Browsing by Author "Stull, Laura G."

Now showing 1 - 8 of 8
  • Thumbnail Image
    Item
    A Comparison of Phone-Based and On-Site Assessment of Fidelity for Assertive Community Treatment in Indiana
    (2011-06) McGrew, John H.; Stull, Laura G.; Rollins, Angela L.; Salyers, Michelle P.; Hicks, Lia J.
    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. (Psychiatric Services 62:670–674, 2011)
  • Thumbnail Image
    Item
    Development and Reliability of a Measure of Clinician Competence in Providing Illness Management and Recovery
    (2012-08) McGuire, Alan B.; Stull, Laura G.; Mueser, Kim T.; Santos, Meghan; Mook, Abigail; Rose, Nicole; Tunze, Chloe; White, Laura; Salyers, Michelle P.
    Objective: Illness management and recovery (IMR) is an evidence-based, manualized illness self-management program for people with severe mental illness. This study sought to develop a measure of IMR clinician competence and test its reliability and validity. Methods: Two groups of subject matter experts each independently created a clinician-level IMR competence scale based on the IMR Fidelity Scale and on two unpublished instruments used to evaluate provider competence. The two versions were merged, and investigators used the initial version to independently rate recordings of IMR sessions. Ratings were compared and discussed, discrepancies were resolved, and the scale was revised through 14 iterations. The resulting IMR Treatment Integrity Scale (IT-IS) includes 13 required items and three optional items rated only when the particular skill is attempted. Four independent raters then used the IT-IS to score tapes of 60 IMR sessions and 20 control group sessions. Results: The IT-IS showed excellent interrater reliability (.92). A factor analysis supported a one-factor model that showed good internal consistency. The scale successfully differentiated between IMR and control groups. Reliability and validity of individual items varied widely. Conclusions: The IT-IS is a promising measure of clinician competence in providing IMR. The scale could be used for research and quality assurance and as a supervisory feedback tool. Future research is needed to examine item-level changes, predictive validity of the IT-IS, discriminant validity compared with other more structured interventions, and the reliability and validity of the scale for nongroup IMR.
  • Thumbnail Image
    Item
    Explicit and Implicit Stigma of Mental Illness as Predictors of Recovery Attitudes of Assertive Community Treatment Practitioners
    (2017) Stull, Laura G.; McConnell, Haley; McGrew, John H.; Salyers, Michelle P.; Psychiatry, School of Medicine
    While explicit negative stereotypes of mental illness are well established as barriers to recovery, implicit attitudes also may negatively impact outcomes. The current study is unique in its focus on both explicit and implicit stigma as predictors of recovery attitudes of mental health practitioners.Assertive Community Treatment practitioners (n = 154) from 55 teams completed online measures of stigma, recovery attitudes, and an Implicit Association Test (IAT).Three of four explicit stigma variables (perceptions of blameworthiness, helplessness, and dangerousness) and all three implicit stigma variables were associated with lower recovery attitudes. In a multivariate, hierarchical model, however, implicit stigma did not explain additional variance in recovery attitudes. In the overall model, perceptions of dangerousness and implicitly associating mental illness with "bad" were significant individual predictors of lower recovery attitudes.The current study demonstrates a need for interventions to lower explicit stigma, particularly perceptions of dangerousness, to increase mental health providers' expectations for recovery. The extent to which implicit and explicit stigma differentially predict outcomes, including recovery attitudes, needs further research.
  • Thumbnail Image
    Item
    Implicit and explicit stigma of mental illness: attitudes in an evidence-based practice
    (Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2013-12) Stull, Laura G.; McGrew, John H.; Salyers, Michelle P.; Ashburn-Nardo, Leslie; Department of Psychology, School of Science
    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.
  • Thumbnail Image
    Item
    Implicit and Explicit Stigma of Mental Illness: Attitudes in an Evidence-Based Practice
    (2013) Stull, Laura G.; McGrew, John H.; Salyers, Michelle P.; Ashburn-Nardo, Leslie
  • Thumbnail Image
    Item
    Measuring the Recovery Orientation of Assertive Community Treatment
    (2013-05) Salyers, Michelle P.; Stull, Laura G.; Rollins, Angela L.; McGrew, John H.; Hicks, Lia J.; Thomas, Dave; Strieter, Doug
    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.
  • Thumbnail Image
    Item
    A new look at the attribution model: Considerations for the measurement of public mental illness stigma.
    (APA, 2021) Johnson-Kwochka, Annalee; Minor, Kyle S.; Ashburn-Nardo, Leslie; Wu, Wei; Stull, Laura G.; Salyers, Michelle P.; Psychology, School of Science
    Multiple versions of the Attribution Model and the corresponding Attribution Questionnaire have been used to assess public mental illness stigma. The objective of the current study was to examine (a) the factor structure of the Attribution Questionnaire and (b) relationships between constructs in the Attribution Model. Analyzing a sample of 334 U.S. adults recruited from Amazon Mechanical Turk, the authors employ confirmatory factor analyses to test three proposed factor structures of the Attribution Questionnaire and latent variable path analyses to reexamine relationships between variables in the stigmatization of people who experience mental illness. Confirmatory factor analyses of three previously examined versions of the Attribution Model revealed that the model proposed by the initial version of the Attribution Questionnaire had the best fit with the data comparative fit index (CFI = 0.92, root-mean-square error of approximation [RMSEA] = 0.07, standardized root-mean-square residual [SRMR] = 0.05). Subsequent path analyses among contructs in the model revealed acceptable model fit (CFI = 0.92, RMSEA = 0.07, SRMR = 0.06) and individual paths largely supported the hypotheses suggested by the Attribution Model. Analyses supported the original version of the Attribution Model and questionnaire with slight modifications, demonstrating that attributions of dangerousness and personal responsibility are associated with the endorsement of coercive treatment, and that attributions about dangerousness are associated with a lower desire to help. These findings suggest modifications in the current measurement of public mental illness stigma.
  • Thumbnail Image
    Item
    The Work of Recovery on Two Assertive Community Treatment Teams
    (2011-05) Salyers, Michelle P.; Stull, Laura G.; Rollins, Angela L.; Hopper, Kim
    The compatibility of recovery work with the Assertive Community Treatment (ACT) model has been debated; and little is known about how to best measure the work of recovery. Two ACT teams with high and low recovery orientation were identified by expert consensus and compared on a number of dimensions. Using an interpretive, qualitative approach to analyze interview and observation data, teams differed in the extent to which the environment, team structure, staff attitudes, and processes of working with consumers supported principles of recovery orientation. We present a model of recovery work and discuss implications for research and practice.