Consumer Recovery Outcomes System (CROS 3.0)

Abstract

The Consumer Recovery Outcomes System (CROS 3.0) is a multi-rater assessment instrument designed to measure clinical status and progress toward recovery among individuals diagnosed with Severe and Persistent Mental Illness (SPMI). Developed by the Colorado Health Networks Partnership, CROS 3.0 provides a comprehensive evaluation across key domains including functioning, coping, subjective well-being, and treatment satisfaction. The scale is unique in that it captures perspectives from three distinct groups: the consumer (self-report), the treatment staff, and significant others or Very Important Persons (VIPs), offering a holistic view of the individual’s recovery journey.

Keywords

Mental health recovery, outcome measurement, severe mental illness, quality of life, treatment satisfaction, daily functioning, consumer report, psychiatric assessment.

Authors

Colorado Health Networks Partnership, B.L. Bloom, A. Miller.

Purpose

The primary purpose of the CROS 3.0 is to function as a robust, consumer-focused index for measuring the effectiveness of mental health services and tracking individual progress over time. It shifts the focus from purely symptom reduction toward holistic recovery, including functional status and perceived quality of life. This instrument allows agencies to systematically monitor outcomes from multiple viewpoints, which is essential for comprehensive treatment planning and accountability within managed care environments.

Specifically, the instrument is intended to assess five core areas relevant to the recovery model, enabling both consumers and providers to identify strengths, target areas needing intervention, and measure the long-term impact of clinical and community support services.

Construct

CROS 3.0 measures the complex, multidimensional construct of mental health recovery, moving beyond traditional symptom checklists. It operationalizes recovery through five empirically supported subscales:

• Hope for the Future: Measures the individual’s belief in their capacity to manage problems, achieve goals, and experience meaning and enjoyment in life.
• Daily Functioning: Assesses observable behaviors related to daily living, such as maintaining routine, concentrating on tasks, managing residence, and engaging in meaningful activity (e.g., employment or volunteering).
• Coping with Clinical Symptoms: Evaluates the individual’s ability to manage internal states like sadness, anxiety, anger, disturbing thoughts, and difficulty sleeping.
• Quality of Life: Measures satisfaction with external factors and environmental conditions, including housing, freedom, privacy, access to reliable transportation, and relationships.
• Treatment Satisfaction (Consumer Version Only): Assesses the consumer’s perception of the quality of services received, including information provided, choices regarding care, and availability of crisis support.

Validity

The validity of the CROS 3.0 is supported by its clear alignment with the principles of recovery-oriented care. The scale demonstrates strong content validity, as its items directly reflect key indicators of successful community functioning and subjective well-being identified in the literature on Severe and Persistent Mental Illness (SPMI). Construct validity is inferred through factor analysis (detailed below) which supports the separation of the measured domains. Furthermore, the instrument’s development was informed by earlier work on patient-focused indices, such as those cited in the references (e.g., Becker et al., 1993), ensuring alignment with established measures of quality of life in this population.

Reliability

The CROS 3.0 exhibits high internal consistency and strong test-retest reliability across its different versions and subscales, confirming its stability and precision in measuring outcomes.

• Consumer Version Reliability Statistics:
  • Hope for the Future: Alpha 0.90 (Internal Consistency), r=.70 (Test-Retest Correlation).
  • Daily Functioning: Alpha 0.83, r=.69.
  • Coping with Clinical Symptoms: Alpha 0.86, r=.76.
  • Quality of Life: Alpha 0.84, r=.75.
  • Treatment Satisfaction: Alpha 0.79, r=.74.
• Staff Version and VIP Version Reliability Statistics:
  • Hope for the Future: Alpha 0.89, r=.80.
  • Daily Functioning: Alpha 0.86, r=.89.
  • Coping with Clinical Symptoms: Alpha 0.85, r=.79.
  • Quality of Life: Alpha 0.89, r=.87.

Factor Analysis

While the specific factor loading matrices are not provided in the source content, the reported reliability statistics and the distinct subscale structure indicate a robust, multi-factor model. The instrument is empirically partitioned into five conceptually distinct domains for the Consumer version and four domains for the Staff and VIP versions (which exclude Treatment Satisfaction, as this is a consumer-subjective rating). This structure confirms that the CROS 3.0 successfully measures separate components of recovery and functioning rather than a single, monolithic construct.

Instrument

Test Type: Outcome assessment measure; Multi-rater scale.

Format: Structured questionnaire using Likert-type scales (e.g., Very satisfied, Believe strongly, All the time, Very well).

Language Available: English (Original).

