Using the Substance Abuse and Mental Health Services Administration (SAMHSA) Evidence-Based Practice Kits in Social Work Education

Illness Management and Recovery (IMR)

The primary aim of IMR (SAMHSA, 2010a) is to “empower consumers to manage their illnesses, find their own goals for recovery, and make informed decisions about their treatment by teaching them the necessary knowledge and skills” (Building your Program, p. 1). IMR is appropriate for consumers who experience symptoms of schizophrenia, bipolar disorder, and depression. The core components of the program include (1) psychoeducation, (2) behavior tailoring for medication management, (3) relapse prevention, and (4) coping skills training.

The kit starts with information on how to gain the support necessary from the stakeholders who could potentially benefit from the program. Initial steps include establishing program goals and standards, addressing financial issues, forming an advisory board, and determining what staff will be needed. The next step is to determine the structure of the program, including such decisions as whether a group or individual format will be used, where sessions will be held, and the length and structure of each session. The 10 core topics that are covered in the IMR program include recovery strategies, facts about mental illness, the stress–vulnerability model and treatment strategies, building social supports, using medication effectively, drug and alcohol use, reducing relapses, coping with stress, coping with persistent symptoms, and getting your needs met by the mental health system. Each of these topics is included in handouts available to each consumer. Helpful forms are provided in the kit, such as a Strengths and Knowledge Inventory and an IMR Progress Notes form.

Training includes basic training for all key stakeholders, including agency staff, consumers, families, mental health authorities, and other community leaders, as well as intensive training for the IMR leader and practitioners. The training unit consists of four modules: (1) Basic Elements and Core Values; (2) Core Processes; (3) Recovery and the Stress–Vulnerability Model; and (4) Motivational, Educational, and Cognitive-Behavioral Strategies. Each module includes notes to the facilitator to help prepare for the training, reading materials, a video, and exercises. The training helps the practitioners better understand mental illness as well as offering detailed instructions on how to lead either individual or group sessions with IMR consumers, including what topics to cover, agendas for each session, and suggested homework assignments.

A review of the literature suggests that IMR programs work with different races and ethnicities, in both urban and rural settings, and in outpatient and inpatient mental health settings. In addition, consumers who participate in IMR programs (1) know more about mental illnesses, (2) reduced relapses and hospitalizations, (3) reduced distress from symptoms, and (4) used their medications more consistently (Mueser et al., 2002).

Supported Employment (SE)

SE (SAMHSA, 2010b) is an “approach to vocational rehabilitation for people with serious mental illness that emphasizes helping them obtain competitive work in the community and providing the supports necessary to ensure their success in the workplace” (Building your Program, p. 3). SE de-emphasizes prevocational training and jobs that are designated specifically for people with disabilities. The goal of SE is to start a job search within 1 month after the client starts the program, looking only at jobs that pay at least minimum wage and are available to everyone, regardless of their disability status. A review of 17 outcome studies demonstrated that 58% of clients in SE programs found competitive employment compared to 21% of clients in traditional employment programs (Bond et al., 2001).

The kit starts with information on how to gain the support necessary from the stakeholders who could potentially benefit from the program, including public mental health authorities, agency administrators and practitioners, local business people, and the consumers and their families. From there, it provides a detailed description of how to implement the program, including articulating the goals of SE, forming advisory groups, establishing program standards, addressing financial issues, developing a training structure, and monitoring the process and outcomes of the program.

The training unit consists of four modules for training various stakeholders: (1) Basic Elements and Practice Principles; (2) Referral, Engagement, and Benefits Counseling; (3) Assessment and Job Finding; and (4) Job Supports and Collaboration. The evidence module offers suggestions for conducting outcome research to evaluate the overall program goals to help consumers obtain competitive work, earn higher wages, work more hours, show improved symptoms, show improved self-esteem, and express satisfaction with their finances.

Family Psychoeducation (FPE)

FPE (SAMHSA, 2010c) is an “approach for partnering with consumers and families to treat serious mental illnesses” (Building your Program, p. 1). The goal is for practitioners, consumers, and families to work together to support recovery. Different formats of FPE are utilized, including multifamily versus single-family treatment, duration and location of sessions, and level of participation of the consumer. Effective FPE models include the following components: (1) education about mental illness, (2) information resources, (3) skills training and guidance about managing mental illness, (4) problem solving, and (5) social and emotional support. Services are divided into three consecutive phases: (1) joining phase, (2) educational workshop, and (3) ongoing FPE sessions.

