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The Psychometric Properties of the Assertive Community Treatment Transition Readiness Scale (ATR)

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Abstract

Assertive community treatment (ACT) is an evidence-based practice for individuals living with severe mental illnesses. Originally conceptualized as a lifetime service, there is a need for standardized measures to help ACT teams identify clients who are potentially ready for a transition to less intensive services. Here, to address this gap in the literature, the psychometric properties of the Assertive Community Treatment Transition Readiness Scale (ATR) were examined. Data on the ATR were collected from ACT staff from across the country who had experience transitioning ACT clients to less intensive services. Results from an exploratory factor analysis suggested a one-factor solution and that items on the ATR demonstrated excellent internal consistency reliability as well as predictive criterion validity and known-groups validity. The ATR is an easy-to-use, 18-item measure that has the potential, in combination with clinical judgment and practice wisdom, to be a useful tool for identifying ACT clients who could transition to a less intensive level of care.

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Change history

  • 20 March 2021

    In Appendix, the sentence “Questions about the ATR should be addressed to (omitted to preserve anonymity of authors).” has been updated as “Questions about the ATR should be addressed to Gary S. Cuddeback, Ph.D., at gcuddeba@email.unc.edu.”

References

  • Anthony, W. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11–23.

    Article  Google Scholar 

  • Audini, B., Marks, I. M., Lawrence, R. E., Connolly, J., & Watts, V. (1994). Home-based versus out-patient/in-patient care for people with serious mental illness. Phase II of a controlled study. The British Journal of Psychiatry, 165(2), 204–210.

    Article  CAS  Google Scholar 

  • Bollen, K. A. (1989). Structural equations with latent variables. New York, USA: John Wiley.

    Book  Google Scholar 

  • Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Disease Management and Health Outcomes, 9(3), 141–159.

    Article  Google Scholar 

  • Bromley, E., Mikesell, L., Whelan, F., Hellemann, G., Hunt, M., Cuddeback, G. S., Bradford, D. W., & Young, A. S. (2017). Clinical factors associated with successful discharge from assertive community treatment. Community Mental Health Journal, 53(8), 916–921. https://doi.org/10.1007/s10597-017-0083-1

    Article  PubMed  Google Scholar 

  • Carter, J. V., Pan, J., Rai, S. N., & Galandiuk, S. (2016). ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves. Surgery, 159(6), 1638–1645. https://doi.org/10.1016/j.surg.2015.12.029

    Article  PubMed  Google Scholar 

  • Comrey, A. L. & Lee, H. B. (2013). A first course in factor analysis. Retrieved October 30, 2020 from https://search.proquest.com.

  • Cuddeback, G. S., Morrissey, J. P., & Meyer, P. S. (2006). How many assertive community treatment teams do we need? Psychiatric Services, 57(12), 1803–1806.

    Article  Google Scholar 

  • Davidson, L. (2003). Living outside mental illness: Qualitative studies of recovery in schizophrenia. New York, USA: New York University Press.

    Google Scholar 

  • DeVellis, R. F. (1991). Scale development: Theory and applications. Newbury Park, CA: Sage.

    Google Scholar 

  • Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. Psychiatric Services, 51(6), 759–765.

    Article  CAS  Google Scholar 

  • Donahue, S. A., Manuel, J. I., Herman, D. B., Fraser, L. H., Chen, H., & Essock, S. M. (2012). Development and use of a transition readiness scale to help manage ACT team capacity. Psychiatric Services, 63(3), 223–229. https://doi.org/10.1176/appi.ps.201100041.

    Article  PubMed  Google Scholar 

  • Ellwood, P. (1988). Outcomes management – a technology of patient experience. New England Journal of Medicine, 318, 1549–1556.

    Article  CAS  Google Scholar 

  • Emerson, R. M., Fretz, R. I., & Shaw, L. L. (1995). Writing ethnographic fieldnotes. Chicago: University of Chicago Press.

    Book  Google Scholar 

  • Fabrigar, L. R., Wegener, D. T., MacCallum, R. C., & Strahan, E. J. (1999). Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods, 4(3), 272–299.

    Article  Google Scholar 

  • Gorsuch, R. L. (1983). Factor analysis (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

    Google Scholar 

  • Hackman, A. L., & Stowell, K. R. (2009). Transitioning clients from assertive community treatment to traditional mental health services. Community Mental Health Journal, 45(1), 1–5.

    Article  Google Scholar 

  • Huxley, P. (1998). Outcomes management in mental health: A brief review. Journal of Mental Health, 7, 273–283.