Population Group: Clinical population diagnosed with Severe and Persistent Mental Illness (SPMI).

Age Group: Adults receiving mental health services.

Population Details: Individuals in community mental health settings who require ongoing support and treatment for serious mental health conditions.

Test Methodology: The scale uses three parallel forms—Consumer (self-report), Staff (clinical observation), and VIP (significant other/family/friend report)—to gather comprehensive data on subjective experience and observable functioning. The Staff version also includes clinical baseline information, such as the primary diagnosis (using DSM-IV criteria) and hospitalization history.

Keywords

Psychometric scale, mental health outcomes, consumer choice, clinical monitoring, functional assessment, symptom coping, quality assurance.

Authors

Author ORCID Identifier: Not provided in source material.

Affiliation Email addresses: [email protected]

Correspondence Address: Colorado Health Networks Partnership, 1997 (Original Developer).

Permissions & Fee and Test Year

Test Year: 1997 (Initial development/version 3.0 noted).

Permissions and Fee: Contact Anita Miller regarding usage permissions and current fee structure. The instrument has been made publicly available through academic publications and certain organizational archives.

The original PDF documents providing access to the instrument and manuscript can be downloaded here: https://www.power2u.org/downloads/pn-55.pdf and http://www.crosllc.com/CROS3.0manuscript-090204.pdf (manuscript).

Reference’s

Becker‚ M.‚ Diamond‚ R.‚ & Sainfort‚ F. (1993). A new patient focused index for measuring quality of life in persons with severe and persistent mental illness. Quality of Life Research‚ 2‚ 239-251.

Bloom‚ B.L.‚ & Miller‚ A. (2004). The Consumer Recovery Outcomes System (CROS 3.0): Assessing clinical status and progress in persons with severe and persistent mental illness. Unpublished manuscript retrieved October 13‚ 2005 from the CROS LLC Web site: http://www.crosllc.com/CROS3.0manuscript-090204.pdf

Eisen‚ S.V. (1996). Behavior and symptom identification scale (BASIS-32). In L.I. Sederer & B. Dickey‚ (Eds.)‚ Outcome assessment in clinical practice (pp. 65-69). Baltimore: Williams &Wilkins.

Faustman‚ W.O. (1994). Brief psychiatric rating scale. In M.E. Maruish (Ed.)‚ The use of psychological testing for treatment planning and outcome assessment (pp. 371-401). Hillsdale: N.J.‚ Lawrence Erlbaum.

Miller‚ L.S. & Faurstman‚ W.O. (1996). Brief psychiatric rating scale (BPRS). In L.I. Sederer & B. Dickey (Eds.)‚ Outcome assessment in clinical practice (pp. 105-109) Baltimore: Williams & Wilkins.

Overall J.E.‚ & Gorham‚ D.R. (1962). The brief psychiatric rating scale. Psychological Reports‚ 10‚ 799-812.

Items of the Consumer Recovery Outcomes System (CROS 3.0)

Consumer CROS 3.0 Questionnaire

Think about the services you receive from this agency:

If you are new to this agency‚ start at Question 6.

Very satisfied‚ Somewhat satisfied‚ Somewhat dissatisfied‚ Very dissatisfied

1. How do I feel about the amount of information I receive about my mental illness?
2. How do I feel about the choices I get about my care?
3. How do I feel about the amount of activities or groups I am offered to help me cope with my mental illness?
4. How do I feel about the help I get finding services I need in the community?
5. How do I feel about the availability of crisis services when I need them?

Think about your hopes for the future:

Believe strongly‚ Believe‚ Believe a little‚ Do not believe

6. I believe I will handle my daily problems.
7. I believe I will trust my thoughts and feelings.
8. I believe I will feel alert and alive.
9. I believe I will achieve goals I set for myself.
10. I believe my life will have meaning.
11. I believe I will have enjoyable experiences.
12. I believe I will recover from mental illness.

Think about things you do in your daily life:

All the time‚ Most of the time‚ Sometimes‚ Almost never

13. I plan and keep a daily routine on my own.
14. I concentrate and finish tasks that I start.
15. I make plans to do things with other people.
16. I manage my residence (for example‚ do chores‚ pay bills‚ keep my room/house clean).
17. I make my own decisions.
18. I take care of my personal appearance (for example‚ bathe‚ wear clean clothes).
19. I am involved in meaningful activity (for example‚ employment‚ school‚ volunteer work).
20. How much progress am I making in recovering from my mental illness? A great deal‚ Some‚ Very little‚ None at all

Think about how well you are coping:

Very well -never a problem‚ Fairly well -rarely a problem‚ Not so well -often a problem‚ Very poorly – always a problem

21. How well am I coping with feeling sad?
22. How well am I coping with feeling tense or anxious?
23. How well am I coping with feeling angry or hostile toward others?
24. How well am I coping with disturbing thoughts?
25. How well am I coping with difficulty sleeping?
26. How well am I coping with external stressors (for example‚ health problems‚ family conflicts‚ unemployment‚ tragedy in community)?

