Client Outcomes II: Longitudinal Client Data from the Colorado Treatment Outcome Study

ArticleinMilbank Quarterly 72(1):123-48 · February 1994with15 Reads
Impact Factor: 3.38 · DOI: 10.2307/3350341 · Source: PubMed

The outcomes of a reform of the Denver mental health system, cosponsored by the state and the RWJF, are contrasted with changes in a comparison area of the state. The study examines the structural characteristics of the mental health system, staff attitudes and satisfaction, and client-reported services and outcome. Results indicate that, in Denver, structural changes, the introduction of new services, and an intervening financial crisis increased worker dissatisfaction. Client reports documented parallel changes in the following variables: continuity of care, unmet need for case management services, frequency of symptoms, and satisfaction with services. The reform had no impact, however, on most quality-of-life indicators. The possibly adverse consequences of centralizing the system and the indirect influences of system integration on quality of life are discussed.

    • "Psychiatric symptoms were assessed using the Colorado Symptom Index (CSI; Shern et al., 1994). The CSI is a brief 14-item self-report measure of psychiatric symptoms, in which respondents report the frequency of various symptoms they have experienced during the past month (e.g., " How often during the past month have you felt depressed? "
    [Show abstract] [Hide abstract] ABSTRACT: Case management services for people with serious mental illness are generally found to be effective, but controlled and randomized studies assessing such services are scarce. The aim of the present study was to assess the effectiveness of a new strengths-based case management (SBCM) service in Israel, using a randomized controlled approach. The sample consisted of 1276 individuals with serious mental illness, who consume psychiatric rehabilitation services (PRS) in the community, and were randomly assigned to receive or not to receive the SBCM service in addition to treatment-as-usual PRS. Quality of life, goal setting and attainment, unmet needs, self-efficacy, interpersonal relationships, symptom severity, and service utilization were assessed by clients at onset and after 20 months. Results show that SBCM participants improved in self-efficacy, unmet needs, and general quality of life, and set more goals than the control group. SBCM participants also consumed fewer services at follow-up. Results suggest that SBCM services are effective in helping individuals with serious mental illness set personal goals and use PRS in a better and more focused manner.
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    • "Similarly, we found good internal consistency estimates in this study ( .85). Shern et al., 1994). The MSPSS is a 12-item self-report Likert scale designed to assess the subjective experience of social support. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: This article presents findings from a naturalistic study that explored the impact of peer support participation on recovery-related outcomes over a 6-month period. In particular, this study hoped to fill gaps in the literature regarding the process through which personal change occurs in peer support organizations. Method: Fifty people newly involved in services provided by Baltic Street AEH (Advocacy, Employment, Housing), a consumer-operated organization, participated in the study. Participants were interviewed at entry and 3- and 6-month follow-up. Attendance records were reviewed to determine the number of days attended, and the sample was divided into 2 categories: minimal or nonattenders (n = 25) and moderate or high attenders (n = 21). The relationship between attendance and outcomes related to recovery over time was examined using a mixed effect regression analysis, allowing data to be included for participants with at least 1 follow-up interview (n = 38). Results: Relative to minimal or nonattenders, moderate or high attenders showed statistically significant improvements over time in internalized stigma, self-esteem-self-efficacy, and community activism-autonomy. No statistically significant differences were observed between groups in hopelessness, social functioning, symptom severity, coping with symptoms, or substance use. Conclusions and implications for practice: This study demonstrates the potential impact of engagement in peer support services on some subjective aspects of mental health recovery. Namely, change mechanisms could be hypothesized to include identity transformation (from patient to peer). Future directions should continue to investigate potential mechanisms of change with larger samples in randomized studies. (PsycINFO Database Record
    Full-text · Article · Feb 2016 · Psychiatric Rehabilitation Journal
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    • "Regardless of the future refinement of the measurement, the constructed CQ presented an excellent preliminary reliability level ( .98) in terms of overall internal consistency. For the purposes of discriminant validity analysis, the Colorado Symptom Index (CSI) was used, which is also a self-reported measure of psychiatric symptoms frequency within a temporal frame (Shern et al., 1994). We used the briefer 14-item version, in which participants rate the frequency of symptoms experienced in the past month according to a 5-point Likert scale (1 not at all, 5 at least every day). "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the present study was to develop the Portuguese version of the Recovery Assessment Scale (RAS-P), and to assess the validity of the findings using the revised test, with 213 users from 5 nonprofit community-based mental health organizations. Participants in the assessment completed a self-reported survey investigating their sense of personal recovery, personal empowerment, capabilities achievement, psychiatric symptoms' frequency, and demographic data. Evidence from exploratory and confirmatory factor analyses using the 24-item version of the test, validated a 4-factor structure for the RAS-P model based on the dimensions of Personal Goals and Hope, Managing Help Needs, Supportive Interpersonal Relationships, and Life Beyond Symptoms, consistent with components of the recovery process. Convergent and discriminant validity was also achieved using bivariate correlation coefficients among the 4 subscales' scores, between the overall scale and the subscales, and in relation to external variables. Findings allowed for the interpretation that the RAS-P is measuring a particular psychological construct, which is different from symptoms of the mental illness. A hypothesized significant association with personal empowerment and with capabilities achievement was demonstrated. Positive association was also found between participants' use of recovery-oriented services such as independent housing or supported employment programs. The RAS-P scores also revealed excellent internal consistency for the overall scale (α = .90), and good consistency for the subscales (>.75), which attest to its precision in measurement. In conclusion, the study proved the RAS-P a reliable and useful tool in the context of the community mental health practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Jun 2015 · Psychological Assessment
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