Outcome Assmt of People w/Dual Diagnosis

• Topics in Outcome Assessment by Ellen A. Dornelas, Ph.D., 9/24/96
  • Mental Health Services Research by Don Baker, Ph.D., 9/26/96
    
    

I share your interest in these topics. These are three areas where doing outcome evaluation is particularly difficult. I would like to only respond to one part of the suggestion for the moment and come back to the topics of assessment of children and crisis services. I'm hoping others out there will be doing some evaluation of these programs and can add to the discussion.

To the best of my knowledge, Anthony Lehman's Schizophrenia Patient Outcomes Research Team (PORT) is the largest of the NIMH studies in this area. I'm not going to refer to the literature however, since it is probably more productive to engage in discussion about what makes outcome evaluation of people with schizophrenia and a co-morbid substance abuse diagnosis so difficult. After 3 years of doing longitudinal outcome research in a psychiatric hospital setting, I would say that this is one of the most difficult groups to get post-discharge follow-up data on. In my experience, people who abuse substances tend to not respond to mailed questionnaires (surprise!) and often dually diagnosed individuals change residences and sometimes become homeless. In terms of practical thoughts, I think it helps to have as many telephone numbers for the individual as possible and a proxy respondant who could provide follow-up data. Like many other hospital's, we use the BASIS-32 as a core questionnaire for all patients, because this is helpful in comparing across heterogeneous groups. Examining the course of illness over an extended period of time seems particularly important for this group. Within the group there are subgroups (women, different ethnic groups, older folks) for whom there is just not much data available. Therefore, even without any additional intervention, I think the effort expended on just tracking and obtaining some basic data (even if it is from a proxy) is very worthwhile from a clinical perspective. If in fact these are the "revolving door patients" who utilize costly inpatient services and for whatever reason don't get any aftercare, then even third party payers would have to agree that it is important to put more effort into outcome evaluation.

This is a just a start. What are your specific thoughts on this group? Are others out there doing similar types of evaluations?

• Australian Dual Diagnosis project by Brian O'Neill, 10/14/96
• Outcomes: dual diagnosis clients by Elaine Kersten, 2/23/97