Client-outcome program evaluation and functional role analysis in a community mental health clinic Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/bk128f38w

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  • The purpose of the study was to: (1) test a client-outcome evaluation methodology in a community mental health clinic, (2) relate a measure of clients' recent life change to client outcomes, (3) relate functions staff perform for clients to staff mental health profession and to client outcomes, and (4) suggest directions for further exploration of relationships between therapist style and client outcomes on the basis of interview and anecdotal data collected from clients and staff. It was intended that results of the study be used to assist in mental health worker education and to improve program evaluation in mental health, education, and other human services. The Denver Community Mental Health Outcome Questionnaire (DCMHOQ) was administered to 33 adult and teen-aged clients at admission and again after three visits or three months. Clients were also rated by staff on a check-list purporting to measure the same dimensions. During the post-interview, clients responded to an adaptation of Holmes' Schedule of Recent Experience (SRE), which contains a scale for measuring social readjustment required by selected recent life events. During the three-month experimental period, clinic staff monitored the amount of time they spent performing functions for client subjects, using direct service functional role categories developed by a 1969 Southern Regional Education Board symposium on mental health manpower utilization. No conclusions were drawn regarding the clinic's treatment effects because of weaknesses in the study design. Both DCMHOQ and staff checklist were sensitive to quantitative changes in psychological distress and social system use; the staff checklist was also sensitive to changes in interpersonal isolation. Neither instrument demonstrated changes in substance abuse or trouble with the law; both demonstrated equal levels of client satisfaction. The staff checklist was more sensitive to pre- post- changes, presumably because it permitted attention to qualitative variables. Further definition of outcomes expected of mental health services at societal and individual client levels was recommended. A multi-faceted approach to client outcome program evaluation was suggested to help balance single methodology deficiencies. Recent life change scores were extremely variable, but were not related to client outcomes or to the amount of time staff spent with clients. A more suitable instrument needs to be developed for low socio-economic clinic populations, incorporating appropriate items and an interview format. Serious difficulties with the functional role classification system resulted in data distortion and loss. Information gathered was not of sufficient quality to permit comparisons with client outcomes or to be useful for detailed curriculum planning. It was found that evaluation and broadly-defined behavior changing are central direct service functions of the community mental health clinic. Workers from all mental health disciplines perform common functional roles, but they devote different proportions of their direct service time to various roles. There are more differences in workers' time distribution within mental health professions than between professions. Functional roles traditionally characteristic of specific mental health professions are performed more frequently, by members of those professions than by other mental health workers, but there is much variation between individual practitioners. The nature of the client population and/or length and closeness of staff working relationships may be more influential in determining staff time distribution among functional roles than professional background. Staff satisfied with their perceived time distribution tend to possess more formal and informal power. Two directions were suggested for further exploration of relationships between therapist style and client outcomes: (1) examination of organizational and administrative characteristics of mental health agencies, and (2) exploration of therapists' beliefs about the causes and cures of emotional disorder and about professionalism.
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