The Checklist of Unit Behaviors (CUB): Psychometric properties of a measure of patient milieu engagement on an acute inpatient psychiatric unit

This paper presents the psychometric properties, including factor structure, internal reliability and relative validity of a 16-item questionnaire measuring patients’ relative activation with milieu activities while hospitalised in an acute psychiatric inpatient unit. 24 hours after admission, and before discharge, psychiatric inpatients (N = 132) completed a set of validated self-reports and the pilot questionnaire, the Checklist of Unit Behaviors (CUB). The CUB outlines items that reflect the extent to which the patient avoided or engaged with the treatment milieu within the previous 24 hours. Factor analysis, bivariate correlations and repeated-measures t-tests were used to analyse the data. Factor analysis identified two factors for the CUB: (1) Behavioural Approach; and (2) Behavioural Avoidance. Psychometric properties were satisfactory (Approach, Cronbach's α = 0.93; Avoidance, Cronbach's α = 0.79). Over the course of treatment, CUB-Approach increased (p < 0.001) and CUB-Avoidance decreased (p < 0.001). The construct validity of the CUB was supported through correlations with measures of positive and negative affect. The CUB demonstrates strong psychometric properties, quantifying patients’ behavioural activation in the treatment milieu. Daily use of the CUB provides clinically useful information that has the potential to improve patient care and treatment planning.