Altitudes for Caregivers

The Altitudes Health Care Climate Questionnaire is a 15-item scale. Answers are on a 7-point Likert scale (1-7) with options Strongly Disagree, Mildly Disagree, Slightly Disagree, Neutral, Slightly Agree, Mildly Agree, and Strongly Agree. Possible scores range from 15 to 105 with higher scores reflecting better perceptions of their relationship with Altitudes moderators.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Altitudes Health Care Climate Questionnaire is a 4-item scale. Answers are on a 7-point Likert scale with options Not at all true\[1\], Somewhat true\[4\], Very true\[7\] with a sliding scale between answers. Possible scores range from 4 to 28. Higher scores indicate stronger perceived competence and ability in using the Altitudes platform.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Altitudes Health Care Climate Questionnaire is a 20-item scale. The barriers to use subscale is six 7-point Likert scale answers with options of Strongly Disagree, Mildly Disagree, Slightly Disagree, Neutral, Slightly Agree, Mildly Agree, and Strongly Agree. Possible scores range from 6 to 42. Lower scores indicate less issues with barriers to engaging with the platform.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Altitudes Health Care Climate Questionnaire is a 20-item scale. The moderation and peer support subscale is three 7-point Likert scale answers with options of Strongly Disagree, Mildly Disagree, Slightly Disagree, Neutral, Slightly Agree, Mildly Agree, and Strongly Agree. Possible scores range from 3 to 21. Higher scores indicate higher regard of the moderators and peer support on the Altitudes platform.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Altitudes Health Care Climate Questionnaire is a 20-item scale. The overall impressions of the platform scale is three 7-point Likert scale answers with options of Strongly Disagree, Mildly Disagree, Slightly Disagree, Neutral, Slightly Agree, Mildly Agree, and Strongly Agree. Possible scores range from 3 to 21. Higher scores indicate better overall impressions of the Altitudes platform.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Altitudes Health Care Climate Questionnaire is a 20-item scale. The perception of other platform users subscale is four 7-point Likert scale answers with options of Strongly Disagree, Mildly Disagree, Slightly Disagree, Neutral, Slightly Agree, Mildly Agree, and Strongly Agree. Possible scores range from 4 to 28. Higher scores indicate better perception of interactions with other Altitudes participants.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Altitudes Health Care Climate Questionnaire is a 20-item scale. The safety and confidentiality subscale is two 7-point Likert scale answers with options of Strongly Disagree, Mildly Disagree, Slightly Disagree, Neutral, Slightly Agree, Mildly Agree, and Strongly Agree. Possible scores range from 2 to 14. Higher scores indicate higher perceived safety and confidentiality when using the platform.

Time frame: Month 3, Month 6

Population: Only participants who have completed both assessments have been included in this analysis. No participants were enrolled in the Treatment as Usual Arm.

The Working Alliance Inventory for Guided Internet Interventions (WAI-I) is a 4-item scale. Answers are on a 5-point scale with options seldom, sometimes, fairly often, very often, and always. Possible scores are averaged across items and range from 1 to 5. Higher scores indicate stronger bond with the supporting therapist

Time frame: Month 3, Month 6

Population: No participants were enrolled into the Treatment as Usual Arm. All data collected are reported. Four participants elected not to complete the post-treatment assessment.

The Working Alliance Inventory for Guided Internet Interventions (WAI-I) task and goals subscale is an 8-item scale. Answers are on a 5-point scale with options seldom, sometimes, fairly often, very often, and always. Possible scores are averaged across items and range from 1 to 5. Higher scores indicate greater agreement between the therapist and client on tasks and goals.

Time frame: Month 3, Month 6

Population: No participants were enrolled into the Treatment as Usual Arm. All data collected are reported. Four participants elected not to complete the post-treatment assessment.

The Working Alliance Inventory for Guided Internet Interventions (WAI-I) is a 12-item scale. Answers are on a 5-point scale with options seldom, sometimes, fairly often, very often, and always. Possible scores are averaged across items and range from 1 to 5. Higher scores indicate greater therapeutic alliance. Reported value is the average value at month 6 minus the average value at month 3.

Time frame: Month 3, Month 6

Population: No participants were enrolled into the Treatment as Usual Arm. All data collected are reported. Four participants elected not to complete the post-treatment assessment.

The Altitudes platform passively collects engagement data, including the number of therapeutic education modules started and completed as well as any posts, reactions, or comments made on the platform. The investigators will provide mean and standard deviation scores for each site usage category, for the Altitudes group only. The data was collected continuously from baseline up to month 6 as a count of occurences with the mean engagement with the Altitudes platform computed across this time frame.

Time frame: Baseline, Up to Month 6

Population: No participants were enrolled into the Treatment as Usual Arm.

