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Effective Use of Ohio Consumer Outcomes

The Ohio Mental Health Consumer Outcomes Initiative provides consumers, clinicians, clinical supervisors, mental health service agencies and mental health boards with a tool that fosters consumer recovery.  Ways that each of these stakeholders can effectively use the Ohio Consumer Outcomes is provided below.

 

I. Consumer Use of Ohio Consumer Outcomes:

All persons with a mental illness can be in the process of recovery, or getting better.  This process should be based on self-determined goals.  The Ohio Consumer Outcomes provides consumers a tool for identifying areas in their life for which to set goals.  The Outcomes survey provides results that are based on the consumer's own perceptions of various aspects of their life.  However, this is not to suggest that other significant supports (mental health professionals, family and friends) shouldn't collaborate in the process of developing goals.

Traditionally, the establishment of treatment plans and goals has been in response to problems that a consumer is experiencing.  These plans tend to be reactive rather than proactive, and weakness rather than strengths based.  Furthermore, treatment plans have typically been generated by professional staff with little consumer participation.  The Outcomes project provides consumers with an opportunity to become proactive, strengths based and involved in their treatment decisions.

The Consumer Outcomes provide a basis for consumers to look at an identified list of outcomes that may help them frame possible areas from which to work.  Since some consumers are unable to determine what areas of their life are most important to work on, they may need to discuss the domains and Outcomes results with their clinician.  Regardless, the Outcomes process provides consumers with an opportunity to become more involved in the development of their treatment plan and their treatment process.  This, in turn, enhances the consumer's movement toward self-determination (empowerment).

From the consumer perspective, the purpose of the Outcomes survey process is to help the consumer:

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become active in their treatment process 

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identify strengths and weaknesses 

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identify the parts of their life in which they are dissatisfied 

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work with mental health professionals and family/friends to achieve goals, and

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participate in the recovery process

 

II. Clinical Staff Use of Ohio Consumer Outcomes:

While the consumer is responsible for participating in recovery-oriented activities, the clinician's job is to facilitate the recovery process.  To this end, clinicians can use the Ohio Consumer Outcomes survey results in the following ways:

bulletAs a means to engage the consumer in their treatment as well as provide structure to the therapeutic relationship.

bulletTo identify needs that require immediate attention

bulletTo identify consumer issues/concerns as well as strengths that the clinician might not otherwise be aware of.  Also, by reviewing the highest and lowest consumer ratings on the survey, the clinician can identify the consumer's strengths and needs.  This information can then be used to develop the treatment plan with the consumer.

bulletA clinician can collaborate with a consumer to use his/her self-assessment Outcomes information, along with the clinician's Outcomes information, to develop an individualized recovery-focused treatment plan.

bulletOutcomes results for a specific consumer can be used to monitor the consumer's change over time.  Graphing the results for each administration of the survey provides a clear picture of the consumer's change or lack of change.

bulletThe outcomes information may also suggest areas in which the clinician needs to serve as an advocate for the consumer.

To date, there are four standardized Outcome results reports that the clinician can use to promote consumer recovery: (1) Summary of Clientís Responses, (2) Strengths Report, (3) Red Flag Report, and (4) Client Trajectory Report. Also, item and subscale scores can be used as a barometer of the recovery process.

  1. Summary of clientís responses: 

The "summary of clientís responses" report is a series of charts that produce an outcomes profile for an individual consumer. This report shows a consumerís response to each item of the outcomes instrument for the two most recent administrations. The report organizes the presentation of the items by domain. The report can help the consumer and worker/clinician to visually compare a consumerís responses to identify the consumerís current strengths and needs and areas of improvement or lack of improvement. The consumer and worker/clinician can use this information to collaborate on developing or revising the treatment plan as needed.

  1. Strengths Report:

This report is a list of all of the items on the Summary of Clientís Responses Report that had a double positive or positive response rating. The consumer and worker/clinician can use this information in treatment planning to assure that strengths are used to work on areas of weakness.

  1. Red flag report: 

This report is a list of all of the items on the Summary of Clientís Responses Report that had a double negative or negative response rating. The consumer and worker/clinician can use this information for treatment planning in terms if their mutually deciding on the areas in need of attention and the consumerís setting self-determined goals.

  1. Client trajectory report: 

This is a set of graphs with trend lines that plot an individual consumerís responses across time for each administration of the outcomes instrument. These graphs help the consumer and worker/clinician to see change in the consumerís outcomes over time. This information can help the consumer and worker/clinician revise the treatment plan as needed (procedure manual 3-14,15).

