Indiana University-Purdue University Indianapolis (IUPUI) / STUDY 1: Objective: Stigma resistance is consistently linked with key recovery outcomes, yet theoretical work is limited. This study explored stigma resistance from the perspective of individuals with serious mental illness (SMI). Methods: Twenty-four individuals with SMI who were either peer-service-providers (those with lived experience providing services; n = 14) or consumers of mental health services (n = 10) engaged in semi-structured interviews regarding experiences with stigma, self-stigma, and stigma resistance, including key elements of this process and examples of situations in which they resisted stigma. Results: Stigma resistance is an ongoing, active process that involves using one’s experiences, knowledge, and sets of skills at the 1) personal, 2) peer, and 3) public levels. Stigma resistance at the personal level involves a) not believing stigma or catching and challenging stigmatizing thoughts, b) empowering oneself by learning about mental health and recovery, c) maintaining one’s recovery and proving stigma wrong, and d) developing a meaningful identity beyond mental illness. Stigma resistance at the peer level involves using one’s experiences to help others fight stigma and at the public level, resistance involved a) education, b) challenging stigma, c) disclosing one’s lived experience, and d) advocacy work. Discussion: Findings present a more nuanced conceptualization of resisting stigma, grounded in the experiences of people with SMI. Interventions should consider focusing on personal stigma resistance early on and increasing the incorporation of peers into services. STUDY 2: Background: Despite strong links between stigma resistance and recovery outcomes, limitations of existing measures of stigma resistance have contributed to this construct remaining largely under-studied. This study sought to develop and validate an improved measure of mental illness stigma resistance, grounded in the perspectives of people with lived experience. Method: An item pool was developed from qualitative interviews (Study 1) and items were piloted in an online MTurk sample with people self-reporting a mental illness diagnosis (n=489). Best performing items were selected and preliminary factor structure was examined using exploratory factor analysis in a subset of the sample (30%, n=161). The new measure was then administered to individuals at two state mental health consumer recovery conferences (n=202) and confirmatory factor analyses were conducted to assess factor structure and refine the measure. Validity of the new scale was then examined through correlations with theoretically relevant measures. Results: The EFA suggested possible models of either 1, 3, or 5 factors. CFA demonstrated that the 5-factor model best fit the remaining MTurk data (n=328) and this was replicated in the conference sample; these samples were then combined to refine the measure across a heterogeneous sample (n=530). The final 20-item measure demonstrated good internal consistency for the total score (.93) and each of the 5 subscales (.71 - .88), good test-retest reliability (.74), and strong construct validity. Discussion: This study produced an improved measure of stigma resistance with strong psychometric properties and construct validity. Use of this new measure will allow for a more nuanced assessment of stigma resistance across important domains of recovery.

BACKGROUND: School discipline—how schools manage and respond to student misbehavior—is a central component of how schools seek to create safe and productive learning environments. School suspensions have been a popular discipline strategy in recent decades. Yet, recent studies have demonstrated the association between punitive discipline strategies and poor outcomes in youth, including increased high school dropout rates, decreased odds of enrolling in postsecondary school, and increased mental health concerns. There is an urgent need to examine alternate mechanisms for addressing school discipline other than punitive exclusionary or reward-based systems. This dissertation seeks to develop an integrated model of promising approaches and define how such a system could work. OBJECTIVES: This dissertation is made up of three studies addressing three aims: (1) to synthesize the existing literature on how school discipline has been constructed and its impact on student well being; (2) to develop a novel conceptual model for an alternate discipline approach, "kind discipline," and; (3) to develop and validate a measure for assessing the practice of kind discipline in elementary and middle schools. METHODS: Study one is a theoretical review utilizing a social ecological model to frame how school discipline models address an individual, relational, or structural level. Study two is a formative evaluation that develops a novel conceptual model for an alternative discipline approach. This study utilized concept mapping to elicit and integrate perspectives on school discipline from teachers, administrators, school staff, and other stakeholders involved in school programming. The concept mapping included a brainstorming phase, a statement analysis phase, a sorting and rating phase, and multidimensional scaling and hierarchical cluster analysis of the collected data. It culminated in a map that visually represent the group's ideas and how they are interrelated. Study three validated a newly developed measure of kind discipline through an assessment of the measure’s internal consistency, an exploration of convergent and discriminant validity, and a descriptive analysis of the strength of relationships between kind discipline and school-level discipline frequency. RESULTS: The theoretical review illustrated how different school discipline approaches address disparate explanations of what may lead to student misbehavior. The formative evaluation developed a conceptual model for kind discipline in which three core themes emerged from 11 identified clusters in the conceptual model: (1) proactively developing a positive school climate, (2) responding to conflict with empathy, accountability, and skill, and (3) supporting staff skills in understanding and sharing expectations. When mapped onto a social ecological model, the identified components of kind discipline encompassed all levels of that model including the individual, relational, environmental/structural, and even community levels. In the study validating a measure of kind discipline, teacher and student assessments of kind discipline were strongly correlated (Pearson’s Correlation -.772, p=0.005). Convergent validity of the measure was supported by our finding that the more positively students assessed kind discipline in their schools, the lower the school disciplinary action rate (β=-0.759, p=0.05). Mixed linear models showed teachers' perceived kind discipline at the school level predicted individual students' perception of kind discipline. Girls reported higher levels of kind discipline than boys; and students in higher grades reported lower levels of kind discipline than students in lower grades. CONCLUSIONS: Effective school discipline programs may need to operate on multiple levels. There is increasing support for the importance of a relationship-level component to disciplinary approaches. This contrasts with the dominant individual-behavioral discipline approaches that focus on fewer levels and may not lead to sustained student and staff motivation. The findings from the concept mapping illustrate the importance of setting and communicating clear expectations and the need for them to be collaboratively developed. The student and teacher measures for assessing the level of kind discipline in a school show promise as tools for evaluating schools working to improve approaches to discipline and for guiding interventions that aim to promote positive and relational motivation strategies.

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