AACP ROSE – Recovery Oriented Service Evaluation (AACP ROSE)

Abstract

The AACP ROSE – Recovery Oriented Service Evaluation is a comprehensive organizational assessment tool developed by the American Association of Community Psychiatrist (AACP) in 2003. Its primary function is to evaluate the degree to which mental health service organizations adhere to and implement recovery principles in their administrative, clinical, supportive, and cultural practices. The instrument measures 46 distinct indicators across four major domains, providing a multi-perspective view (including service users, family members, and staff) of the organization’s commitment to consumer empowerment and self-determination.

The scale serves as a guide for Continuous Quality Improvement (CQI), helping agencies identify gaps between current operations and ideal recovery standards. Scores are benchmarked against performance levels ranging from “Traditional Standards” to “Excellent,” facilitating targeted strategic planning and system transformation.

Keywords

Recovery, Recovery Oriented Service Evaluation, Community Psychiatry, Organizational Assessment, Mental Health Services, Continuous Quality Improvement (CQI), Service User Participation, Organizational Culture, Behavioral Health.

Authors

American Association of Community Psychiatrist (AACP)

Purpose

The main purpose of the AACP ROSE is to facilitate systematic organizational self-assessment regarding the implementation of recovery-oriented systems of care. It provides a standardized method for organizations to gauge their alignment with best practices that emphasize consumer choice, individualized treatment, and community integration, moving away from traditional models of dependency and control.

The scale enables organizations to gather feedback from diverse stakeholders—including service users, family members, and clinical staff—to ensure that the evaluation process is holistic and representative of the lived experience within the system. This feedback loop is crucial for driving meaningful change and ensuring that administrative policies directly support the clinical goal of promoting recovery.

Construct

The AACP ROSE measures the construct of Recovery-Oriented Service Delivery, which is operationalized across four distinct domains: Administration, Treatment, Supports, and Organizational Culture. This construct posits that effective mental health services must transcend basic clinical stabilization and actively foster hope, self-determination, and empowerment among service users.

Key elements of the construct measured include the organization’s commitment to collaborative treatment planning, the use of advance directives, the integration of peer support, sensitivity to cultural needs, and the presence of non-coercive practices. By assessing these components, the instrument evaluates the fundamental shift required for an agency to fully embrace and sustain recovery as its core mission.

Validity

Specific psychometric validation studies detailing external or internal validity measures (e.g., criterion validity against other established recovery measures) are not explicitly provided in the source documentation. However, the instrument demonstrates strong face validity and content validity, as its 46 items are logically grouped into four critical domains (Administration, Treatment, Supports, and Organizational Culture) considered essential for comprehensive recovery-oriented systems of care by the American Association of Community Psychiatrists.

Reliability

Detailed reliability statistics, such as test-retest reliability or internal consistency (e.g., Cronbach’s alpha), are not specified in the initial scale documentation provided by the AACP. Given its primary intended use as a CQI and organizational assessment tool, the instrument relies on consistent scoring across different rater categories (e.g., Service User versus Administrator) to indicate areas for improvement, suggesting intended utility as a consensus-building and descriptive measure.

Factor Analysis

The AACP ROSE is structured around four predefined, non-orthogonal factors or domains: Administration, Treatment, Supports, and Organizational Culture. The scoring system reflects this structure, providing weighted sub-scores for each domain, suggesting an underlying multi-dimensional structure relevant to organizational assessment rather than a singular clinical psychological construct. The scoring key indicates the maximum possible points for each domain, reinforcing this intended factor structure (e.g., Treatment has the highest weight, reflecting its complexity).

Instrument

Test Type: Organizational Self-Assessment / Continuous Quality Improvement (CQI) Tool

Format: 46 items rated on a 5-point Likert scale (0=Strongly Disagree to 4=Strongly Agree).

Language Available: English (based on available documentation).

Population Group: Mental Health Service Organizations and their stakeholders.

Age Group: Applicable to organizations serving adults and adolescents in mental health recovery.

Population Details: Designed for use within community behavioral health settings committed to evaluating and implementing recovery models. Raters include Service Users, Family Members, Clinicians, Administrators, and Stakeholder Advocates.

Test Methodology: Raters complete the 46 items, yielding sub-scores for the four domains and a total score (max 184). The total score is interpreted using defined benchmarks (e.g., ≥ 160 points is Excellent; ≤ 95 points is Traditional Standards) to guide organizational strategic planning.

