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  • Measure Summary
  • NQMC:000521
  • Jun 2003

Competency Assessment Instrument (CAI): provider's mean score on the "Family Education" scale.

Chinman M, Young AS, Rowe M, Forquer S, Knight E, Miller A. An instrument to assess competencies of providers treating severe mental illness. Ment Health Serv Res. 2003 Jun;5(2):97-108. PubMed External Web Site Policy
Providing care to people with severe and persistent mental illness [questionnaire]. Los Angeles (CA): Matthew Chinman, Ph.D; 2003. 9 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Primary Measure Domain

Clinical Quality Measures: Structure

Secondary Measure Domain

Does not apply to this measure

Description

The Competency Assessment Instrument (CAI) measures 15 competencies needed to provide high quality care for those with severe and persistent mental illness (SPMI). This measure assesses the "Family Education" scale on the CAI; defined as "Educates family members and other caregivers about mental illness."

This measure is a component of a disaggregatable composite measure. The "Family Education" scale is one of 15 individual CAI scales. A summary total score (summary index) of all 15 scales is calculated.

Rationale

The quality of care for serious mental illness is frequently poor. Most practicing mental health clinicians lack sufficient specialized training, and are not well prepared to provide rehabilitation services. In the United States, over three-quarters of clinicians have a bachelor's degree or less education. Even among the small proportion of doctoral-level professionals, many have not been exposed to curricula or practicum experiences that are relevant to the care of people with severe and persistent mental illness (SPMI). Thus, existing care is often not patient-centered because many clinicians lack important clinical competencies in the areas of empowerment and recovery that are at the heart of rehabilitation. Recent reviews find that this lack of competencies is a critical barrier to provide high quality care. Therefore, competency assessment has the potential to inform broad quality improvement efforts that affect clinician recruitment, training, feedback and profiling.

There is a critical need for measures of important domains of treatment process for SPMI. Competencies are a useful domain to assess because they emphasize the skills and values that may be less visible in a guideline or standards-based approach, but are equally important to care. Thus, the Competency Assessment Instrument (CAI) is well suited to be a quality improvement tool enabling researchers, providers, and administrators to reliably and validly assess which competencies need the most attention, which improves with training, and which need further development.

A strength of the competencies included in the CAI are that they were specifically chosen to represent rehabilitation, recovery, and empowerment principles, which are aspects of care that are critical to the treatment of patients with SPMI but are often lacking in public settings. Underlying recovery-oriented care is the idea that persons can regain purpose and meaning in life while having a serious mental illness. These concepts, which tend not to be included in many treatment guidelines and standards, have proved to be important aspects of high quality care for those with SPMI.

Evidence for Rationale

Chinman M. (Health Science Specialist. Mental Illness Research, Education and Clinical Center. Los Angeles, CA). National Quality Measures Clearinghouse (NQMC) measure submission form: Competency Assessment Instrument (CAI). 2003 May 22.  9 p.

Primary Health Components

Provider competency; serious mental illness, schizophrenia, bipolar disorder; major depression

Denominator Description

This measure applies to providers of services to those with serious mental illness (one provider at a time).

Numerator Description

Mean scale score on "Family Education" scale of the Competency Assessment Instrument (CAI)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • Treatment quality for those with severe and persistent mental illness (SPMI), including schizophrenia, bipolar disorder, and major depression is often poor, which can lead to serious negative outcomes such as injury or death.

Evidence for Additional Information Supporting Need for the Measure

Chinman M, Young AS, Rowe M, Forquer S, Knight E, Miller A. An instrument to assess competencies of providers treating severe mental illness. Ment Health Serv Res. 2003 Jun;5(2):97-108. PubMed External Web Site Policy

Extent of Measure Testing

The "Family Education" scale of the Competency Assessment Instrument (CAI) was tested for internal consistency (Cronbach's alpha equal to 0.84) and test-retest reliability (intraclass correlation equal to 0.60). Results also support the concurrent and construct validity of the CAI.

