Progress To Date

Results of the model building efforts were summarized in New Research in Mental Health, Volume 13. Service models to be tested and planning for the implementation of the pilot-tests at the two study agencies were described in New Research in Mental Health, Volume 14.

Briefly, Study Site A is pilot-testing a best practice model for individuals in the more traditional "SAMI" cluster. Members of this cluster have Serious Problems with Drugs and/or Alcohol, Serious Mental Health Problems, and Limited Daily Living and Social Skills. The Goodness of Fit model that was created by a local, diverse expert planning group includes the following services:

Dual Diagnosis ACT Team Psycho-Social Rehab Groups Independent Payees
Dual Diagnosis Therapy Groups 12-Step Consumer Groups  

This model had much in common with the dual diagnosis treatment model established in New Hampshire at Dartmouth and recognized as a best practice by the ODMH. Since Study Site A was also receiving funding to implement the Dartmouth/New Hampshire model as part of an ODMH/ODADAS joint initiative, we have been able to consider all clients in the cluster as one large group whose members receive varying degrees of the Goodness of Fit model services.

Study Site A has just over 100 clients in the pilot-test cluster. Funding and staffing problems caused a one-year delay in start-up of the pilot-test (until July 2000), and have presented ongoing difficulties to full implementation of the Goodness of Fit Preferred Service Model. However, twenty-five (25) consumers have been assigned to the Dual Diagnosis ACT Team and the agency is currently serving 40 additional members of this cluster under the ODMH/ODADAS joint initiative. Thus approximately 65 cluster members are receiving some level of Goodness of Fit model services.

Study Site B is pilot testing services for a cluster of adults who are Severely Disabled In Many Life Areas. These individuals have often had long histories of hospitalization. They suffer considerable interference in their lives from psychiatric symptoms, have lost social and self-care skills, often isolate themselves, and require considerable support from mental health agencies to manage on a day-to-day basis. The model developed for members of this cluster employs a number of group-based interventions.

Study Site B chose to combine three of the model services (Medication Education Groups, Groups Focused On Preventing Decompensation, And Disability Awareness Groups) into one, 17-week program known as the Symptom Awareness and Management group (SAM). This program was implemented in August of 1999. To-date, five groups have completed the core 17-week Symptom Awareness and Management (SAM) program and a sixth group began the curriculum in September 2001. Study Site B also combined two other model services (the Independent Living Skills Training group and the Be Your Own Case Manager Training group) to form the Living Independently For Everyone (LIFE) program. The LIFE groups began in the summer of calendar year 2000. Early in the pilot-test, the agency created an additional group (the Alumni Group) to accommodate consumers who had finished one group but wished to continue meeting until new SAM and/or LIFE groups were started. As of this date 52 cluster members have participated in the pilot test of the preferred services. Forty-two (42) consumers have participated in one or more SAM Groups, ten (10) consumers have received one or more LIFE group services, and six (6) consumers have received both SAM and LIFE group services.

Data collection

Data on outcomes, services, and costs have been collected on members of each cluster for several years at each site. However, to test the Goodness of Fit hypotheses, it was necessary to gather additional data at each research site. Data collection systems that were affected can be classified into three general categories: 1) Service data, 2) Fit assessment data, and 3) Enhanced outcomes.

Procedures were developed at each site to allow for the coding, recording, and tracking of the pilot services. In most cases, data collection modifications were made to the agencies existing billing system. In a few cases "service logs" were created for use by staff in tracking specific pilot services.

As Goodness of Fit is essentially an individual-level construct, the research team also worked with staff at each site to develop methods to assess the level of "fit" of each potential subject for pilot test services. These fit assessment measures incorporated the consumer's readiness to engage in recovery-oriented services as well as the match between the client's individual treatment goals and the focus of the model services. External barriers to participation such as transportation were also identified at Site B. Fit assessments are made by case managers every 6 months at Site A and every 3 months at Site B.

In order to improve the likelihood of detecting change on cluster-based outcomes over the limited, two year pilot-test, the research team decided to enhance the measurement process by: 1) dissecting some of the global scales measuring specific cluster-based outcomes, and 2) adding one or two additional items related to the scales. These Enhanced Outcomes were intended to allow for finer discrimination of progress.


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