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:
Diagnosis ACT Team
Diagnosis Therapy Groups
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
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
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