The results supported the development of a 'push and pull' conceptualization of recruitment and retention issues, including job-related (intrinsic) and non-job-related (extrinsic) issues. This conceptualization allows organisations to closely examine factors that attract practitioners to positions and those that support or damage staff tenure.

Introduction Australian occupational therapists working on mental health inpatient wards are often requested to assess a person’s function and, based on that assessment, recommend the best support environments for that person post‐discharge. The Allen Cognitive Level Screen (ACLS) is a tool used by some therapists to screen cognitive functioning as a basis with which to make support recommendations. There is limited examination of the outcomes for people post‐discharge if the ACLS score‐based support recommendations are followed. Method A retrospective cohort design involved quantitative analysis of archival data for 150 adult (18–65 years old) consumers with a primary diagnosis of schizophrenia and an ACLS completed pre‐discharge. Data up to 12 months post‐discharge from hospital were studied. Outcomes examined included re‐presentations or readmission to hospital, length of time in community prior to re‐presentation and length of stay in hospital if readmitted. Results Being younger, male, receiving formal supports, having a drug and alcohol disorder comorbidity, living in public housing and having a lower cognitive level as measured by the ACLS were significant univariate factors associated with higher hospital utilisation for one or more of the outcome variables. Multivariate analyses revealed fewer significant relationships, with being younger and receiving formal supports significantly associated with greater likelihood of return to hospital. Conclusion This research contributes to evidence of the complexity of living with schizophrenia in the community and supporting people to stay out of hospital. More research regarding how the ACLS score‐aligned support recommendations are carried out and the impact on hospital utilisation is needed in order to enhance occupational therapists confidence in their use and prescription.

Importance: Research involving the use of the Allen Cognitive Level Screen (ACLS) in mental health practice has been available for more than 40 yr, yet there has been no comprehensive synthesis and review of this body of literature. Objective: To review, summarize, compare, and evaluate the existing literature regarding the relationship between the ACLS and the functional and adaptive functional performance of adults living with mental illness. Data Sources: Searches with no date limits were conducted in the CINAHL, MEDLINE, PsycINFO, ProQuest, and OTseeker databases. Study Selection and Data Collection: A five-stage scoping review methodology was used to examine peer-reviewed English-language literature reporting on the relationship between ACLS scores and functional and adaptive functional performance of adults with mental illness. Information from 15 studies was charted, collated, and numerically and thematically summarized. Findings: A positive relationship between ACLS scores and in-the-moment performance was consistently reported. The relationship of ACLS scores to community living performance was less consistent. Methods of assessing performance, complexity of tasks assessed, and timing of assessments affected relationships with cognition as measured by ACLS. Gaps in the literature were identified. Conclusions and Relevance: Findings raise questions about how, why, and when occupational therapists use the ACLS. Increased examination is needed of what aspects of performance and functional cognition reliably determine people’s ability to live successfully in the community. What This Article Adds: This article provides the first synthesis of the existing literature on the relationship between ACLS scores and functional and adaptive functional performance of people living with mental illness.

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