples.

Assertive Community Treatment (ACT) is an evidence-based practice for individuals with severe mental illness. Although studies estimate at least half of all people with severe mental illness are parents, little is known about ACT policies and services for consumers who are parents. ACT providers from 67 teams completed a survey assessing policies for identifying parent consumers of ACT, estimated prevalence of parent consumers, available treatment services, and attitudes about parent consumers. Participants estimated that 18% of ACT consumers are parents. However, less than half of participants (47.8%) reported formally asking about parental status during intake and only 22.4% reported providing programs or services designed for parent consumers. Most participants (about 80%) reported negative or mixed attitudes about parenting with severe mental illness. Findings suggest the need for more attention and focus on parent consumers, including the formal identification of consumers' parental status and availability of parent-related treatment services.

Objective: Misperceptions about individuals with mental illness and their ability to recover and live productive lives are common. Consumer presentation programs, such as NAMI's (National Alliance on Mental Illness) In Our Own Voice (IOOV), employ psychoeducation and direct contact to help correct misperceptions and offer encouraging messages about recovery for those with and without mental illness. Prior research on IOOV has been limited to student samples in artificial settings. This study was designed to understand audience members' responses to IOOV in natural settings., Method: IOOV audience evaluations collected from two NAMI affiliates in 2009 were analyzed (n = 599). A mixed methods approach was used to explore (a) overall responses to the program, (b) whether the program satisfied program goals for audience members, and (c) differences between consumer and nonconsumer responses., Results: The majority of viewers responded very positively. Qualitative responses suggested that the program is meeting NAMI's goals for audience members: educating the public and offering a hope-inspiring message of recovery. The program's effects generalized across consumers and nonconsumers with few differences. Nonconsumers were more likely to report that the program was educational, offered hope, and delivered a message of recovery; only the first difference remained when controlling for students. Consumers were more likely to report personally relating to presenters., Conclusions and Implications for Practice: IOOV, as performed in the field, appears to provide educational and inspiring recovery-oriented programming freely available to the public., ((PsycINFO Database Record (c) 2013 APA, all rights reserved).)

Objective: Most children with autism rely on schools as their primary source of intervention, yet research has suggested that teachers rarely use evidence-based practices. To address the need for improved educational outcomes, a previously tested consultation intervention called the Collaborative Model for Promoting Competence and Success (COMPASS; Ruble, Dalrymple, & McGrew, 2010; Ruble, Dalrymple, & McGrew, 2012) was evaluated in a 2nd randomized controlled trial, with the addition of a web-based group., Method: Forty-nine teacher-child dyads were randomized into 1 of 3 groups: (1) a placebo control (PBO) group, (2) COMPASS followed by face-to-face (FF) coaching sessions, and (3) COMPASS followed by web-based (WEB) coaching sessions. Three individualized goals (social, communication, and independence skills) were selected for intervention for each child. The primary outcome of independent ratings of child goal attainment and several process measures (e.g., consultant and teacher fidelity) were evaluated., Results: Using an intent-to-treat approach, findings replicated earlier results with a very large effect size (d = 1.41) for the FF group and a large effect size (d = 1.12) for the WEB group relative to the PBO group. There were no differences in overall change across goal domains between the FF and WEB groups, suggesting the efficacy of videoconferencing technology., Conclusions: COMPASS is effective and results in improved educational outcomes for young children with autism. Videoconferencing technology, as a scalable tool, has promise for facilitating access to autism specialists and bridging the research-to-practice gap.

Background: Approaches to measuring recovery orientation are needed, particularly for programs that may struggle with implementing recovery-oriented treatment., Objective: A mixed-methods comparative study was conducted to explore effective approaches to measuring recovery orientation of assertive community treatment (ACT) teams., Design: Two ACT teams exhibiting high and low recovery orientation were compared using surveys, treatment plan ratings, diaries of treatment visits, and team leader-reported treatment control mechanisms., Results: The recovery-oriented team differed on one survey measure (higher expectations for consumer recovery), treatment planning (greater consumer involvement and goal-directed content), and use of control mechanisms (less use of representative payee, agency-held lease, daily medication delivery, and family involvement). Staff and consumer diaries showed the most consistent differences (e.g., conveying hope and choice) and were the least susceptible to observer bias but had the lowest response rates., Conclusions: Several practices differentiate recovery orientation on ACT teams, and a mixed-methods assessment approach is feasible.

