Prediction of changes in self-stigma among veterans participating in partial psychiatric hospitalization: The role of disability status and military cohort.

OBJECTIVE: Interventions addressing internalized stigma are a new area of research, and it is important to identify the types of clientele who derive benefit from existing interventions. METHOD: Information was provided by 235 veterans attending a partial psychiatric hospitalization program, regarding their levels of internalized stigma on admission and discharge from a 3-week program that included interventions targeting internalized stigma. RESULTS: Upon discharge, veterans receiving disability benefits demonstrated less reduction in internalized stigma than those not receiving disability benefits. Time of service moderated the relationship between disability status and change in internalized stigma, such that veterans serving in the more recent Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) cohort who received disability benefits had a more difficult time resolving internalized stigma. Further analyses suggested that OEF/OIF/OND cohort veterans receiving disability benefits have more difficulty developing effective stigma resistance, and more difficulty resolving stigma-related alienation, than other veterans. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Based on this research, particular attention should be devoted to internalized stigma among OEF/OIF/OND veterans.

A comparison of self-reported and phone-administered methods of ACT fidelity assessment: a pilot study in Indiana.

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.

A comparison of phone-based and on-site assessment of fidelity for assertive community treatment in Indiana.

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.