Development, reliability, and validity of the case management quality of care scale (CMQS) among clients with first episode psychosis.

This paper describes the development and validation of the Case Management Quality Scale (CMQS) to measure the quality of care provided by case managers in an early intervention service for clients with first episode psychosis. A total of 300 client participants from the Singapore Early Psychosis Programme completed a self-administered survey comprising 52 items measuring case management, the Client Satisfaction Questionnaire 8-item version (CSQ-8), Recovery Self-Assessment - person in recovery version (RSA-R), and Working Alliance Inventory - long form client version (WAI-C), and Recovering Quality of Life 10-item version (ReQoL-10). Exploratory factor analysis was conducted on the 52-item scale and the items were reduced using criterion validity. Psychometric properties of the 25-item CMQS were tested using internal consistency and concurrent validity. A 2-factor structure of the CMQS was established comprising two subscales - Therapeutic alliance and Care and empowerment. The test of normality for CMQS and subscales was largely found to be within the acceptable range. The Cronbach's alpha for the CMQS scale was high (0.97) and in terms of convergent validity, the CMQS and the two subscales had a moderate correlation with the CSQ-8, RSA-R, and WAI-C (r ranging from 0.596-0.711) and a mild correlation with the ReQoL-10. In conclusion, the CMQS is a user-friendly, and psychometrically sound instrument that is potentially useful for measuring case manager-client therapeutic alliance, and the level of care and empowerment in a case management service.