Evidence for Extent of Measure Testing

Chinman M, Young AS, Rowe M, Forquer S, Knight E, Miller A. An instrument to assess competencies of providers treating severe mental illness. Ment Health Serv Res. 2003 Jun;5(2):97-108. PubMed External Web Site Policy

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Behavioral Health Care

Community Health Care

Managed Care Plans

Rehabilitation Centers

Residential Care Facilities

Rural Health Care

Professionals Involved in Delivery of Health Services

Allied Health Personnel

Physicians

Psychologists/Non-physician Behavioral Health Clinicians

Social Workers

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Does not apply to this measure

Target Population Age

Does not apply to this measure

Target Population Gender

Does not apply to this measure

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

Does not apply to this measure

Denominator Sampling Frame

Professionals/Staff

Denominator (Index) Event or Characteristic

Health Professional Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
This measure applies to providers of services to those with serious mental illness (one provider at a time).

Exclusions
Unspecified

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
Mean scale score on "Family Education" scale of the Competency Assessment Instrument (CAI)

Exclusions
Unspecified

Numerator Search Strategy

Fixed time period or point in time

Data Source

Health professional survey

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Competency Assessment Instrument (CAI)

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Mean/Median

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Does not apply to this measure

Standard of Comparison

Internal time comparison

Original Title

Family Education.

Measure Collection Name

Competency Assessment Instrument (CAI)

Submitter

Chinman, Matthew, PhD; Young, Alexander S., MD, MSHS; Veterans Administration Desert Pacific Mental Illness Research, Education and Clinical Center (MIRECC)

Developer

Chinman, Matthew, PhD (MIRECC); Young, Alexander S., MD, MSHS (MIRECC); Sandy Forquer (Comprehensive Neuroscience Inc.); Edward Knight (ValueOptions); Anita Miller (ValueOptions); Melissa Rowe (RAND) - Independent Author(s)

Funding Source(s)

The Center for Health Care Strategies (CHCS) provided funding for the development of the Competency Assessment Instrument (CAI) through support of Increasing the Use of Self-Help Programs and Mental Health Empowerment Competencies (# ML-580), which was made possible through a separate grant to CHCS by the Robert Wood Johnson Foundation. Work on the CAI was also supported by ValueOptions; The Department of Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center (MIRECC); and the UCLA-RAND-NIMH Research Center on Managed Care for Psychiatric Disorders (Grant P50 MH-54623).

Composition of the Group that Developed the Measure

Matthew Chinman, Alexander S. Young, Melissa Rowe, Sandy Forquer, Edward Knight, Anita Miller

Financial Disclosures/Other Potential Conflicts of Interest

None

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2003 Jun

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in April 2016.

Source(s)

Chinman M, Young AS, Rowe M, Forquer S, Knight E, Miller A. An instrument to assess competencies of providers treating severe mental illness. Ment Health Serv Res. 2003 Jun;5(2):97-108. PubMed External Web Site Policy

Providing care to people with severe and persistent mental illness [questionnaire]. Los Angeles (CA): Matthew Chinman, Ph.D; 2003. 9 p.

Measure Availability

Source available from the U.S. Department of Veterans Affairs Web site External Web Site Policy.

For more information, contact Dawn Glover at the U.S. Department of Veterans Affairs; Phone: 310-478-3711 x48338; E-mail: dawnglover@ucla.edu.

Companion Documents

The following is available:

  • Young AS, Forquer SL, Tran A, Starzynski M, Shatkin J. Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness. J Behav Health Serv Res 2000 Aug;27(3):321-33.

NQMC Status

This NQMC summary was completed by ECRI on April 14, 2004. The information was verified by the measure developer on April 19, 2004.

This NQMC summary was retrofitted into the new template on April 27, 2011.

The information was reaffirmed by the measure developer on April 29, 2016.

Copyright Statement

No copyright restrictions apply.

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