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.
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.
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
From the consumer
perspective, the purpose of the Outcomes survey process is to help the
become active in their treatment process
identify strengths and weaknesses
identify the parts of their life in which they are
work with mental health professionals and
family/friends to achieve goals, and
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:
|As a means to engage the consumer in their treatment as well as
provide structure to the therapeutic relationship.|
|To identify needs that require immediate attention|
|To 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.|
|A 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
|Outcomes 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.|
|The 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
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.
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
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.
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
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).|
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.
- 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.
- 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.
- 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.
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.
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
IV. Agency/Board Use of Ohio Consumer Outcomes:
|There are three primary uses of the outcomes data at the agency/board
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.
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
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
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
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