Community-Oriented Programs Environment Scale Research Articles

A mixed-methods evaluative study of the life model of residential care for trauma-affected children and youth

ABSTRACT We examined the Life Model of residential care for trauma-affected foster youth with life-skill deficits. Staff interviews described implementation. The Community-Oriented Programs Environment Scale, completed by youth and staff, assessed the care environment. The Child Assessment of Needs and Strengths, the Life Assessment, and discharge data were available for 42 youth. Results from the COPES indicated moderate-high scores on relationship, personal growth, and system maintenance. Paired-samples t-tests showed improvements in functioning, behavioral/emotional needs, and strengths. RMANOVAs of the Life Assessment showed youth experienced growth in spirituality/culture, education, vocation, and overall development. Most youth discharged to family-based placements or independent living.

Refining the COPES to Measure Social Climate in Therapeutic Residential Youth Care

BackgroundPrevious studies have shown that social climate in therapeutic residential youth care (TRC) is important to the welfare of residents, staff, and assessing treatment outcomes. The most influential theory on social climate in residential settings is the theory of Moos. The measurement of the concepts and aspects of this theory using the Community Oriented Programs Environment Scale (COPES) has repeatedly been criticized regarding usability, validity, and reliability, especially for TRC.ObjectiveTo improve the usability and psychometric quality of the COPES by shortening and refining the original subscale structure for usage in TRC.MethodsFour-hundred adolescents living in Norwegian TRC participated. We supplemented confirmatory factor analysis (CFA) with item response theory (IRT) to evaluate model fit, investigate factor loadings, and shorten scales to improve their psychometric qualities and usability in describing social climate in TRC.ResultsThe original subscales were not acceptable as evaluated by the criteria for CFA and IRT. By removing psychometrically weak items, the instrument was shortened to 40 items within the original ten subscales. This short version showed acceptable psychometric qualities based on both CFA and IRT criteria and the instrument retained its content validity. Finally, the original three higher-order dimensions was not supported.ConclusionsCompared to the original instrument, the refined 40-item version of the COPES represents a more usable instrument for measuring social climate in TRC. Future studies are needed to confirm the multifaceted refined short version in comparable samples of youth and staff to further investigate predictive value and construct validity.

Measuring Opportunities for Engaging in Meaningful Home-Based Activities in Housing Services for People With Psychiatric Disabilities: Development of the Perceived Meaning of Activity in Housing (PMA-H).

There is a scarcity of instruments for assessing opportunities for residents with psychiatric disabilities to engage in meaningful home-based activities. We thus developed the Perceived Meaning of Activity in Housing (PMA-H), containing four subscales (activity opportunities, social interaction, developing as a person, and organization and planning). The aim of the study was to investigate the content validity, utility, internal consistency and concurrent and criterion validity of the PMA-H, as well as possible floor and ceiling effects. One hundred and fifty-five residents in supported housing (SH) and 111 in ordinary housing with support (OHS) completed the PMA-H. The SH group also competed the Community-Oriented Programs Environment Scale (COPES). A majority of the participants found the content of the PMA-H relevant, easy to complete, and the time for completion as reasonable. Internal consistency varied between 0.85 and 0.92 for the subscales. Logical associations with COPES indicated construct validity. The subscales social interaction and developing as a person could discriminate between the SH and OHS groups, whereas activity opportunities could not. No floor or ceiling effects were found. This study indicated adequate initial psychometric properties of the PMA-H. It can thus be used in housing settings to assess the residents' perceived opportunities for meaningful activity in the housing context.

Using Clinicians’ Ideal Social Climate Ratings in Group Therapy Training: Staff Development, Supervision, and Teaching

ABSTRACTA group’s norms are reflected in the group’s social climate, and social climate dimensions have been associated with treatment outcomes in group therapy. However, novice group therapists are often not clear about which norms to develop in a given group. We describe a procedure in which clinicians specify their ideal social climate for a therapy group or a treatment setting on the Group Environment Scale (Moos, 2002) or the Community-Oriented Program Environment Scale (Moos, 1988) and compare their ideals with various reference groups and with one another. Discrepancies in ideal social climate ratings between co-therapists or among clinical staff can be explored in order to enhance coordinated interventions. This procedure has been used with experienced clinicians, trainees, and graduate students in group therapy courses.