Initial steps include establishing program goals and standards, addressing financial issues, forming an advisory board, and determining what staff will be needed. Practical concerns, such as the issue of consumer willingness to participate in the program and finding supportive family members who are willing to participate, comparing the cost of implementing an FPE program to the cost of hospitalization, and financial reimbursement for FPE services, are addressed early in the kit. Establishing program procedures, such as staff criteria, referral procedures, and admission and discharge criteria, are discussed in the section, Tips for Administrators and Coordinators. Forms for documenting detailed progress notes on the three joining phase sessions, the 1-day educational workshop, and the ongoing multifamily sessions are included.

Training includes basic training for all key stakeholders, including agency staff, consumers, families, and mental health authorities, as well as intensive training for the FPE leader and practitioners. The training unit consists of five modules: (1) Basic Elements and Practice Principles; (2) Core Processes of FPE; (3) Joining Sessions and Educational Workshops; (4) Ongoing FPE Workshops; and (5) Problem Solutions from Actual Practice. Each module includes notes to the FPE coordinator to help prepare for the training, reading materials, exercises, and videos. The training covers all of the core principles and procedures of the FPE program, as well as detailed instructions on implementing each phase of the program, including example agendas for the three joining sessions, the educational workshop, and the ongoing family sessions. A list of common problem areas is offered along with a problem-solving strategy for facing these concerns with consumers and their families.

Research has shown that families that participated in FPE programs showed reduced relapses and rehospitalizations; improved family well-being; reported greater knowledge of mental illnesses; showed a decrease in confusion, stress, and isolation; and reported reduced use of medical care (Dixon & Lehman, 1995; Dixon et al., 2001; Dyke, Hendryx, Short, Voss, & McFarlane, 2002). The greatest amount of research has looked at the effectiveness of FPE with consumers with schizophrenic disorders, with promising results with bipolar disorder, major depression, obsessive-compulsive disorder, and borderline personality disorder (Dixon et al., 2001).

Assertive Community Treatment (ACT)

ACT (SAMHSA, 2008a) is “a service delivery model, not a case management program” (Building your Program, p. 5). ACT serves consumers with the most serious psychiatric symptoms, who often have extensive histories of hospitalizations, are homeless, have co-occurring substance abuse or medical problems, and are involved in the criminal justice system. ACT programs are characterized by (1) a team approach—multiple professionals work together to provide services; (2) in vivo services—services are offered where needed; (3) small caseloads—10–12 staff members serve about 100 consumers; (4) time-unlimited services—service is provided as long as needed; (5) shared caseload—the entire team provides services as needed; (6) flexible service delivery—services are adjusted quickly to respond to changes in consumers’ needs; (7) fixed point of responsibility—if other services are needed, the team ensures that they are received; and (8) 24/7 crisis availability—services are always available. Core ACT services include crisis assessment and intervention; comprehensive assessment; illness management and recovery skills; individual supportive therapy; substance abuse treatment; employment support; daily living assistance; intervention with support networks; support services (medical, housing, benefits, and transportation); case management; and medication administration and monitoring.

As in all of the kits, the ACT kit starts with information on creating a vision, developing an advisory board, establishing program standards, and addressing budgeting issues. Practical concerns, such as admission and discharge standards, design of the ACT office, and hours of operation, are addressed. ACT staff members include the ACT leader, a psychiatrist, psychiatric nurses, employment specialists, substance abuse specialists, mental health professionals, peer specialists (consumers who have utilized mental health services), and a program assistant. Since the ACT program offers 24-hour a day services and monitoring, the practitioner is given suggestions on how to ensure the treatment is not perceived by the consumer as coercive. The kit includes a discussion of ACT programs that have been used in conjunction with the criminal justice system as an alternative to incarceration, as well as interviews with three administrators who have designed and implemented an ACT program (Building your Program, pp. 47–69).

The training unit consists of four modules: (1) Basic Elements of ACT, (2) Recovery and the Stress–Vulnerability Model, (3) Core Processes of ACT, and (4) Service Areas of ACT. Each module includes notes to the facilitator to help prepare for the training, reading materials, a video, and exercises. Research has shown that ACT programs (1) greatly reduce hospitalizations, (2) increase housing stability, (3) lead to better substance abuse outcomes, (4) yield higher rates of competitive employment, and (5) are more satisfying to consumers and their families than alternative treatments (Phillips et al., 2001). The program has been endorsed not only by SAMSHA but also by the U.S. Department of Health and Human Services and the National Alliance on Mental Illness. Research suggests that the ACT program is cost-effective when the model is closely followed, and costs are offset by the reduced hospitalizations experienced by the consumers (Bond, Drake, Mueser, & Latimer, 2001; Essock, Frisman, & Kontos, 1998).