Objective: Monitoring fidelity of assertive community treatment (ACT) teams is costly. This study investigated the reliability and validity of a less burdensome approach: self-reported assessment., Methods: Phone-administered and self-reported assessments were compared for 16 ACT teams. Team leaders completed a self-report protocol providing information sufficient to score the Dartmouth Assertive Community Treatment Scale (DACTS). Two raters scored the DACTS using only self-reported information. Two additional raters conducted phone interviews with team leaders, verifying the self-reported data, and independently scored the DACTS., Results: DACTS total scores obtained via self-reported assessments were reliable and valid compared with phone-administered assessment on the basis of interrater consistency (intraclass correlation) and consensus (mean rating differences). Phone-administered assessments agreed with self-reported assessments within .25 scale points (out of 5 points) for 15 of 16 teams., Conclusions: A self-report approach could address concerns regarding costs of monitoring as part of a stepped approach to quality assurance.

Objective: Assertive Community Treatment (ACT) is an evidence-based practice for individuals with severe mental illness. Although at least half of all people with severe mental illness are parents, little is known about their experiences as parents and as recipients of mental health interventions like ACT. The purpose of the current study was to examine the experiences of parent consumers served by ACT., Method: Seventeen parents being served by ACT teams were interviewed about parenting, parenting needs, severe mental illness, satisfaction with ACT services, and suggestions for improved parent-focused treatment services., Results: All parents identified at least one positive aspect of parenting and most parents (77%) also identified negative aspects of parenting. Loss of custody emerged as a significant parenting problem, with most parents (88%) experiencing custody loss at least once. Parents expressed interest in numerous parent-focused services, including family therapy, parenting skills, communication skills training, resources for children, and peer support groups. Most participants with adult children (88%) reported having no unmet parent-related needs and high satisfaction (4.63 of 5) with ACT services, whereas parents with young children (78%) reported having several unmet parenting needs and relatively lower satisfaction (3.78 out of 5) with ACT services., Conclusions and Implications for Practice: The ACT treatment model may not be adequately serving parents of young, dependent children. Findings suggest the need for more attention and focus on parent consumers, including identification of parental status and improved parent-related treatment services and support., (PsycINFO Database Record (c) 2013 APA, all rights reserved)

Goal attainment scaling (GAS) holds promise as an idiographic approach for measuring outcomes of psychosocial interventions in community settings. GAS has been criticized for untested assumptions of scaling level (i.e., interval or ordinal), inter-individual equivalence and comparability, and reliability of coding across different behavioral observation methods. We tested assumptions of equality between GAS descriptions for outcome measurement in a randomized trial (i.e., measurability, equidistance, level of difficulty, comparability of behavior samples collected from teachers vs. researchers and live vs. videotape). Results suggest GAS descriptions can be evaluated for equivalency, that teacher collected behavior samples are representative, and that varied sources of behavior samples can be reliably coded. GAS is a promising measurement approach. Recommendations are provided to ensure methodological quality.

Background: Processes underlying success and failure in assertive community treatment (ACT), a widely investigated treatment model for persons with severe mental illness, are poorly understood., Aims: The purpose of the current study was to examine processes in ACT by (1) understanding how consumers and staff describe the processes underlying treatment success and failure and (2) comparing processes identified by staff and consumers., Method: Investigators conducted semi-structured interviews with 25 staff and 23 consumers from four ACT teams., Results: Both staff and consumers identified aspects of the ACT team itself as the most critical in the process of consumer success. For failure, consumers identified consumer characteristics as most critical and staff identified lack of social relationships. Processes underlying failure were not viewed as merely the opposite of processes underlying success. In addition, there was notable disagreement between staff and consumers on important processes., Conclusions: Findings overlap with critical ingredients identified in previous studies, including aspects of the ACT team, social involvement and employment. In contrast to prior studies, there was little emphasis on hospitalizations and greater emphasis on not abusing substances, obtaining wants and desires, and consumer characteristics.