The consumer and clinician can use the results of the standardized Outcomes reports to identify the consumerís strengths and weaknesses. The treatment plan goals should focus on one or several of the items identified. The consumer, with the assistance of the clinician, can then identify specific and measurable goals for their recovery.  A projected timeline for achieving these goals should be developed. The consumer and clinician should also identify what roles each is going to fill in the attempt to reach this goal. When appropriate, activities conducted by community supports should also be identified.

 

III. Clinical Supervisor Use of Ohio Consumer Outcomes:

Little has been written regarding the potential use of outcome data to inform clinical supervision.  However, Outcomes data may be integrated into many of the routine tasks of clinical supervisors.  Three specific time points are especially relevant: the initiation of services, periodic review of ongoing cases and ending services (Ogles, 2001).
  1. Initiation of Services:

Depending in the intake process at a given agency, initial outcome data may be useful to the supervisor when making decisions about case assignment, treatment planning and allocation of services.

  1. Case Assignment:  The supervisor can review a consumer's outcome reports and data to identify consumer strengths, problems and preferences to effectively match the consumer to the most appropriate treatment provider.

For example, the supervisor may note that the consumer reports periodic thoughts of self-harm.  As a result, a clinician who has a record of high quality work with individuals in this circumstance may be assigned.  Likewise, clinicians who are in training or new to the agency may be assigned cases with fewer potential difficulties based on the initial assessment and the standardized outcome data - matching clinician level of experience with case difficulty.

  1. Treatment Planning:  The outcome data and reports also provide important assessment information.  The supervisor can review the outcome results with the clinician to identify potential issues, plan an approach for reviewing the issues with the consumer and project the potential treatment issues and services that may be provided.  Identifying the types of services needed and determining the appropriate intensity of services are especially important factors to consider.

  2. Allocation of Services:  Individuals may report needs, problems or strengths in a variety of domains that indicate potential provision of vocational, recreational, therapeutic, medical or other services.  Clinical supervisors can review the intake outcome ratings to help supplement other assessment data and supervisee reports to determine the types and intensity of services offered to the consumer.
  1. Periodic Review:

Tracking consumer progress on goals and treatment issues using outcome instruments is the primary function of ongoing outcome assessment.  The clinical supervisor can use this data to inform the supervisory process.

A review of outcome tracking data will reveal cases in which the consumers are making progress, remaining stable, or deteriorating.  Supervisors can use this information to determine what cases to review during supervision.  This information can also be used to increase or decrease the intensity of services depending on the situation.

Once ongoing data results are available, supervisors can review individual consumer cases to determine which ones are progressing, deteriorating or plateauing.  This allows the supervisor to focus more attention on those consumers who are struggling and/or need more clinical attention.  It also gives them an opportunity to identify treatment techniques that may contribute to consumer success and to use this information when training new clinicians.

When consumers seem to plateau in their recovery, clinical supervisors can review the outcome data reports with the clinician to identify areas in the consumer's life that could be addressed to propel growth.  For example, if a consumer has attained stability but is not employed, the supervisor and clinician may brainstorm about ways to help the consumer obtain employment - if the consumer desires this.  This may require a modification in services.

  1. Ending Services:

When consumers report improved functioning, fewer symptoms or the ability to cope with symptoms, better quality of life, etc., clinical supervisors can consider the possibility of gradually diminishing or ending services.  Or, they can consider the possibility of modifying services.

IV. Agency/Board Use of Ohio Consumer Outcomes:

There are three primary uses of the outcomes data at the agency/board level:

  1. Care Management:

In the future, when norms and benchmarking adjusted for case mix are available, agency/board administrators can use outcomes data to retrospectively monitor and manage consumers' service utilization.

Using statistical analyses to identify consumers, especially those with high costs and whose outcome scores are outliers, administrators will compare consumers actual scores with the expected scores and review their current level of care and service utilization pattern.

If there is a marked discrepancy between the actual and expected outcomes scores for a consumer, the administrator may recommend a change in the treatment plan to improve the consumer's outcomes.

  1. Quality Improvement:

One of the most important uses of consumer outcomes is for quality improvement of the service delivery system.

For example, if consumer's receiving services from a particular program at an agency routinely display poor outcomes results, it may be necessary to review the program operations and goals to identify potential reasons for poor outcomes and make the necessary modifications.

Likewise, if a particular program routinely leads to positive consumer outcomes, the program can be reviewed to determine what aspects of the program contribute to consumer success to use in other programs.

  1. Accountability for Resources:

Agency/board administrators can use consumer outcomes results to assure that they are meeting the requirements of certifying, accrediting, or payor organizations.

Agencies/boards can also use consumer outcomes results to provide educational information to their Board members.

Agencies can use outcomes results for strategic planning.

Finally, outcomes results can be used as a means to improve an agency's/board's marketing, fund raising and grant writing capabilities.

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