Integrated Treatment (IT) for Co-Occurring Disorders

Practitioners in an IT (SAMHSA, 2010d) program “develop integrated treatment plans and treat both serious mental illnesses and substance use disorders so that consumers do not get lost, excluded, or confused going back and forth between different mental health and substance abuse programs” (Building your Program, p. 1). The goal of the IT model is to support consumers in their recovery process, which includes (1) abstaining from substance use, (2) controlling symptoms, (3) complying with mental health treatment, and (4) learning to move beyond mental illness so they can pursue a personally meaningful life. As the name suggests, the treatment for the mental illness and the substance use disorder is integrated, include motivational interventions, cognitive-behavioral treatments, and medication services, and can be offered in an individual, group, self-help, or family format.

The kit starts with suggestions for creating a vision, forming an advisory board, establishing program standards, addressing financial issues, developing a training structure, and evaluating the program. Practical items, such as staff position descriptions, detailed descriptions of policies and procedures, for example, an Integrated Treatment Referral Form, a sample of the three assessment forms, and an Integrated Treatment Plan form, are included as well. The kit offers information on another excellent resource for working with this population, Substance Abuse Treatment for Persons with Co-occurring Disorders: A Treatment Improvement Protocol (TIP 42), also produced by SAMHSA (2008b). TIP 42 offers professionals who provide substance abuse treatment advances in treatment for people with co-occurring mental disorders.

Training includes basic training for all key stakeholders, including agency staff, consumers, families, mental health authorities, and other community leaders, as well as intensive training for IT leaders and practitioners. The training unit consists of five modules: (1) Basic Elements and Practice Principles, (2) Practice Knowledge of Common Substances, (3) Stages of Treatment and Core Processes, (4) Practical Skills for IT, and (5) Service Formats. Training focuses on teaching IT specialists about substance abuse and the basic skills needed to help consumers recover from both mental illness and substance abuse. Each module includes helpful notes to the facilitator to help prepare and implement the training.

Research has shown that IT programs are associated with the following positive outcomes: (1) reduced substance use, (2) improvement in psychiatric symptoms and functioning, (3) decreased hospitalization, (4) increased housing stability, (5) fewer arrests, and (6) improved quality of life (Drake et al., 2001).

Medication Treatment, Evaluation, and Management

Medication Treatment, Evaluation, and Management (MedTEAM; SAMHSA, 2010e) is an approach for “offering medication management to people with serious mental illnesses” (Building your Program, p. 1). The MedTEAM approach does not dictate what medications to prescribe but rather emphasizes that the decision must be shared between the consumer and the treatment team based on clinical expertise and personal experience. The practice principles of MedTEAM include the following: (1) medication decisions are guided by the latest scientific evidence, (2) medication management requires a team approach, (3) systematically assessing medication-related outcomes is key to evaluating clinical progress, (4) high-quality documentation provides a record of medication response over a consumer’s lifetime, and (5) consumers and medication prescribers share in the decision-making process.

The initial steps for building a MedTEAM program include creating a vision that articulates the MedTEAM principles and goals, forming an advisory board, establishing program goals and standards, and developing a training structure and a plan for evaluating the program. It is important to establish collaborative relationships with outside organizations, such as psychiatric hospitals, emergency rooms in general hospitals, general medical providers, and mental health specialists, in order to promote sharing of information regarding consumers and their medication needs. A sample Admissions Form is offered to gather the information needed on each new consumer, including a personal and family history of psychiatric disorders, past and current psychiatric and nonpsychiatric medication history, and current mental status evaluation. A sample Ongoing Treatment Plan Form gathers current information, including diagnoses, medications, and progress notes, throughout the consumer’s involvement in the program.