    Article  Google Scholar 

  • Huz, S., Thorning, H., White, C. N., Fang, L., Smith, B. T., Radigan, M., & Dixon, L. B. (2017). Time in assertive community treatment: A statewide quality improvement initiative to reduce length of pJensarticipation. Psychiatric Services, 68(6), 539–541. https://doi.org/10.1176/appi.ps.201700127

    Article  PubMed  Google Scholar 

  • Jenkins, R. (1990). Towards a system of outcome indicators for mental health care. British Journal of Psychiatry, 157, 500–514.

    Article  CAS  Google Scholar 

  • Jones, K., Colson, P. W., Holter, M. C., Lin, S., Valencia, E., Susser, E., & Wyatt, R. J. (2003). Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness. Psychiatric Services, 54(6), 884–890.

    Article  Google Scholar 

  • Loehlin, J. C. (1998). Latent variable models: An introduction to factor, path, and structural analysis (3rd ed.). Mahwah, NJ: Lawrence Erlbaum.

    Google Scholar 

  • McRae, J., Higgins, M., Lycan, C., & Sherman, W. (1990). What happens to patients after five years of intensive case management stops? Psychiatric Services, 41(2), 175–179.

    Article  CAS  Google Scholar 

  • Monroe-DeVita, M., Teague, G. B., & Moser, L. L. (2011). The TMACT: A new tool for measuring fidelity to assertive community treatment. Journal of the American Psychiatric Nurses Association, 17(1), 17–29. https://doi.org/10.1177/1078390310394658.

  • New Freedom Commission on Mental Health (2003) Achieving the promise: Transforming mental health care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.

  • Nunnally, J. C., & Bernstein, I. H. (2001). Psychometric theory (4th ed.). New York, USA: McGraw-Hill.

    Google Scholar 

  • Rosenheck, R. A., & Dennis, D. (2001). Time-limited assertive community treatment for homeless persons with severe mental illness. Archives of General Psychiatry, 58(11), 1073–1080. https://doi.org/10.1001/archpsyc.58.11.1073.

    Article  CAS  PubMed  Google Scholar 

  • Salyers, M. P., Masterton, T. W., Fekete, D. M., Picone, J. J., & Bond, G. R. (1998). Transferring clients from intensive case management: Impact on client functioning. American Journal of Orthopsychiatry, 68(2), 233.

    Article  CAS  Google Scholar 

  • Slade, M., Thornicroft, G., & Glover, G. (1999). The feasibility of routine outcome measures in mental health. Social Psychiatry and Psychiatric Epidemiology, 34, 243–249.

    Article  CAS  Google Scholar 

  • Sowers, W., George, C., & Thompson, K. (1999). Level of care utilization system for psychiatric and addiction services (LOCUS): A preliminary assessment of reliability and validity. Community Mental Health Journal, 35(6), 545–563.

    Article  CAS  Google Scholar 

  • Stein, L. I., Barry, K. L., Van Dien, G., Hollingsworth, E. J., & Sweeney, J. K. (1999). Work and social support: A comparison of consumers who have achieved stability in ACT and clubhouse programs. Community Mental Health Journal, 35(2), 193–204.

    Article  CAS  Google Scholar 

  • Stein, L. I., & Test, M. A. (1980). Alternative to mental hospital treatment. Archives of General Psychiatry, 37(4), 392–397.

    Article  CAS  Google Scholar 

  • Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W. Y., & Wyatt, R. J. (1997). Preventing recurrent homelessness among mentally ill men: A” critical time” intervention after discharge from a shelter. American Journal of Public Health, 87(2), 256–262.

    Article  CAS  Google Scholar 

  • Tomar, N., Ghezzi, M. A., Wilson, A. B., Van Deinse, T. B., Burgin, S., & Cuddeback, G. S. (2020). Demographic and clinical characteristics of consumers who transition from assertive community treatment to less intensive services. Social Work in Mental Health, 18(4), 398–409. https://doi.org/10.1080/15332985.2020.1769002.

    Article  Google Scholar 

  • Winter, J. P., & Calsyn, R. J. (2000). The Dartmouth Assertive Community Treatment Scale (DACTS): A generalizability study. Evaluation Review, 24(3), 319–338. https://doi.org/10.1177/0193841X0002400304.

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Funding

This research was funded by the Ohio Department of Mental Health and the Health Foundation of Greater Cincinnati.

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Correspondence to Gary S. Cuddeback.

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Cuddeback, G.S., Wu, J.C. The Psychometric Properties of the Assertive Community Treatment Transition Readiness Scale (ATR). Community Ment Health J 57, 1301–1309 (2021). https://doi.org/10.1007/s10597-021-00806-9

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  • DOI: https://doi.org/10.1007/s10597-021-00806-9

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