Think about how satisfied you are with your life:

Very satisfied‚ Somewhat satisfied‚ Somewhat dissatisfied‚ Very dissatisfied

27. How do I feel about the amount of freedom I have where I live?
28. How do I feel about ha‎ving things to do that I enjoy (for example‚ going to the movies‚ sports events‚ hobbies)?
29. How do I feel about the way I spend my free time?
30. How do I feel about the amount of privacy I have where I live?
31. How do I feel about the amount of comfort and security I have where I live?
32. How do I feel about my access to health care?
33. How do I feel about the neighborhood and residence where I live?
34. How do I feel about my access to reliable transportation?
35. How do I feel about my relationships with family/significant others/friends?
36. I believe my use of alcohol or street drugs interferes with my recovery from mental illness. I do not use alcohol or street drugs. Believe strongly‚ Believe ‚ Believe a little‚ Do not believe
37. I take my psychiatric medication as prescribed. Psychiatric medication has not been prescribed for me. All the time‚ Most of the time‚ Sometimes‚ Almost never
38. I believe taking my psychiatric medication helps with my recovery from mental illness. Psychiatric medication has not been prescribed for me. Believe strongly‚ Believe‚ Believe a little‚ Do not believe

Did anyone help you complete this form? Yes ‚ No

Was this questionnaire translated into another language for you? Yes‚ No

***************

Staff CROS 3.0 Questionnaire

1. Current Assessment (DSM-IV) Primary… Secondary… Tertiary…
2. Last hospital disch‎arge was: (Leave blank if never hospitalized) Within last 6 months‚ Within 6 months to 1 year ago‚ Over 1 year ago
3. Does the consumer have a representative payee? Yes‚ No
4. Is the consumer chronically homeless? Yes‚ No
5. Is the consumer new to this agency? Yes‚ No

Think about the consumer’s hopes for the future:

All the time‚ Most of the time‚ Sometimes‚ Almost never

6. To what extent does the consumer seem to believe he/she will handle daily problems?
7. To what extent does the consumer seem to believe he/she will trust his/her thoughts and feelings?
8. To what extent does the consumer seem to believe he/she will feel alert and alive?
9. To what extent does the consumer seem to believe he/she will achieve goals he/she sets?
10. To what extent does the consumer seem to believe his/her life will have meaning?
11. To what extent does the consumer seem to believe he/she will have enjoyable experiences?
12. To what extent does the consumer seem to believe he/she will recover from mental illness?

Think about things the consumer does in his/her daily life:

13. How often does the consumer plan and keep a daily routine on his/her own?
14. How often does the consumer concentrate and finish tasks that he/she starts?
15. How often does the consumer make plans to do things with other people?
16. How often does the consumer manage his/her residence (for example‚ do chores‚ pay bills‚ keep his/her room/house clean)?
17. How often does the consumer make his/her own decisions?
18. How often does the consumer take care of his/her personal appearance (for example‚ bathe‚ wear clean clothes)?
19. How often is the consumer involved in meaningful activity (for example‚ employment‚ school‚ volunteer work)?
20. How much progress is the consumer making toward recovering from his/her mental illness?

Think about how well the consumer is coping:

Very well -never a problem‚ Fairly well -rarely a problem‚ Not so well -often a problem‚ Very poorly -always a problem

21. How well is the consumer coping with feeling sad?
22. How well is the consumer coping with feeling tense or anxious?
23. How well is the consumer coping with feeling angry or hostile toward others?
24. How well is the consumer coping with disturbing thoughts?
25. How well is the consumer coping with difficulty sleeping?
26. How well is the consumer coping with external stressors (health problems‚ family conflicts‚ unemployment‚ tragedy in community)?

