The Characteristics of Treatment Environment (CTE) questionnaire has succeeded not only in differentiating treatment environments between Peruvian and US mental hospitals, but it has also delineated important differences between the treatment environments of two Peruvian mental hospitals that cut across cultural differences. The cultural factors of paternalism in the Peruvian mental hospital environment, formerly described by independent observers, is measured across several factors on the CTE scales but seems to show up strongest as a difference from US hospitals in the Factor 5 scale, Instrumental Activity. The successful cross-cultural use of the CTE has increased its applicability to measurement of treatment environments in mental hospitals.
Bechtel RB, Gonzalez A. Comparison of Treatment Environments Among Some Peruvian and North American Mental Hospitals. Arch Gen Psychiatry. 1971;25(1):64-68. doi:10.1001/archpsyc.1971.01750130066007