Success indicators
Research into effectiveness
CHT has a small team of six research assistants working in its projects. They work closely under the direction of the Clinical Director.
CHT also out sources research projects each year to different universities. A qualitative research programme was been conducted by Dr Barbara Rawlins, Research Fellow at Manchester University, together with CHT's own six research assistants, into a group of 100 former clients who were discharged over the last two years. Data was collected through interviews or observation, examination of documents, users thoughts and feelings, and practitioners' accounts. We have also conducted a research programme led by Dr. Mark Freestone of Nottingham University. The aim of this research project was to compile a triangulated dataset a strong emphasis on the physical,therapeutic and psycho-social environments, and provide data that would be comparable to datasets produced by the ATC NLCB research project, as well as on-going TC research in Nottinghamshire, Leicestershire and West London NHS Mental Healthcare Trusts.
Currently we are working with Dr Nick Maguire at Southampton University.
Measuring Successful Outcomes*
*Sigla: ACR/QAA (Annual Clinical Review and Quality Assurance Audit); IR (Incident Reports); DSM IV (Diagnostic and Statistical Manual of the American Psychiatric Association); ICD (The International Statistical
How do we measure the effectiveness of the care and treatment we offer
1. Reduction in the number and length of hospitalisations (ACR/QAA)
2. Reduction in psychiatric symptoms according to DSM IV/ICD 10 (BoSI, HoNOS, CORE, SFQ)
3. Reduction in anti-social behaviour (IR)
4. Reduction in levels of anti psychotic medication (ACR/QAA)
5. Increased levels of social inclusion (SFQ; ACR/QAA)
6. Increase in autonomy - this includes move-on rates/independent living (SFQ; ACR/QAA)
7. Increased quality of life (QLS21)
Current research programme
We are currently carrying out a naturalistic analysis of the relationship between clinical outcomes and the therapeutic environment.
The data collection measures are divided in 3 areas:
1. Measures of Therapeutic Programme and Environment (GMI, COPES, WAI)
2. Dynamic Measures of Therapeutic Change and Outcomes (BoSI, HoNOS, CORE, SFQ)
3. Ultimate Outcomes
The following instruments that measure the above areas are normally administered three monthly:
1. Measures of Therapeutic Programme and Environment
Good Milieu Index (GMI) -
A 5 item self reporting questionnaire that provides information about the quality of the environment. Staff and clients complete this in order to build up a picture of the milieu. E.g. "Does what you do in the community help you to have more confidence in yourself?"; "does what you do in the community help you see how good your abilities are?".
Community Oriented Programmes Environment Scale (COPES) -
A 100 item self reporting questionnaire, with 10 sub scales, completed by staff and clients. It helps compare client and staff perceptions, monitor programme changes over time and promote programme improvement. The sub scales are: involvement, support, spontaneity, autonomy, practical orientation, anger and aggression, order and organisation, programme clarity and staff control.
Classification of Diseases and Related Health Problems); IR (Incident Reports); The QLS21 (Quality of Life in Schizophrenia) we intend to introduce in the coming year.
Working Alliance Inventory (WAI) -
A 12 items self reporting questionnaire completed by clients and staff and measures the strength of the therapeutic alliance, i.e. the bond that allows positive progress. E.g. "My therapist and I trust each other", "my therapist and I agree about the things I will need to do in therapy to help improve my situation".
2. Dynamic Measures of Therapeutic Change and Outcomes
Borderline Syndrome Index (BoSI) -
A 52 item self report questionnaire that measures psychopathological distress. E.g. "I want to hurt myself", "I am afraid of forming a close relationship", "I feel my life is out of control", "I feel live is hopeless".
Health of the Nation Outcome Scales (HoNOS) -
A 12 items scale measuring mental health outcomes, filling in by staff divided in 4 sections measuring behavioural problems, impairments, symptomatic problems and social problems. E.g. Staff need to give a give a ranking from 0 to 4 about problems with hallucinations and delusions, problems with activities of daily living, drug taking, self injury, aggressive or agitated behaviours.
Clinical Outcomes Routine Evaluation (CORE) -
A 34 item self report questionnaire about how an individual is feeling on a particular day. E.g. "I have felt tense, anxious and nervous"; " I have thought of hurting myself"; " I have felt like crying"; " I made plans to end my life" etc.
Social Functioning Questionnaire (SFQ) -
A 9 item self report questionnaire about how an individual has been functioning over the last 6 months. These questions are divided into different areas, including close relationships, family, work, finance, spare time. E.g. "I feel lonely and isolated from other people".
3. Ultimate Outcomes
Follow-Up Questionnaire -
An in-house developed questionnaire that asks discharged members for structured information on their activities and experiences after leaving the community. E.g "Have you had an admission to hospital, have you seen a psychiatrist, have you lost time from work, do you have difficulties in getting and keeping close relationships, do you feel lonely and isolated from other people".
Examples of results from last year's study
Clients social functioning (SFQ)The batch sample mean (M=10.32) was significantly lower than the sequential (in-treatment) sample mean (M=13.00), suggesting that a period of treatment improves social functioning.
Psychopathological distress (BoSI)Considering the outcomes longitudinally, the 'sequential' sample - that is, those client members for whom we can control for previous treatment effects as they are 'new' to the communities - displayed overall significant and reliable positive improvement according to psyhcometric tools measuring psychological and social functioning during a period of 9 months in treatment. This study suggests that statistically significant positive change was evident based on the BoSI, representing borderline-life symptomatology.
Overall mental health outcomes (HoNOS, SFQ, BoSI)In terms of self-reported presenting difficulties in psychological and social functioning, the CHT client group surveyed in this study approximates well to a psychiatric inpatients group. This suggest that CHT's model is able to treat people who experience a similar level of disturbance as those in psychiatric wards, i.e. the severe end of the psychiatric population.