Basic training for all agency staff, consumers, families, mental health authorities, and members of the advisory board can be offered using an introductory PowerPoint presentation, a brochure, and an introductory video. More intensive training for the MedTEAM leader and practitioners consists of three modules: (1) New Documentation Practices, (2) Ongoing Training on Medications, and (3) Integrating Outcome Measures into Clinical Assessments. Research has shown that the MedTEAM approach leads to (1) fewer mental health symptoms, (2) improved quality of care, (3) increased retention of employment, and (4) increased satisfaction with treatment (Simon, Von Korff, Rutter, & Wagner, 2000; Wells et al., 2000; Worrall, Angel, Chaulk, Clarke, & Robbins, 1999).

Consumer Operated Services (COS)

COS (SAMHSA, 2011a) are “peer-run service programs that are owned, administratively controlled, and operated by mental health consumers and emphasize self-help as their operational approach” (Building your Program, p. 1). Using COS allows the consumer to see that recovery is possible because they see it in the people involved in the program. Consumer-operated means the services are (1) independent—administratively controlled and operated by the consumers, (2) autonomous—all operational and administrative decisions are made by the program, (3) accountable—responsibility for all decisions rests with the program, (4) consumer controlled—at least 51% of board members are mental health consumers; and (5) peer workers—staff and management are individuals who have received mental health services. Services offered through COS may include peer counseling, help with housing, employment and education, social and recreational opportunities, support groups, crisis response and respite, and community outreach.

The kit starts with suggestions on how to establish a COS program, including tips for building support for the program, developing program policies and procedures, and assessing training needs. It offers a list of consumer benefits, such as well-being, recovery, and empowerment; a list of mental health agency benefits, such as economic value, enriched service choice, expanded availability and access, and reaching underserved populations; and a list of benefits to the greater community. Tables describe the optimal structure, environment, belief systems, peer support, educational programs, and advocacy for a COS program that would obtain a perfect score on a program fidelity scale (Building your Program, pp. 19–21). Information on a variety of grant sources that may help fund COS is offered, along with tips for addressing performance problems. Practical suggestions for the COS leader include basic steps for applying for and obtaining tax-exempt nonprofit organization status, tips for building a board of directors, and hiring and employment policies.

The training unit consists of six modules: (1) Belief Systems, (2) Environment, (3) Peer Support, (4) Education, (5) Leadership, and (6) Advocacy. It offers a resource for program leaders to train COS volunteers and workers. Modules include detailed discussions of each topic, along with group exercises, role plays for practicing and developing skills, individual exercises involving written responses, group discussions, and thought-provoking questions for readers.

To aid in the outcome evaluation, the kit provides suggestions for commonly used evaluation protocols. It suggests that the peer outcomes protocol (POP) may be the most useful evaluation tool. The tool was developed by consumers to ensure that consumer values were included in the evaluation outcomes. The POP includes seven independent modules: (1) demographics, (2) service use, (3) employment, (4) community life, (5) quality of life, (6) well-being, and (7) program satisfaction. The evaluation module offers a literature review of the principles and philosophy of COS, as well as the outcome research from the many different types of consumer-operated programs.

Permanent Supportive Housing (PSH)

PSH (SAMHSA, 2010f) is a program that assists consumers who have psychiatric disabilities find and keep adequate housing. As the name implies, PSH is (1) Permanent—tenants may live in their homes as long as they meet basic obligations, such as paying rent; (2) Supportive—tenants have access to the support services they want and need to help them retain their housing; and (3) Housing—tenants have a secure and private place to call home, with the same rights and responsibilities of other members of the community (Building your Program, p. 1). PSH offers an alternative to housing options that segregate people based on their disability. The program supports the following critical elements: (1) tenants must hold a lease or, in some cases, a sublease, with full rights of tenancy; (2) leases do not contain any provisions that would not be in a lease held by someone without a psychiatric disability; (3) participation in support services is voluntary and tenants cannot be evicted for rejecting services; (4) house rules, if any, are no different than those for tenants without a psychiatric disability; (5) housing is not transitional or temporary and can be renewed as long as basic obligations are met; (6) tenants are offered the same range of options as other people in their income range and housing market; (7) housing is affordable, with tenants paying no more than 30% of their income toward rent and utilities; (8) housing is integrated; and (9) tenants have a choice in the support services they receive, and services can change as tenants' needs change (Building your Program, pp. 2–4).

