Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness

  • Alexander S. Young
  • Sandra L. Forquer
  • Anh Tran
  • Midge Starzynski
  • Jess Shatkin
Brief Reports


Individuals with severe mental illness often do not receive appropriate treatment or rehabilitation. One approach to improving their care begins by identifying competencies that clinicians should possess. This project developed a set of core clinical competencies that pertain to community-based care and support the goals of empowerment and rehabilitation. Development of the competency set began with review of existing literature and competency statements, and focus groups and interviews with clients, family members, clinicians, managers, experts, and advocates. Representatives from each of these groups participated in a national panel and used a structured process to identify 37 final competencies. Panel members agreed that these competencies are very important in determining outcomes and often are not present in current clinicians. This project demonstrates that it is possible to develop a core competency set that can be strongly supported by diverse groups of stakeholders. These competencies may be useful in clinician training, recruitment, and credentialing efforts.


Public Health Family Member Focus Group Health Promotion Health Psychology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Lehman AF: Quality of care in mental health: The case of schizophrenia.Health Affairs 1999; 18:52–65.Google Scholar
  2. 2.
    Geller JL, Brown JM, Fisher WH, et al.: A national survey of “consumer empowerment” at the state level.Psychiatric Services 1998; 49:498–503.Google Scholar
  3. 3.
    National Advisory Mental Health Council's Clinical Treatment and Services Research Workgroup:Bridging Science and Service. NIH Pub. No. 99-4353. Bethesda, MD: National Institutes of Health/National Institute of Mental Health, 1999.Google Scholar
  4. 4.
    Young AS, Sullivan G, Burnam MA, et al.: Measuring the quality of outpatient treatment for schizophrenia.Archives of General Psychiatry 1998; 55:611–617.Google Scholar
  5. 5.
    Lehman AF, Steinwachs DM: Patterns of usual care for schizophrenia: Initial results from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey.Schizophrenia Bulletin 1998; 24:11–20.Google Scholar
  6. 6.
    Grusky O, Podus D, Webster C, et al.: Measuring the cost and outcome effects of case management teams.Research in the Sociology of Health Care 1997; 14:305–325.Google Scholar
  7. 7.
    Kissling W: Compliance, quality assurance and standards for relapse prevention in schizophrenia.Acta Psychiatrica Scandinavica Supplement 1994; 382:16–24.Google Scholar
  8. 8.
    Chassin MR: Quality of health care. Part 3: Improving the quality of care.New England Journal of Medicine 1996; 335:1060–1063.Google Scholar
  9. 9.
    Soumerai SB, Avorn J: Principles of educational outreach (“academic detailing”) to improve clinical decision making.Journal of the American Medical Association 1990; 263:549–556.Google Scholar
  10. 10.
    Coursey RD:CMHS Adult Panel of Managed Care Initiative: Competencies for Direct Service Staff who Work with Adults with Serious Mental Illness in Public Mental Health/Managed Care Systems. 3rd rev. ed. Philadelphia: University of Pennsylvania Center for Mental Health Policy and Services Research, 1998.Google Scholar
  11. 11.
    Drake RE, McHugo GJ, Bebout RR, et al.: A randomized clinical trial of supported employment for inner-city patients with severe mental disorders.Archives of General Psychiatry 1999; 56:627–633.Google Scholar
  12. 12.
    Marder SR, Wirshing WC, Mintz J, et al.: Two-year outcome of social skills training and group psychotherapy for outpatients with schizophrenia.American Journal of Psychiatry 1996; 153:1585–1592.Google Scholar
  13. 13.
    Lehman AF, Steinwachs DM: Translating research into practice: The Schizophrenia Patient Outcomes Research Team (PORT) treatment recommendations.Schizophrenia Bulletin 1998; 24:1–10.Google Scholar
  14. 14.
    American Psychiatric Association: Practice guideline for psychiatric evaluation of adults.American Journal of Psychiatry 1995; 152:63–80.Google Scholar
