Long-term, persistent mental illness is typically associated with poverty and unemployment. Despite advances in MH treatment methods, prospects for full rehabilitation remain poor for most adults with psychiatric disabilities. Consumer-operated services as alternatives or adjuncts to professional treatments have been promoted for potential benefits in engaging and empowering individuals with serious mental illnesses. Effectiveness research, using experimental designs, has yet to be done. Given the heterogeneity of programs labeled """"""""consumer-operated,"""""""" it is argued that such research will not be useful until a model is fully described, criteria established, and validated methods available to measure fidelity to this treatment model. This R24 application proposes to describe the most common model of consumer-operated services - the drop-in center (CDI), to establish fidelity criteria, and to operationalize and validate them. We will collect data on all the CDIs in Michigan (n=29)- interviewing consumer-users and key informants, collecting qualitative observational measures, and examining records and other documentation. The same data will be collected on structurally comparable programs (clubhouses), matched for geographic location. Through this R24, we will have a rich description of the operation of consumer-operated drop-in centers, as well as of clubhouses, utilizing criteria from the literature and consumer experts. We will analyze how the CDIs differ from clubhouses, according to a large number of users of these settings. The R24 will produce fidelity criteria, certified by a group of consumer experts and validated through reports of consumers using the services - in terms of levels reported and discriminant validity. Furthermore, we will operationalize these criteria through more readily available data (records, documents, and key informants) so that future research on CDIs can establish fidelity with less resource-intensive methods than interviewing center users. As we are completing this R24, we will design a multisite (R01) effectiveness study of consumer-operated drop-ins, using an experimental design. The fidelity measure from this R24 and the program manual produced will be integral to the R01, providing a consistent quality assessment of the model being delivered, as well as process measures for use as moderating variables to interpret differential intermediate and long-term behavioral outcomes for CDI users. A preliminary conceptual model for the future effectiveness study is presented. Initiating this research through the UM Center for Research on Poverty, Risk and Mental Health will enable an established investigator (Mowbray) to work with new faculty (Holter) and senior faculty (Garvin), and to involve other young investigators (post-doc and doctoral students) on a mental health services research topic that will serve as the basis for further significant studies on consumerism and recovery. These studies of consumer-operated services will benefit from the expertise of our colleagues at the poverty center ways to measure human capital. The R24 will enable us to develop relationships with consumer groups and consumer researchers around the country, colleagues in psychiatry and other related areas at UM, and other national sites undertaking MH services research.