The kit starts with suggestions for identifying key stakeholders and building support, establishing program standards and procedures, addressing financial issues, developing a training structure, maximizing cultural competence, and evaluating the program. Typical approaches to PSH include (1) project-based rental assistance—housing subsidies are tied to a particular unit and consumers pay reduced rent, (2) sponsor-based rental assistance—nonprofit agencies buy or lease housing and then lease to consumers, and (3) tenant-based rental assistance—tenants receive vouchers that entitle them to a reduced rent. These three strategies can be used in either (1) single-site housing in which tenants live together in a single building or a complex of buildings or (2) scattered-site housing in which tenants receive support services but live throughout the community. In addition to housing assistance, a wide array of other support services may be provided, such as services to help consumers maintain housing, independent living skills, recovery-focused services, community integration services, mental health and substance abuse services, health and medical services, employment services, and family services. Other information, such as funding sources, details on the housing rights of people with disabilities, job descriptions and responsibilities for PSH staff, and hints on how to evaluate your local housing market and work with individual landlords, is offered throughout the kit. It also includes a separate handbook for the tenant/consumer.

The training unit consists of six modules: (1) Core Elements of PSH, (2) Outreach and Engagement, (3) Helping People Find and Acquire Housing, (4) Connecting Tenants to Benefits and Community-Based Services, (5) Directly Providing Supports for Housing Retention, and (6) Addressing Additional Special Needs. The evaluation module offers suggestions and forms for conducting process evaluations and minimal guidance for conducting outcome evaluation. The evidence module offers an overview of current research on PSH programs.

Treatment of Depression in Older Adults

The EBT kit for the treatment of depression in older adults (SAMHSA, 2011b) provides information on service approaches and evidence-based treatments that have been used to improve outcomes for this population. The term “older adults with depression” refers to adults aged 65 years or older who have major depression, minor depression, or dysthymia. Since older adults with depression often need a combination of mental health, aging, and medical health services, this model encourages collaboration among agencies and practitioners who provide these services. It emphasizes that depression is not a normal part of aging and can impair an individual’s ability to function independently, contribute to poor health outcomes, cause family disruptions, and generally inhibit an older person’s ability to achieve successful aging.

The Key Issues module includes a discussion of the diagnostic criteria and risk factors for major depression, minor depression, and dysthymia. It also points out the difficulties in diagnosing these disabilities in older adults, such as the overlap of symptoms between depression and some physical health disorders often found among older adults. Physical health problems, such as chronic pain, limited mobility, stroke, hip fracture, cancer, arthritis, hearing and vision loss, and heart attack, make older adults more susceptible to depression. In turn, depression can increase the risk of further medical issues and can complicate recovery. Other factors, such as reduced financial and social supports, also increase the risk of depression.

The Selecting EBPs module describes the interventions that are supported by research and offers information on how to find manuals for providing each of these interventions. The following EBP interventions that have been shown to successfully help older adults with depression are described, along with references to manual(s) for each intervention: cognitive-behavioral therapy, behavioral therapy, problem-solving treatment, interpersonal psychotherapy, reminiscence therapy, and cognitive bibliotherapy. Other evidence-based treatments are described, including antidepressant medications, multidisciplinary geriatric outreach services, and collaborative mental and physical health care.

The kit discusses issues involved in selecting which of these treatments to implement, both at the agency level and for individual clients. A table is included that displays the different EBTs for depression along with the type(s) of depression for which studies have been conducted, outcomes affected, service delivery settings, time frame of sessions, and practitioner qualifications, all extremely helpful in determining which treatment can best be implemented with the available needs and resources (Selecting EBTs for Treatment of Depression, pp. 8–9). Detailed descriptions of the EBTs include (1) description of the intervention, (2) practitioner qualifications, (3) disorders addressed, (4) available evidence, (5) settings that have been evaluated, (6) populations included in research, (7) training and resources available (including therapist and client manuals), (8) key issues related to implementation, and (9) program contact information. More detailed implementation descriptions are provided for the programs PATCH and IMPACT. The kit offers a guide for the elderly consumer, family members, and caregivers, one for the practitioner working with this population, and one for agency administrators, as well as a leadership guide for mental health, aging, and medical health authorities.

Interventions for Disruptive Behavior Disorders (DBDs)

DBDs (SAMHSA, 2011c) include the diagnoses of oppositional defiant disorder and conduct disorder. DBDs “occur across the stages of child and youth development; have a significant impact on a child’s functioning across many social settings (i.e., home, school, community, etc.); involve multiple service sectors (i.e., mental health, education, child welfare, juvenile justice, etc.); and can result in great social costs to communities when untreated” (How to Use the EBP Kits, p. 4). A description of a variety of research-supported prevention models are offered, along with references to manuals and websites that give detailed information on the programs. An overview of the outcome studies for all of these interventions for DBDs is provided in the module, How to Use the EBP Kits (pp. 6–8).