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Self-Help and Community Mental Health Agency Outcomes: A Recovery-Focused Randomized Controlled Trial

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

Factors Associated With Departure From Supported Independent Living Programs for Persons With Serious Mental Illness

Special Section: A Memorial Tribute: Exacerbation of Psychiatric Symptoms During Substance Use Disorder Treatment

Special Section: A Memorial Tribute: Exacerbation of Psychiatric Symptoms During Substance Use Disorder Treatment

Stability of perceived ward atmosphere over time, diagnosis and gender for patients with psychosis

In this study the focus was on patients with psychosis treated in a psychiatric rehabilitation unit in southern Sweden. The study described the stability of the ward atmosphere over 2 years, as well as differences between subgroups of patients regarding gender and diagnosis. Furthermore, the perceived ward atmosphere was compared with what has been recommended in the literature. The ward atmosphere was measured by The Community-Oriented Programs Environment Scale (COPES) five times during a 2-year period. The ward atmosphere was fairly stable over time, and in several respects it met the recommendations suggested for psychotic patients. There were few differences between schizophrenia patients and patients with other psychoses. No difference was found in perceived ward atmosphere with respect to gender. The study showed that the investigated unit, admitting almost only patients with psychosis, could provide a ward atmosphere accordance with the recommendations, probably due to a carefully planned program with a psychodynamically oriented supportive treatment milieu.

Perceptions of the real and the ideal ward atmosphere among trainees and staff before and after the introduction of a new work rehabilitation model

Changes in the ward atmosphere of a psychiatric work rehabilitation unit were investigated. Both trainees and staff filled in the Community-Oriented Programs Environment Scale (COPES) before and after a new rehabilitation model was implemented. It was hypothesised that the levels of autonomy and practical orientation would increase from both the trainees’ and staff’s perspective concerning the real ward atmosphere and that the staff’s perceptions of an ideal ward atmosphere would change in the same way. The staff perceived an increased level of autonomy with respect to both the real ward atmosphere and to what constitutes an ideal ward atmosphere, which partly confirmed the hypotheses, but the level of practical orientation was stable. Concerning the staff’s estimate of an ideal ward atmosphere, further changes were an increased level of involvement and a decrease in spontaneity, which was not hypothesised, but was not in conflict with the philosophy behind the new model. From the trainee’s perspective there was no change of either autonomy or practical orientation. Instead, there was a decrease in personal problem orientation. Compared to an optimal profile, the ward atmosphere was beneficial, before as well as after implementation of the new programme. Differences were found between the staff and the trainees, but they were not large enough to separate the groups according to what is considered an optimal profile. The few changes found support earlier conclusions that the ward atmosphere is a stable phenomenon over time.

Ward atmosphere, client satisfaction, and client motivation in a psychiatric work rehabilitation unit.

This study investigated the ward atmosphere of a psychiatric work rehabilitation unit and its relationships to clients' satisfaction with the unit and client motivation, operationalised as proneness to set personal goals for their rehabilitation. The Community-oriented Programs Environment Scale was used and 52 clients participated. Their report of the ward atmosphere was in accordance with recommended levels on 5 sub-scales out of 10. A regression analysis revealed that optimal levels of order-and-organization and support were of importance for satisfaction with the unit. An optimal level of support was associated with a high rating of personal goals. This study added two therapeutically interesting factors-satisfaction and motivation-to the flora of factors that have been related to perceptions of the ward atmosphere.

Living Room Assessment

Community living room programs, initially developed as part of the settlement house movement, strive to maintain a safe and welcoming atmosphere for clients with basic needs who can then be linked to concrete services. These rare programs do not generally include formal intake and termination criteria and are thus difficult to assess by quantitative means. In this project, the authors used the Community Oriented Programs Environment Scale (COPES) to perform a social climate assessment of a living room program at an urban homeless shelter. The agency board and staff were concerned that expanding numbers of clientele might deter potential and current members from participation and thus defeat the program's major purpose. This paper reports the social climate perceptions of staff and members and recommends agency program adjustments. This type of evaluation has implications for macro practice in determining whether nontraditional programs can be shown to meet certain human needs that complement those addressed by the broader social service system.

