"You might lose him through the cracks": clinicians' views on discharge from Assertive Community Treatment.

Assertive Community Treatment (ACT) teams are increasingly interested in improving access to ACT through discharge of improved clients to less intensive mental health care services. We report results from a process evaluation of three teams in the VA's ACT program, Mental Health Intensive Case Management (MHICM), that began to implement discharge. MHICM clinicians (n=15) describe significant barriers to discharge. Clinicians support the concept of discharge but raise concerns about clients' future stability, clients' feelings about discharge, and other aspects of the discharge process. We propose strategies that can be used to support clinicians and clients in discharge decision-making.

The recovery promotion fidelity scale: assessing the organizational promotion of recovery.

The Recovery Promotion Fidelity Scale (RPFS) was developed to evaluate the extent to which public mental health agencies in Hawai'i incorporate recovery principles into their services and operations. The project progressed through two phases using concept mapping and expert review methods to generate scale items and identify dimensions of recovery that were used as scale domains. The resultant measure consists of 12 items organized around five recovery domains. This paper describes the development of the RPFS, illustrating how public mental health stakeholders, particularly persons in recovery, can be involved in efforts toward making a system of care more recovery oriented.

Validating a brief version of the Mental Health Recovery Measure for individuals with schizophrenia.

OBJECTIVE: This study explored the psychometric properties of the 30-item Mental Health Recovery Measure (MHRM) and a brief, ten-item version of the scale (MHRM-10) in a large, multisite sample of individuals with schizophrenia. METHODS: The sample consisted of 795 veterans with schizophrenia or schizoaffective disorder diagnoses who were receiving mental health services in one of eight Veterans Health Administration medical centers across four regions of the United States. Exploratory factor analysis was used to examine the factor structure of the MHRM and to select the most appropriate ten items for the brief measure. Correlations of the MHRM and the MHRM-10 with measures of quality of life, satisfaction with mental health services, symptom severity, and functioning were computed to further establish construct validity. Cronbach's alpha was used to assess the internal reliability of the MHRM and MHRM-10. RESULTS: Factor analysis resulted in an interpretable single-factor solution. The MHRM-10 was established by selecting the ten items with the highest factor loading scores. MHRM and MHRM-10 total scores correlated strongly and positively with quality-of-life measures (overall, leisure, general health, and daily activities) and negatively with depressive mood. Negligible correlations existed between the MHRM instruments and measures of functioning and satisfaction with services. Both instruments demonstrated excellent internal consistency. CONCLUSIONS: This study provides initial support for use of the MHRM-10 as a brief, valid, and reliable assessment of perceived recovery among individuals with schizophrenia and one that may be easily used in routine care.