Think about how satisfied the consumer is with his/her life:

Very satisfied‚ Somewhat satisfied‚ Somewhat dissatisfied‚ Very dissatisfied

27. How does the consumer feel about the amount of freedom he/she has where he/she lives?
28. How does the consumer feel about ha‎ving things to do that he/she enjoys (for example‚ going to the movies‚ sports events‚ hobbies)?
29. How does the consumer feel about the way he/she spends his/her free time?
30. How does the consumer feel about the amount of privacy he/she has where he/she lives?
31. How does the consumer feel about the amount of comfort and security he/she has where he/she lives?
32. How does the consumer feel about his/her access to health care?
33. How does the consumer feel about the neighborhood and residence where he/she lives?
34. How does the consumer feel about his/her access to reliable transportation?
35. How does the consumer feel about his/her relationships with family/significant others/friends?
36. To what extent do you believe the consumer’s use of alcohol or street drugs interferes with his/her recovery from mental illness? The consumer does not use alcohol or street drugs. Strongly believe‚ Believe‚ Believe a little‚ Do not believe
37. To what extent do you believe the consumer takes his/her psychiatric medication as prescribed? Psychiatric medication has not been prescribed for the consumer. All the time‚ Most of the time‚ Sometimes‚ Almost never
38. To what extent do you believe the consumer’s psychiatric medication helps with his/her recovery from mental illness? Psychiatric medication has not been prescribed for the consumer. Strongly believe‚ Believe‚ Believe a little‚ Do not believe

***************************************

VIP CROS 3.0 Questionnaire for …

Please indicate your relationship to the consumer:

Spouse/Significant Other ○ Other Relative ○ Residential Facility Staff ○ Parent/Step-parent ○ Friend ○ Other

Think about the consumer’s hopes for the future:

All the time‚ Most of the time‚ Sometimes‚ Almost never

1. To what extent does the consumer seem to believe he/she will handle daily problems?
2. To what extent does the consumer seem to believe he/she will trust his/her thoughts and feelings?
3. To what extent does the consumer seem to believe he/she will feel alert and alive?
4. To what extent does the consumer seem to believe he/she will achieve goals he/she sets?
5. To what extent does the consumer seem to believe his/her life will have meaning?
6. To what extent does the consumer seem to believe he/she will have enjoyable experiences?
7. To what extent does the consumer seem to believe he/she will recover from mental illness?

Think about things the consumer does in his/her daily life:

8. How often does the consumer plan and keep a daily routine on his/her own?
9. How often does the consumer concentrate and finish tasks that he/she starts?
10. How often does the consumer make plans to do things with other people?
11. How often does the consumer manage his/her residence (for example‚ do chores‚ pay bills‚ keep his/her room/house clean)?
12. How often does the consumer make his/her own decisions?
13. How often does the consumer take care of his/her personal appearance (for example‚ bathe‚ wear clean clothes)?
14. How often is the consumer involved in meaningful activity (for example‚ employment‚ school‚ volunteer work)?
15. How much progress is the consumer making toward recovering from his/her mental illness?

Think about how well the consumer is coping:

Very well -never a problem‚ Fairly well -rarely a problem‚ Not so well -often a problem‚ Very poorly -always a problem

16. How well is the consumer coping with feeling sad?
17. How well is the consumer coping with feeling tense or anxious?
18. How well is the consumer coping with feeling angry or hostile toward others?
19. How well is the consumer coping with disturbing thoughts?
20. How well is the consumer coping with difficulty sleeping?
21. How well is the consumer coping with external stressors (health problems‚ family conflicts‚ unemployment‚ tragedy in community)?

Think about how satisfied the consumer is with his/her life:

Very satisfied‚ Somewhat satisfied‚ Somewhat dissatisfied‚ Very dissatisfied

22. How does the consumer feel about the amount of freedom he/she has where he/she lives?
23. How does the consumer feel about ha‎ving things to do that he/she enjoys (for example‚ going to the movies‚ sports events‚ hobbies)?
24. How does the consumer feel about the way he/she spends his/her free time?
25. How does the consumer feel about the amount of privacy he/she has where he/she lives?
26. How does the consumer feel about the amount of comfort and security he/she has where he/she lives?
27. How does the consumer feel about his/her access to health care?
28. How does the consumer feel about the neighborhood and residence where he/she lives?
29. How does the consumer feel about his/her access to reliable transportation?
30. How does the consumer feel about his/her relationships with family/significant others/friends?
31. To what extent do you believe the consumer’s use of alcohol or street drugs interferes with his/her recovery from mental illness? The consumer does not use alcohol or street drugs. Strongly believe‚ Believe‚ Believe a little‚ Do not believe
32. To what extent do you believe the consumer takes his/her psychiatric medication as prescribed? Psychiatric medication has not been prescribed for the consumer. All the time‚ Most of the time‚ Sometimes‚ Almost never
33. To what extent do you believe the consumer’s psychiatric medication helps with his/her recovery from mental illness? Psychiatric medication has not been prescribed for the consumer. Strongly believe‚ Believe‚ Believe a little‚ Do not believe