This qualitative data will be collected post-treatment from Altitudes participants. Individual interviews will discuss usage of the platform and any feedback participants may have. Feedback from participants will be summarized to include common themes regarding likes and dislikes of the platform, implementation within the clinical setting, and participant ideas for future directions.

Time frame: Up to 6 months

Population: No participants were enrolled into the Treatment as Usual Arm. Two participants elected not to complete the post-treatment interview.

The Family Questionnaire (FQ) is a 20-item, self-administered questionnaire that measures expressed emotion status (criticism and emotional over involvement (EOI)) of family members toward patients with mental illness. The critical comments subscale consists of 10 items and is rated on a 4-point scale (1 = never/very rarely; 4 = very often). The critical comments subscale is scored by adding together the ratings from the individual items. Possible scores ranging from 10 to 40 with higher scores indicating greater levels of critical comments with their loved one.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Family Questionnaire (FQ) is a 20-item, self-administered questionnaire that measures expressed emotion status (criticism and emotional over involvement (EOI)) of family members toward patients with mental illness. The EOI subscale consists of 10 items with each item is rated on a 4-point scale (1 = never/very rarely; 4 = very often). The EOI subscale is scored by adding together the ratings from the individual items. Possible scores ranging from 10 to 40 with higher scores indicating greater levels of emotional overinvolvement with their loved one.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Family Questionnaire (FQ) is a 20-item, self-administered questionnaire that measures expressed emotion status (criticism and emotional over involvement (EOI)) of family members toward patients with mental illness. The FQ has two subscales: critical comments, and EOI. Each item is rated on a 4-point scale (1 = never/very rarely; 4 = very often). The FQ is scored by adding together the ratings from the individual items. Possible scores range from 20 to 80 with higher scores indicating greater levels of expressed emotion.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Five Facet Mindfulness Questionnaire: 24 is a 24-item self-report questionnaire designed to measure an individual's mindful self-awareness. The description subscale is 5 items with answers are on a 5-point Likert scale of Never or very rarely true, Rarely true, Sometimes true, Often true, and Very often true or always true. Possible scores range from 5 to 25 after reverse scoring of appropriate items with higher scores indicate more to describe their feelings and experiences.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Five Facet Mindfulness Questionnaire: 24 is a 24-item self-report questionnaire designed to measure an individual's mindful self-awareness. The mindful action subscale is 5 items with answers are on a 5-point Likert scale of Never or very rarely true, Rarely true, Sometimes true, Often true, and Very often true or always true. Possible scores range from 5 to 25 after appropriate items have been reversed scored with higher scores indicate more awareness around their actions and experiences.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Five Facet Mindfulness Questionnaire: 24 is a 24-item self-report questionnaire designed to measure an individual's mindful self-awareness. The non-judgemental subscale is 5 items with answers are on a 5-point Likert scale of Never or very rarely true, Rarely true, Sometimes true, Often true, and Very often true or always true. Possible scores range from 5 to 25 once appropriate items have been reversed scored with higher scores indicate more nonjudgmental thoughts towards their beliefs and feelings.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Five Facet Mindfulness Questionnaire: 24 is a 24-item self-report questionnaire designed to measure an individual's mindful self-awareness. The non-reactivity subscale is 5 items with answers are on a 5-point Likert scale of Never or very rarely true, Rarely true, Sometimes true, Often true, and Very often true or always true. Possible scores range from 5 to 25 with higher scores indicate more mindful non-reactivity to thoughts and feelings.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Five Facet Mindfulness Questionnaire: 24 is a 24-item self-report questionnaire designed to measure an individual's mindful self-awareness. The observation subscale is 3 items with answers are on a 5-point Likert scale of Never or very rarely true, Rarely true, Sometimes true, Often true, and Very often true or always true. Possible scores range from 3 to 15 with higher scores indicate more observational awareness.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Five Facet Mindfulness Questionnaire: 24-item is a 24-item self-report questionnaire designed to measure an individual's mindful self-awareness. It can be divided into five subscales: Observing, Describing, Acting in Awareness, Non-judging, and Non-reactivity. Answers are on a 5-point Likert scale of Never or very rarely true, Rarely true, Sometimes true, Often true, and Very often true or always true. Possible scores range from 24 to 120 once necessary questions (i.e., negative) have been reversed scored. Higher scores indicate more mindfulness and self-awareness.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The GHQ-12 is a 12-item scale. Answers are on a 4-point scale ranging from 0 not at all to 3 much more than usual. Possible scores range from 0 to 36. Higher scores reflect worse outcomes (more frequent depressive symptoms).

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Multidimensional Scale of Perceived Social Support Survey is a 16-item scale. Answers are on a 7-point scale with options ranging from very strongly disagree to very strongly agree. Possible scores range from 16 to 112. Higher scores reflect higher feelings of social support (more perceived social support).