Homeless veterans' satisfaction with residential treatment.

Because little is known about homeless individuals' satisfaction with mental health services or the association between satisfaction and measures of treatment outcome, the study examined those issues in a group of homeless veterans. Demographic and clinical data were obtained from intake assessments conducted before veterans' admission to residential treatment facilities under contract with the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program. Clients completed a satisfaction survey and the Community-Oriented Programs Environment Scale, which asks them to rate dimensions of the treatment environment. Outcome data came from discharge outcome summaries completed by VA case managers. Overall satisfaction with residential treatment services was high among the 1,048 veterans surveyed. Greater satisfaction was associated with more days of drug abuse and more days spent institutionalized in the month before intake and with an intake diagnosis of drug abuse. Regression analyses indicated that satisfaction was most strongly related to clients' perceptions of several factors in the treatment environment. Policy clarity, clients' involvement in the program, an emphasis on order, a practical orientation, and peer support were positively related to satisfaction; staff control and clients' expression of anger were negatively related. Satisfaction was significantly associated with case managers' discharge ratings of clinical improvement of drug problems and psychiatric problems. Homeless veterans are more satisfied in environments they perceive to be supportive, orderly, and focused on practical solutions. The results indicate that client satisfaction is not related to treatment outcomes strongly enough to serve as a substitute for other outcome measures.

Program environments of self-help agencies for persons with mental disabilities.

Leaders of self-help agencies (SHAs) aspire to develop program environments that are different from community mental health agencies (CMHAs). This article addresses two questions. Do consumers' perceptions of SHAs approximate the characteristics leaders think ought to typify such agencies? Do SHA and CMHA consumers differ in their program perceptions? Using the Community-Oriented Program Environment Scale, leader expectations of ideal SHA environments were obtained from a national survey of 189 consumer-run agency heads, perceptions of actual environments from interviews with 310 SHA consumers, and perceptions of CMHAs from questionnaire responses of 779 consumers in 54 programs. SHA reality conforms to ideology in offering opportunities for consumers to experience involvement, support, and autonomy in the receipt of needed service. While showing only modest differences from CMHAs on relationship and treatment characteristics, SHA consumers differ in their perceived control over program rules, a fact previously found significant in promoting positive outcomes.

Relationships between characteristics of the ward atmosphere and treatment outcome in a psychiatric day-care unit based on occupational therapy.

The relationships between characteristics of the ward atmosphere and treatment outcome in a psychiatric day-care unit were investigated. The treatment programme was based on occupational group therapy and included long-term mentally ill patients, equally distributed with regard to psychosis and non-psychosis diagnoses. The ward atmosphere was rated on the Community-Oriented Programs Environment Scale (COPES), and outcome variables concerned symptoms, global mental health, quality of life, and functioning in daily life. The COPES ratings were re-coded in order to control for the fact that different levels of ward atmosphere factors are recommended for psychotic and non-psychotic patients. The results revealed that an optimal initial level of anger and aggression in treatment was significantly associated with improvement in global mental health and functioning in everyday life. Initial optimal levels of staff control and practical orientation were significantly associated with improvement in psychiatric symptoms. The characteristics of the ward atmosphere at the end of the treatment period were significantly correlated with various aspects of functioning in daily life. The study demonstrated associations with outcome variables not previously linked with ward atmosphere characteristics, e.g. functioning in daily life and quality of life.