Teacher self-efficacy refers to the beliefs teachers hold regarding their capability to bring about desired instructional outcomes and may be helpful for understanding and addressing critical issues such as teacher attrition and teacher use of research-supported practices. Educating students with autism likely presents teachers with some of the most significant instructional challenges. The self-efficacy of 35 special education teachers of students with autism between the ages of 3 to 9 years was evaluated. Teachers completed rating scales that represented self-efficacy and aspects of the following 3 of Bandura's 4 sources of self-efficacy: (1) sense of mastery, (2) social persuasions, and (3) physiological/affective states. Significant associations were observed between physiological/affective states and self-efficacy, but no associations were observed for the other sources.

The significant increase in the numbers of students with autism combined with the need for better trained teachers (National Research Council, 2001) call for research on the effectiveness of alternative methods, such as consultation, that have the potential to improve service delivery. Data from 2 randomized controlled single-blind trials indicate that an autism-specific consultation planning framework known as the collaborative model for promoting competence and success (COMPASS) is effective in increasing child Individual Education Programs (IEP) outcomes (Ruble, Dal-rymple, & McGrew, 2010; Ruble, McGrew, & Toland, 2011). In this study, we describe the verbal interactions, defined as speech acts and speech act exchanges that take place during COMPASS consultation, and examine the associations between speech exchanges and child outcomes. We applied the Psychosocial Processes Coding Scheme (Leaper, 1991) to code speech acts. Speech act exchanges were overwhelmingly affiliative, failed to show statistically significant relationships with child IEP outcomes and teacher adherence, but did correlate positively with IEP quality.

Objective: Although assertive community treatment (ACT) has been consistently recognized as effective, there has been little research as to what constitutes success in ACT. The purpose of this study was to understand how ACT consumers and staff define treatment success and failure and to examine whether definitions varied between staff and consumers., Methods: Investigators conducted semistructured interviews with 25 staff and 23 consumers from four ACT teams., Results: Across perspectives, success and failure were most clearly related to consumer factors. Other themes included having basic needs met, being socially involved, and taking medications. Reduced hospitalizations were mentioned infrequently. Consumers were more likely than staff to identify the level or type of treatment as defining success and failure, whereas staff were more likely than consumers to discuss substance abuse when defining failure and improved symptoms when defining success., Conclusions: Success in ACT should be viewed more broadly than reduced hospitalizations and include domains such as social involvement.

The effects of a teacher consultation intervention were examined-namely, the collaborative model for promoting competence and success (COMPASS), which was designed to improve objectives of individualized education programs for children with autism. The intervention consists of an initial parent-teacher consultation, followed by four teacher consultations across the school year. Thirty-five teachers and a randomly selected child with autism (M age = 6.1 years) from each classroom participated. Compared to the nonintervention teacher-child dyads, the intervention teacher-child dyads showed improvements in individualized education program objectives, with a large effect size (d = 1.51).

Vocational rehabilitation (VR) supervisors and counselors (n = 35) as well as supported employment (SE) program managers and employment specialists (n = 26) were enrolled in a 12-month evaluation comparing two models of funding services for persons with severe mental illness: fee-for-service and results-based funding (RBF). Quantitative measures of job satisfaction and preference for funding method were obtained prospectively on a quarterly basis, and SE staff activity logs were collected monthly. Qualitative data were collected using a series of focus groups conducted at the conclusion of the study. Despite recording a substantial increase in semi-annualized VR billing charges when using RBF (45-49%), SE staff expressed less satisfaction with RBF over time. Staff raised concerns about increased financial risks and pressures to achieve job placements under RBF. Vocational rehabilitation staff were consistently more satisfied with RBF, expressing particular satisfaction with perceived effectiveness and the payment authorization process. Both VR and SE staff expressed some reservations about RBF, primarily concerning possible pressures for adverse client selection.

The ability of the Individual Placement and Support (IPS) and the Quality of Supported Employment Implementation Scale (QSEIS) fidelity scales to predict independently rated SE adherence and percentage of clients closed by the Office of Vocational Rehabilitation (OVR) was tested at 23 SE sites. QSEIS Total score (r = .47), Integration subscale (r = .53), and Support subscales (r = .61) correlated with SE adherence. Total QSEIS score also predicted OVR closure rate (r = .42). Correlations between IPS (sub)scale scores and the criterion measures were non-significant. The results support QSEIS validity and provide evidence that fidelity to the SE model is associated with better employment outcomes.

