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1、Community Ment Health J. 1999 Jun;35(3):251-69Comparing practice patterns of consumer and non-consumer mental health service providers.Paulson R, Herinckx H, Demmler J, Clarke G, Cutler D, Birecree E.Portland State University, OR 97207-0751, USA.The practice patterns of consumer and non-consumer pro
2、viders of assertive community treatment are compared using both quantitative and qualitative data collected as part of a randomized trial. Activity log data showed that there were few substantive differences in the pattern of either the administrative or direct service tasks performed by the two tea
3、ms. In contrast, the qualitative data revealed that there were discernable differences in the culture of the two teams. The consumer team culture emphasized being there with the client while the non-consumer team was more concerned with accomplishing tasks.Publication Types: *Clinical Trial*Randomiz
4、ed Controlled TrialTABLE OF CONTENTSSpecific Aims2Background for the Project 4Method11Subjects and Recruitment11The ACT Programs13Assessment16The Sample27Analyses27Engagement & Retention30Twenty-Four Month Outcomes46Adverse Events54Comparing Practice Patterns of the Two ACT Teams66Overall Conclusion
5、s88References90Appendix 1: Research Protocols Appendix 2: ArticlesFINAL REPORTGrant # HD5 SM51349COMPARING CONSUMER AND NON-CONSUMER ACT TEAMS AND USUAL CARE SPECIFIC AIMSThis research project was a randomized trial comparing consumer or non-consumer staffed assertive community treatment (ACT) teams
6、 for persons with major mental illness (MMI) in a consumer-run organization with a control group receiving services from the usual system of care. The specific aims of the project were:1. To compare the 24-month outcomes of 120 persons with major mental illness served by two different ACT teams and
7、the usual service system, including: (a) psychiatric status; (b) quality of life; (c) social functioning; (d) substance abuse; (e) arrests and convictions; (f) utilization of corollary mental health and community support services; (g) housing and employment status; (h) client satisfaction with servi
8、ces; (i) medication compliance; and (j) hospitalization and emergency room usage.2. To examine the process of the assertive case management (ACT) intervention and therapeutic change in both teams for possible differences and similarities between non-consumer and consumer case managers, controlling f
9、or the intervention model and organizational variables. 3. To explore the strengths and limitations of consumer and non-consumer case managers and the conditions which maximize the effectiveness of each.4. In the context of this investigation, to remedy the methodological shortcomings of similar ong
10、oing and previous investigations, including (a) lack of random assignment; (b) different underlying intervention models; (c) different organizations implementing the intervention; (d) use of handy sample comparison groups, which differed on many variables in contrast to a true control group; (e) lac
11、k of specificity of the intervention model; and (f) inadequate implementation checks to assure the model was being faithfully implemented.5. To explore the variables which support consumer effectiveness as providers of mental health services, and the issues in employing non-consumer providers in a c
12、onsumer-run organization.6. To compare the results of this project with the results of another study of consumer case managers being conducted by Phyllis Solomon in Philadelphia (a consultant to the study).This report presents the results of four different types of analysis: 1) the differences in en
13、gagement and retention of subjects among the three conditions; 2) the results of the intervention across conditions; 3) the differential occurrence of adverse events in the three conditions, and; 4) differences in practice patterns of the two ACT teams.93BACKGROUND FOR THE PROJECTFrom the beginning
14、of the Community Support Program (CSP; Stroul, 1986; Turner & Tenhoor, 1978) case management and the participation of consumers have been two principal components in the planning and delivery of mental health services. These issues remain major concerns in state and federal policy today, and are rev
15、iewed in turn. Case Management: Substantial financial investments in case management services have been required, and mental health scholars and advocates continue to support the key role of case management in effective community support programming (Rog, Andranovich & Rosenblum, 1987; Rubin, 1992;
16、Solomon, 1992). Furthermore, most CSP improvement strategies are designed around the central role of case management (Ridgeley, Morrissey, Paulson, Goldman & Calloway, 1996).Despite these policy advances, the effectiveness of case management in general and any model in particular has yet to be firmly established.