The ward atmosphere of a psychiatric day care unit on the basis of occupational therapy: Characteristics and development during a 5-year period

As part of a process-outcome study the development of the ward atmosphere over 5 years in a psychiatric day care unit on the basis of occupational therapy was investigated. The Community Oriented Programs Environment Scale (COPES) was administered to patients -about equal numbers of psychotic and non-psychotic—and staff on ten occasions, covering three phases. The ward atmosphere was distinguished by high levels of involvement, support, order and organization, and program clarity and by low levels of anger and aggression and staff control. In phase one the ward atmosphere was mainly in accordance with recommendations for psychotic patients, but during phases two and three there was a development towards more optimal factors for non-psychotic patients, probably reflecting changing needs of the patients. The patient and staff ratings were more in accordance than in most other studies, probably due to high patient-staff interaction. (Less)

Features of the Ward Atmosphere in a Psychiatric Day Care Unit Based on Occupational Therapy – a Comparative Study

As part of a process-outcome study the specific occupational therapy features of the ward atmosphere in a psychiatric day care unit were investigated. The Community-Oriented Programs Environment Scale (COPES) was used to investigate the patients' perceptions of the ward atmosphere in a psychiatric occupational therapy unit as compared to a sample of eight other psychiatric units. The results pointed to high levels of support and order and organisation, and low levels of anger and aggression and staff control as the most prominent features of the ward atmosphere in the investigated unit, indicating occupational therapy specific traits. Furthermore, the ward atmosphere in the unit showed a good balance between supportive and explorative factors and seemed to provide optimal levels for both psychosis and non-psychosis patients.

Social environments of adult homes.

The purpose of this study was to examine the social environments of adult homes in the community to determine if different types of adult homes existed and which environmental variables best described each home type. Three hundred and two adult home staff rated 10 social environment variables of 49 adult homes using Moos' Community Oriented Programs Environment Scale. Using cluster analysis, 4 distinct environmental home types were identified. Discriminant analysis suggested that homes in each cluster differed primarily in their degree of staff involvement, staff support and expression of anger.

Exploration and support in psychotherapeutic environments for psychotic patients.

Clinical experience and previous investigations suggest that insight-oriented milieu therapy with psychotic patients presupposes a specific balance of explorative and supportive factors in the milieu. Explorative and supportive factors were translated here to two optimal ward atmosphere profiles using the subscales in the Community-oriented Programs Environment Scale (COPES) as profile variables. Three Swedish therapeutic communities for psychotic patients were then studied by means of COPES. The study showed distinct patterns in these units regarding deviations from the optimal profiles, differences in the balance between the explorative and supportive factors, divergences between explicit treatment philosophy and the perceived ward atmosphere, and differences between patient and staff perceptions of the ward atmosphere. These patterns followed a continuum from a self-governing, nonhierarchical and nonmedical organization to a hierarchical unit that is an integral part of the medical care organization. The conclusion was that a beneficial psychotherapeutic environment requires consistency in the applied treatment model, including an organization and setting that corresponds to the explicit treatment philosophy, well mirrored in the patients' perceptions.

Establishing reliability of the Community Oriented Program Environment Scale on chemically-dependent black females.

Research instruments are often used on samples without determining their reliability for that group of subjects. As a result, information is disseminated that really has no scientifically sound base. Thirty chemically-dependent Black females were chosen as subjects to determine reliability of the Community Oriented Program Environment Scale on this population. They were administered the instrument, and reliability was obtained using the Kuder-Richardson 20 internal consistency test. Findings showed low overall reliability and extremely low subscale reliability on this sample. It was concluded that this instrument would yield uninterpretable data in looking at attrition and treatment environment with this population.

Measuring the treatment environment of a psychiatric ward and a community mental health center after the Italian reform

In 1978 a major psychiatric reform drastically changed the Italian psychiatric system by the closing of admissions to mental hospitals and the development of psychiatric units in general hospitals and of alternative services in the community. The paper presents the results of a study in which two treatment environments set up according to the reform, i.e. a psychiatric unit in a general hospital and a community mental health center run by the same staff, were examined using the Ward Atmosphere Scale (WAS) and the Community Oriented Programs Environment Scale (COPES). In addition, validity studies of the Italian versions of the WAS and COPES are presented. Both instruments were found to be feasible and useful, easily understood, easy to administer and relatively well accepted by the psychiatric staff. The quality of the two scales has been confirmed by psychometric analysis, with the exception of the independence of scales. No major differences between the two environments emerged, both showing characteristics consistent with the new treatment philosophy.