Objective: Although success rates for bone marrow transplantation (BMT) continue to improve, there is still a high level of morbidity and physical and emotional distress associated with BMT. To date, limited research has focused on the assessment of and screening for specific psychiatric disorders of patients facing BMT. This is especially true with regard to identifying adjustment disorder (AD), despite the fact that AD is the most prevalent psychiatric diagnosis in cancer patients., Methods: A sample of 95 BMT patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID) and completed several commonly used self-report instruments to determine if these tools could be used to identify patients with adjustment disorder in need of further assessment and intervention., Results: Of these patients, 34.7% were diagnosed with adjustment disorder, 11.6% with major depression, and 5.3% with generalized anxiety disorder. The instruments were not found to be predictive of AD. However, the results of a regression analysis showed that the Social Subscale of the Functional Assessment of Cancer Therapy-General (R2 delta = 0.04, F = 4.30, p < 0.05) was a significant predictor of adjustment disorder., Significance of Results: We conclude that there is little efficacy in using existing scales for detecting adjustment disorders in cancer patients undergoing bone marrow transplantation, and that other tools for identifying patients with adjustment disorder who might benefit from counseling are needed.

Objective: Screening for adjustment disorder (AD) in cancer patients presents a significant clinical challenge. As seen in Part I of this research, conventional, existing measures are rather poor at detecting this most common of psychiatric diagnoses. Bone marrow transplantation (BMT) has a high level of morbidity that can cause significant stress for patients faced with the procedure., Methods: A sample of 95 BMT patients completed a semistructured interview and a novel self-report instrument, the Coping Flexibility Scale for Cancer (C-Flex), to determine if it could identify patients with adjustment disorder in need of further assessment and intervention., Results: The screen yielded four factors but was not predictive of AD. However, the C-Flex was significantly related to the presence of any disorder (r = -0.44, p < 0.001) in this sample. In addition, Factor I of the screen was found to be correlated to the presence of any diagnosis (r = -0.44, p < 0.001) and to have adequate sensitivity (81.63%) and specificity (76.09%)., Significance of Results: Either because of problems with the scale or the amorphous nature of the AD category, or both, rapid identification of patients with this common problem has proven to be elusive.

Objective: The authors sought to identify case managers' perspectives on the critical ingredients, therapeutic mechanisms of action, and gaps in implementation of the critical ingredients of assertive community treatment., Methods: Seventy-three assertive community treatment teams that attended the 1997 National Assertive Community Treatment Conference rated the degree to which 16 clinical activities were beneficial to clients and rated the importance of 27 possible critical ingredients of the ideal team as well as the extent to which each ingredient characterized their team., Results: At least 50 percent of the teams rated 24 of the 27 critical ingredients as "very important." Having a full-time nurse on the team was rated as the most important ingredient, and medication management was rated as the most beneficial clinical activity. The ratings of teams from urban and rural settings were highly correlated. Critical elements that the teams reported as being the most underimplemented included the presence of a full-time substance abuse specialist, a psychiatrist's involvement on the team, team involvement with hospital discharge, and working with a client support system., Conclusions: Case managers strongly endorsed the team approach as well as medical aspects of assertive community treatment. Despite broad consensus on the critical ingredients of the ideal assertive community treatment team, several important ingredients appear to be consistently underimplemented.

As part of a larger interview, clients of assertive community treatment programs answered an open-ended question about what they liked least about assertive community treatment. Of 182 clients, 44 percent reported that they disliked nothing; 21 percent said that they disliked features that are considered specific to assertive community treatment, such as home visits, or that have been criticized in the literature, such as intrusiveness; 16 percent said that they were dissatisfied with underimplementation of elements thought to characterize assertive community treatment, such as frequency of visits; and 19 percent said that they were dissatisfied with general aspects of mental health service delivery, such as an inconvenient office location. Compared with clients of programs with low levels of fidelity to assertive community treatment, clients of high-fidelity programs had fewer complaints overall and fewer complaints about features considered to be specific to assertive community treatment.

This study compared experts' views on the critical ingredients of assertive community treatment and intensive case management. Twenty experts on assertive community treatment and 22 experts on intensive case management rated the importance of 40 elements common to each treatment approach. The assertive community treatment experts gave higher importance ratings than the intensive case management experts to 37 of the 40 items; for 21 of these items, the ratings were significantly higher. Differences in importance ratings were greatest for organizational and structural elements and smallest for treatment goals. The results of this study indicate that although intensive case management resembles assertive community treatment in most respects, assertive community treatment may be a more clearly articulated model overall.