  15. 15.
    American Psychiatric Association: Practice guidelines for the treatment of patients with bipolar disorder.American Journal of Psychiatry 1994; 151:S1-S36.Google Scholar
  16. 16.
    American Psychiatric Association: Practice guidelines for major depressive disorder in adults.American Journal of Psychiatry 1993; 150:S1-S26.Google Scholar
  17. 17.
    American Psychiatric Association: Practice guideline for the treatment of patients with schizophrenia.American Journal of Psychiatry 1997; 154:1–63.Google Scholar
  18. 18.
    Zarate CA, Jr., Daniel DG, Kinon BJ, et al.: Algorithms for the treatment of schizophrenia.Psychopharmacology Bulletin 1995; 31:461–467.Google Scholar
  19. 19.
    Suppes T, Calabrese JR, Mitchell PB, et al.: Algorithms for the treatment of bipolar manic-depressive illness.Psychopharmacology Bulletin 1995; 31:469–474.Google Scholar
  20. 20.
    Department of Veterans Affairs:Clinical Guideline for Management of Persons with Psychoses, Version 1.0. Washington, DC: Veterans Health Administration, 1997.Google Scholar
  21. 21.
    Chiles JA, Miller AL, Crismon ML, et al.: The Texas Medication Algorithm Project: Development and implementation of the schizophrenia algorithm.Psychiatric Services 1999; 50:69–74.Google Scholar
  22. 22.
    American Psychiatric Association: Practice guideline for the treatment of patients with substance use disorders: Alcohol, cocaine, opioids.American Journal of Psychiatry 1995; 152:1–80.Google Scholar
  23. 23.
    American Psychiatric Association Steering Committee: The expert consensus guideline series: Treatment of schizophrenia.Journal of Clinical Psychiatry 1996; 57:3–58.Google Scholar
  24. 24.
    American Psychiatric Association Steering Committee: The expert consensus guideline series: Treatment of bipolar disorder.Journal of Clinical Psychiatry 1996; 57:3–88.Google Scholar
  25. 25.
    American Psychological Association: Guidelines for providers of psychological services to ethnic, linguistic, and culturally diverse populations.American Psychologist 1993; 48:45–48.Google Scholar
  26. 26.
    Trochim W, Cook J:Workforce Competencies for Psychosocial Rehabilitation Workers: A Concept Mapping Project (final report). The International Association of Psychosocial Rehabilitation Services, 1993.Google Scholar
  27. 27.
    Jonikas J:Staff Competencies for Service-Delivery Staff in Psychosocial Rehabilitation Programs. Chicago: Thresholds National Research and Training Center on Rehabilitation and Mental Illness, 1993.Google Scholar
  28. 28.
    Kuehnel TG, Liberman RP:Competencies for Psychiatric Rehabilitation Workers. Camarillo, CA: Psychiatric Rehabilitation Consultants, 1997.Google Scholar
  29. 29.
    Glynn SM, Liberman RP, Backer TE:Involving Families in Mental Health Services: Competencies for Mental Health Workers. Northridge, CA: Center for Improving Mental Health Systems, 1997.Google Scholar
  30. 30.
    International Association of Psychosocial Rehabilitation Services:Practice Guidelines for the Psychiatric Rehabilitation of Persons with Severe and Persistent Mental Illness in a Managed Care Environment. Columbia, MD: IAPSRS, 1997.Google Scholar
  31. 31.
    International Association of Psychosocial Rehabilitation Services:Code of Ethics for Psychiatric Rehabilitation Practitioners. Columbia, MD: IAPSRS, 1996.Google Scholar
  32. 32.
    Carling P, Curtis L:Training Standards for Staff Who Work with Serous Mental Illnesses in Public Mental Health Services. Waterbury, VT: Vermont Department of Mental Health and Mental Retardation, 1993.Google Scholar
  33. 33.
    Young AS, Clark GH, Jr.: Guidelines for community psychiatric practice. In: Vaccaro JV, Clark GH, Jr. (Eds.):Practicing Psychiatry in the Community: A Manual. Washington, DC: American Psychiatric Press, 1996, pp. 331–341.Google Scholar
  34. 34.
    Torrey WC, Wyzik PF:New Hampshire Clinical Practice Guidelines for Adults in Community Support Programs. Concord: New Hampshire-Dartmouth Psychiatric Research Center, 1997.Google Scholar
  35. 35.
    Gill KJ, Pratt CW, Barrett N: Preparing psychiatric rehabilitation specialists through undergraduate education.Community Mental Health Journal 1997; 33:323–329.Google Scholar