Keywords

Recovery-Oriented Service Delivery, Peer Support, Self-Management, Co-occurring Disorders, Quality Assurance, Mental Health Administration, Consumer Empowerment, Crisis Plans, Organizational Change.

Authors

Author ORCID Identifier: Not provided.

Affiliation Email addresses: [email protected]

Correspondence Address: Correspondence is typically directed through the American Association of Community Psychiatrist (AACP).

Permissions & Fee and Test Year

The AACP ROSE instrument was developed and released by the American Association of Community Psychiatrist (AACP) in 2003. It is generally utilized by organizations for internal quality improvement and assessment purposes. Specific copyright or usage fees related to its deployment are not detailed in the public source materials, suggesting it is often used for non-commercial organizational development.

Reference’s

American Association of Community Psychiatrist (AACP). (2003). AACP ROSE – Recovery Oriented Service Evaluation (AACP ROSE).

The original PDF documentation for the instrument can be downloaded here: https://www.power2u.org/downloads/pn-55.pdf

A secondary organizational resource link is available here: http://www.communitypsychiatry.org/aacpassets/docs/publications/clinical_and_administrative_tools_guidelines/AACPROSEIII.pdf

Items of the AACP ROSE – Recovery Oriented Service Evaluation (AACP ROSE)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Administration

1. Promotion of recovery is included in organization’s mission and vision
2. Service users are well represented in organization’s internal review and strategic planning processes
3. Stakeholders are recruited and retained to participate in organizational oversight and development
4. Consumers are compensated for participation in administrative activities (committees‚ CQI‚ etc)
5. Agency employs persons in recovery and persons with disabilities as mentors and counselors
6. There are significant opportunities for service users and service providers to interact outside clinical relationships
7. Service providers are knowledgeable about recovery principles and recovery promotion
8. Service users are enlisted to participate in training of service providers.
9. Service users are well represented and respected in CQI processes
10. Outcome indicators are developed with service user participation
11. Outcome indicators are available to and make sense to service users

Treatment

12. There is comprehensive array of services available to meet all identified needs.
13. All clinical services encourage the use of self-management principles
14. Advance directives/crisis plans are encouraged and respected by the organization
15. A process is in place to assist service users to develop advance directives
16. A process is in place to assure review and implement advance directives during periods of incapacitation.
17. Organization is sensitive to cultural issues and provides services that meet cultural needs
18. Staffing patterns reflect community’s ethnic/racial/linguistic profile.
19. Treatment planning is a collaborative process between service users and providers
20. Service users are provided adequate information about service options to make decisions regarding their service plans.
21. Choices made by service users are respected by providers
22. Recovery management plans are developed that emphasize individual strengths and choice
23. Co-occurring disorders are treated at the same time and by the same clinicians
24. A screening process is in place to assure detection of co-occurring disorders
25. Organization meets competency standards for treating persons with co-occurring Disorders
26. Organization has program to reduce or eliminate the use of coercive treatment
27. Attempts are made to engage and empower persons on involuntary treatment status
28. Staff has been adequately trained to de-escalate volatile situations and to avoid seclusion and restraint
29. Debriefing occurs following all episodes of seclusion or restraint if it must be used.

Supports

30. Organization facilitates service user participation and leadership in advocacy and peer support efforts/organizations
31. Organization has an active liaison with local advocacy and peer support groups
32. Service users consistently indicate satisfaction with access to services.
33. Family members are engaged and educated to support recovery efforts.
34. Opportunities exist for family members to be involved in treatment planning and organizational development
35. Family members are represented on committees and are involved in staff training
36. Service users are encouraged and supported in pursuit of employment and vocational skills.
37. Development of educational and employment goals are emphasized in recovery plans
38. Individualized placement and support guides vocational activities
39. Tolerant housing is available to those who cannot maintain sobriety or stable recovery.
40. Service users are satisfied with housing options available.

Organizational Culture

41. Service users feel respected by service providers
42. Service users feel welcome and valued
43. Providers communicate with service users honestly and sincerely.
44. Documentation is an open process that service users may have easy access to if desired.
45. *Service users are informed of their rights and responsibilities.
46. There is an equitable process through which service users and providers can resolve conflicts or disagreement