Assertive Community Treatment (ACT) programs provide community-based services for individuals with severe mental illness. In Ontario, these programs are funded by the Ministry of Health and Long-Term Care and administered through sponsoring agencies (hospitals, mental health facilities, and "other" community-based organizations). This article reports on the results of a survey of ACT programs and investigates the relationship between sponsoring agency type and ACT program operations. Findings and implications for policy makers and administrators are discussed.
This article examines the differences found between clientele with severe mental health problems and their key health workers in terms of assessing service users' needs in 6 Quebec service areas.
We questioned 165 pairs of users and staff, using the Camberwell Assessment of Needs questionnaire. The profile of serious and overall problems encountered by clientele from each of the sites was compared.
The sites with the greatest degree of user-staff agreement in identifying problems were also the ones where users considered that local services best met their needs.
The study demonstrated that, in needs assessment, major differences exist between the perceptions of users and their key workers in the various sites. These differences can be explained in part by users' individual characteristics, by types of needs, by local particularities, and by service use.
Using chart-review procedures, the authors examined the management of patients with a recognized alcohol problem in 12 medical facilities and 20 alcoholism programs throughout Alaska. The evaluation, which covered a one-year period, focused on the service delivery system rather than on treatment outcome, and sought to determine if problems of alcohol abuse were being solved. The authors found that a treatment plan was developed, followed up, and evaluated for 8 per cent of the problem drinkers treated in medical facilities and for 16.7 per cent of those in alcohol programs.
A new approach to assessment of quality of psychiatric hospital care is proposed. It is based on comparison of goals of hospitalisation and results achieved. The necessary condition for such assessment is formulation of these goals for each patient. Three components should be considered: clinical which coincides with the prognosis; social which includes achievement of the patient adaptation and psychological which assesses patient's satisfaction with the treatment. The preliminary results of practical use of the proposed method are presented.
General practitioners' evaluation of Community Mental Health Centres (CMHC) has become a part of the Norwegian system of quality indicators. On the basis of a national survey, we present the way in which GPs have assessed the quality of 77 CMHCs.
A questionnaire was posted to every GP in Norway from November 2005 to March 2006. This was followed up with 2-3 reminders and telephone interviews. 2,415 out of 3,704 GPs (65%) responded.
GPs gave highest score for professional competence, the average being 55 on a scale of 0-100, where 100 is best. They gave lowest score for counselling (30) and staff situation (45). The average score given to the various CMHCs varied a lot for all dimensions, the largest difference being for counselling, with the highest average 58 and the lowest 8. There were many significant differences between various CMHCs' scores and the national average. When it came to counselling, the average score for 20 CMHCs was significantly different from that for the other CMHCs.
As GPs are important collaborators and users of the CMHCs, their views are valuable. The present findings need to be discussed. Many of the community mental health centres received all in all positive feedback from the GPs, suggesting that they may have useful experiences to share.
Comment In: Tidsskr Nor Laegeforen. 2007 Jan 4;127(1):64-5; author reply 6517205097
The aim of the present study was to investigate the use and attitudes toward standardized assessment tools among clinicians in a public mental health service in Norway. A total of 606 clinicians provided feedback on their use and attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone using the Attitudes toward Standardized Assessment (ASA) Scales. Clinicians working in the adult mental health field scored significantly higher on use of diagnostic interviews, pre-post evaluations, and ongoing evaluations, whereas clinicians working in the child/adolescent mental health field scored significantly higher on use of screening instruments and held more positive attitudes towards using standardized assessment tools. Attitudes toward standardized assessment tools predicted use of such tools, and results were found to be similar to a study on US clinicians. Whereas the US study only found attitudes regarding the practicality of using such instrument as an independent predictor of assessment use, the current study found that attitudes regarding psychometric qualities of such tools, their practicality, and their benefit over clinical judgment alone were independent predictors of use.