This kit starts with a module, Characteristics and Needs of Children with DBDs and their Families, that looks at risk factors, protective factors, behavioral manifestations, Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, co-occurring conditions, and the course of the disorders. Risk factors include poverty, harsh and inconsistent parenting, drug and alcohol use by caregivers, emotional, physical, or sexual abuse, neglect, modeling of aggression, media violence, negative attitude toward school, death or divorce in family, and parent criminality. Protective factors, on the other hand, include high IQ, being female, a positive social orientation, supportive relationship with parents, parental supervision, extracurricular activities, encouraging teachers, and having friends who behave well and disapprove of violence. Behavioral symptoms are varied and depend on the child’s developmental stage. Co-occurring conditions include attention deficit/hyperactivity and trauma symptoms in younger children, anxiety and depressive symptoms in school-aged children, and substance abuse in early adolescents.

The kit offers a detailed six-step decision-making process for analyzing the supportive research and selecting the evidence-based intervention that will best meet the needs of your community, agency, families, and youth. Another module, Interventions for DBDs, offers a description of each of the evidence-based prevention models and interventions, including background and characteristics, research base and outcomes, implementation, financing, training, evaluation, and resources and references.

The module, Implementation Considerations, considers issues related to building support, funding, developing policies and procedures, training, cultural competence, and evaluation. With regard to evaluation, this same module offers a list of measurement instruments that can be used to assess child and family outcomes (see table on p. 17). A final module, Medication Management, offers guidance and information regarding the use of medication in the treatment of DBDs. The most widely used medications for DBDs are atypical antipsychotics (used to treat aggressive behaviors often associated with DBDs) and mood stabilizers and α agonists (both used to decrease levels of aggression and impulsivity).

Supported Education

Supported education (SE; SAMHSA, 2012) focuses on consumers who experience the onset of mental illness during the time when they are developing their adult roles and are completing the education that prepares them for the workforce. SE supports consumers in pursuing their educational goals, which in turn promotes career development and improves long-term career opportunities. In tandem with supportive employment, consumers can develop a sense of independence and self-efficacy. Core services of SE include (1) career planning including vocational assessment, career exploration, Educational Goal Plan development, course selection, instruction, support, and counseling; (2) academic survival skills including information about college and training programs, disability rights and resources, tutoring and mentoring services, time and stress management, and social supports; (3) direct assistance including help with enrollment, financial aid, education debt, and contingency funds; and (4) outreach including contact with campus resources, mental health treatment team members, and other agencies such as vocational rehabilitation (Building your Program, p. 2). SE services have been provided in both mental health centers and educational institutions. Evidence suggests that SE programs lead to more access to and participation in educational programs, increased competitive employment, improved self-esteem, reduced hospitalization, and increased consumer satisfaction (Building your Program, p. 5).

After the overview of SE services, the kit offers tips to mental health authorities, including why they should be involved with SE, as well as directions for developing an SE program. It then offers more detailed tips for agency administrators and program leaders for successfully implementing SE, such as recruiting staff, building support in the community, developing effective policies and procedures, developing assessment and treatment criteria, and budgeting issues. The Training Frontline Staff is a four-part workbook to help program leaders teach SE staff members the skills necessary to deliver SE services. The four sections include (1) basic elements and practice principles of SE, (2) knowledge and skills to help consumers make informed choices about returning to school, (3) skills and supports to help enrollment activities, and (4) follow-along activities to support educational goals. Each module offers detailed information along with exercises to use in the training classes. The kit offers a readiness assessment that tracks the tasks required to develop the SE program and a fidelity assessment that measures how well the program follows the key elements of the SE model. To aid in the outcome evaluation, the kit provides suggestions for publicly available evaluation instruments, such as Consumer Outcomes Monitoring Package (http://research.socwel.ku.edu/epb), Decision Support 2000+ Online (www.ds2kplus.org), the Mental Health Statistics Improvement Program Consumer Satisfaction Survey (www.mhsip.org), and Measuring the Promise: A Compendium of Recovery Measures (www.tecathsri.org). The evaluation module describes both process and outcome research studies that have evaluated SE programs.