Quality Measures Database

Competence involves ensuring that the care provider’s knowledge and skills are appropriate to the care/service being provided. Competent providers are knowledgeable about the use of evidence based psychotherapy and about techniques to improve quality of care.

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 "Stress" scale on the CAI; defined as "Helps clients understand and cope with stressors that trigger deterioration."
This measure is a component of a disaggregatable composite measure. The "Stress" scale is one of 15 individual CAI scales. A summary total score (summary index) of all 15 scales is calculated.
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.

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.
PMID:12801073

V: Validated scale: Research has been conducted to determine it has at least some properties associated with a high quality scale

• Competence should take into consideration any specific forms of psychotherapy used (e.g. CBT, dynamic, etc) and ensure there is ongoing supervision/ training/ certification as appropriate.
• * I like a direct measure of relevant competency if available.
• Shorter scale needed, length not practical for primary care
• The CAI is ONLY applicable to ONE area of mental health, and certainly can not be used as a measure across all mental health areas. (It could be if it was revised, but not as it stands at this time)

Ratings-based Rank Relevance 71 Actionability 89 Overall Importance 77		Stakeholder Rank Academics 102 Clinicians 84 Consumers 58 Decision Makers 69 �		Special Group Rank First Nations 97 Rural Areas 94 Federal Stakeholders 102
Regional Rank BC AB SK MB ON QC NB NS PE NL YT NT NU 68 80 117 31 102 40 73 77 27 38 73 44 16				Overall Rank        81