  36. 36.
    University of Pennsylvania Center for Mental Health Policy and Services Research:Managed Care Initiative Panel Reports., accessed March 10, 2000.Google Scholar
  37. 37.
    Lehman AF: Vocational rehabilitation in schizophrenia.Schizophrenia Bulletin 1995; 21:645–656.Google Scholar
  38. 38.
    Drake RE, Becker DR: The individual placement and support model of supported employment.Psychiatric Services 1996; 47:473–475.Google Scholar
  39. 39.
    Kaplan SH, Greenfield S, Ware JE, Jr.: Assessing the effects of physician-patient interactions on the outcomes of chronic disease.Medical Care 1989; 27:S110-S127.Google Scholar
  40. 40.
    Liberman RP, Kopelowicz A, Young AS: Biobehavioral treatment and rehabilitation of schizophrenia.Behavior Therapy 1994; 25:89–107.Google Scholar
  41. 41.
    Mueser KT, Glynn SM: Family intervention for schizophrenia. In: Dobson KS, Craig KD (Eds.):Emprically-Supported Therapies: Best Practices in Professional Psychology. Thousand Oaks, CA: Sage, 1998, pp. 157–185.Google Scholar
  42. 42.
    Anthony WA: Recovery from mental illness: The guiding vision of the mental health service system in the 1990s.Psychosocial Rehabilitation Journal 1993; 16:11–23.Google Scholar
  43. 43.
    Rogers ES, Chamberlin J, Ellison ML, et al.: A consumer-constructed scale to measure empowerment among users of mental health services.Psychiatric Services 1997; 48:1042–1047.Google Scholar
  44. 44.
    American Nurses Association:Position Statements: Psychiatric Mental Health Nursing and Managed Care. Kansas City, MO: American Nurses Association, 1997.Google Scholar
  45. 45.
    Kissling W (Eds.):Guidelines for Neuroleptic Relapse Prevention in Schizophrenia. New York: Springer-Verlag, 1991, p. 166.Google Scholar
  46. 46.
    Lu FG, Lim RF, Mezzich JE: Issues in the assessment and diagnosis of culturally diverse individuals. In: Oldham J, Riba M (Eds.):Review of Psychiatry. Washington, DC: American Psychiatric Press, 1995, pp. 477–509.Google Scholar
  47. 47.
    Stein LI: The community psychiatrist: Skills and personal characteristics.Community Mental Health Journal 1998; 34:437–445.Google Scholar
  48. 48.
    Taylor M, Bradley V, Warren R (Eds.):The Community Support Skill Standards: Tools for Managing Change and Achieving Outcomes, Skill Standards for Direct Service Workers in the Human Service. Cambridge, MA: Human Services Research Institute, 1996.Google Scholar
  49. 49.
    Yager J, Docherty JP, Tischler GL: Preparing psychiatric residents for managed care: Values, proficiencies, curriculum, and implications for psychotherapy training.Journal of Psychotherapy Practice and Research 1997; 6:108–122.Google Scholar
  50. 50.
    Brook RH, Chassin MR, Fink A, et al.: A method for the detailed assessment of the appropriateness of medical technologies.International Journal of Technology Assessment in Health Care 1986; 2:53–63.Google Scholar
  51. 51.
    Shekelle PG, Kahan JP, Bernstein SJ, et al.: The reproducibility of a method to identify the overuse and underuse of medical procedures.New England Journal of Medicine 1998; 338:1888–1895.Google Scholar
  52. 52.
    Essock SM, Drake RE, Burns BJ: A research network to evaluate assertive community treatment: Introduction.American Journal of Orthopsychiatry 1998; 68:176–178.Google Scholar
  53. 53.
    Corrigan PW, McCracken SG: Training teams to deliver better psychiatric rehabilitation programs.Psychiatric Services 1999; 50:43–45.Google Scholar

Copyright information

© Association of Behavioral Healthcare Management 2000

Authors and Affiliations

  • Alexander S. Young
    • 1
  • Sandra L. Forquer
    • 2
  • Anh Tran
    • 3
  • Midge Starzynski
    • 4
  • Jess Shatkin
    • 5
  1. 1.Department of Veterans AffairsWest Los Angeles Veterans Healthcare CenterLos Angeles
  2. 2.Value-Options HealthcareColorado Health NetworksUSA
  3. 3.the Department of Veterans Affairs at the West Los Angeles Veterans Healthcare CenterUSA
  4. 4.Colorado Health NetworksUSA
  5. 5.the Department of Psychiatrythe University of California Los AngelesUSA

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