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Self-Compassion Scale is a 12-item self-report questionnaire designed to measure an individual's self-compassion towards themselves as well as their feelings and emotions. It can be divided into six subscales with two questions for each: Self-Kindness, Self-Judgment, Common Humanity, Isolation, Mindfulness, Over-identified. Answers are on a 5-point scale ranging from 1 Almost never to 5 Almost always. Total score is calculated by totaling the mean of each subscales and reversing the negative subscales (self-judgment, isolation, and over-identification) then taking the mean of the summed subscales. Possible scores range from 1 to 5 with higher scores indicate increased self-compassion.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Brief-COPE is a 28-item self-report questionnaire designed to measure effective and ineffective ways to cope with a stressful life event. The avoidant-focused subscale is 8 items. Answers are on a 4-point scale ranging from 1 I haven't been doing this at all to 4 I have been doing this a lot. Possible scores range from 8 to 32. Higher scores on each reflect more frequent use of avoidance for coping.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled into the Treatment as Usual Arm.

The Brief-COPE is a 28-item self-report questionnaire designed to measure effective and ineffective ways to cope with a stressful life event. The emotion-focused subscale is 12 items. Answers are on a 4-point scale ranging from 1 I haven't been doing this at all to 4 I have been doing this a lot. Possible scores range from 12 to 48. Higher scores on each reflect more frequent use of emotion focused coping.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled into the Treatment as Usual Arm.

The Brief-COPE is a 28-item self-report questionnaire designed to measure effective and ineffective ways to cope with a stressful life event. The problem-focused subscale is 8 items. Answers are on a 4-point scale ranging from 1 I haven't been doing this at all to 4 I have been doing this a lot. Possible scores range from 8 to 32. Higher scores on each reflect more frequent use of problem focused coping.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled into the Treatment as Usual Arm.

The ECI Scale is a 66-item scale. Answers are on a 5-point scale starting at 0 with options never, rarely, sometimes, often, and nearly always. The negative experience subscale is 52 items with possible scores range from 0 to 208. Higher scores reflect feeling less prepared to provide caregiving and more negative experiences in caregiving.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The ECI Scale is a 66-item scale. Answers are on a 5-point scale starting at 0 with options never, rarely, sometimes, often, and nearly always. The positive experience subscale is 14 items with possible scores range from 0 to 56. Higher scores indicate greater feelings of preparedness and experiences with caregiving.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The ECI Scale is a 66-item scale. Answers are on a 5-point scale starting at 0 with options never, rarely, sometimes, often, and nearly always. Possible scores range from 0 to 264 after appropriate items have been reversed scored. Higher scores indicate greater feelings of preparedness for caregiving whereas lower scores reflect feeling less prepared to provide caregiving.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The Modified Psychosis Attitudes Survey is a 19-item self-report questionnaire designed to measure an individual's beliefs and attitude towards psychosis (e.g., identifying psychosis, interacting with individuals experiencing psychosis, etc.). The survey can be divided into 4 subscales: perceived confidence, optimism, fulfillment, and stress-vulnerability orientation. Answers range from Very strongly disagree, Strongly disagree, Mildly disagree, Neutral, Mildly agree, Strongly agree, Very strongly agree. Total score is obtained with summing each question, after reverse scoring appropriate questions. Possible scores range from 19 to 133. Higher total score indicates an increased knowledge, optimism, and attitudes towards psychosis.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The UCLA Loneliness scale is a 20-item scale. Answers are on a 4-point scale with options I often feel this way, I sometimes feel this way, I rarely feel this way, and I never feel this way. Possible scores range from 20 to 80. Higher scores reflect worse outcomes (greater feelings of loneliness). The UCLA Loneliness Scale is a part of the PhenX Toolkit.

Time frame: Baseline, Post Treatment (Month 6)

Population: No participants were enrolled in the Treatment as Usual Arm.

The PTGI is a 25-item self-report measure that assesses five domains of personal growth that may follow a stressful encounter. Answers are on a 6-point scale ranging from 0 I did not experience this to 5 I experienced this change to a very great degree. Total scores on this scale range from 0 to 125. Higher scores reflect more positive changes in an individual's life following a stressful experience.

Time frame: Baseline, Post Treatment (Month 6)

The PCL-5 is a 20-item self-report measure of the 20 DSM-5 symptoms of Post Traumatic Stress Disorder (PTSD). Included in the scale are four domains consistent with the four criteria of PTSD in DSM-5: Re-experiencing (criterion B), Avoidance (criterion C), Negative alterations in cognition and mood (criterion D), and Hyper-arousal (criterion E). Answers are on a 5-point scale including Not at all, A little bit, Moderately, Quite a bit, and Extremely and with total scores ranging from 0 to 80. Higher scores on the PCL-5 reflect more severe trauma-related symptoms.

Time frame: Baseline, Post Treatment (Month 6)