Needs-based planning: Evaluation of a level-of-care planning model

Durbin, Janet; Cochrane, Jeanette; Goering, Paula; Macfarlane, Dianne

doi:10.1007/bf02287235

Cited by 40 publications

(37 citation statements)

References 32 publications

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“…Ratings are made across multiple domains including symptoms, problem areas, functioning, risk and strengths. It does not require extensive training, assessments are relatively brief, and there are high levels of inter-rater reliability when using trained raters to interview clinicians (Durbin et al, 2001). Findings have shown that the CCAR problem severity and functional status scales are valid indicators of mental health status and outcomes (and are correlated to scores from other assessment instruments including the Brief Psychiatric Rating Scale and Global Assessment of Functioning) (Coffman, Bloom, & Wallace, 2004).…”

Section: Introductionmentioning

confidence: 94%

“…In needs assessments across a specific population, knowledge about the demand for intensity and level of care needed provides important information to guide service planning and resource allocation. There are relatively few validated methods available of determining level-of-care needed by clients of mental health services (Durbin, Cochrane, Goering, & Macfarlane, 2001;Srebnik, Uehara, & Smukler, 1998;Uehara, Smukler & Newman, 1994). One tool for which there is a validated means of determining level-of-care within mental health is the Colorado Client Assessment Record (CCAR) (Durbin et al, 2001;Ellis, Wilson, & Foster, 1984).…”

Section: Introductionmentioning

confidence: 99%

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A Population-based Needs Assessment for Mental Health Services

Hanson

Houde

McDowell

et al. 2006

Adm Policy Ment Health

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A needs assessment was done to objectively evaluate client need and determine gaps between these needs and the services provided by mental health services. The services included were standard case management, assertive case management and residential care across the Fraser Health Region in British Columbia, Canada. Assessments involved collection of data on current symptoms, functioning, and service use and needs. Results showed many specific areas where client needs were under met. A level-of-care planning model was applied to the data and results suggest that a high percentage of clients may be in fact receiving too high or too low a level of care for their needs. This method of performing a population-based needs assessment provided findings that have proved useful for planning purposes in order to ensure that community mental health services better match client need.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

A Population-based Needs Assessment for Mental Health Services

Hanson

Houde

McDowell

et al. 2006

Adm Policy Ment Health

View full text Add to dashboard Cite

show abstract

“…Data from US and Ontario studies support the reliability and validity of the CCAR. [46][47][48] The research protocol was reviewed and approved by the institution review board of the Centre for Addiction and Mental Health in Toronto. Informed consent was not sought directly from current patients.…”

Section: Data Collection Protocol and Measuresmentioning

confidence: 99%

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Rush

Koegl

2008

Can J Psychiatry

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Objective: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.Method: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.Results: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm. Conclusion:The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems. Can J Psychiatry 2008;53(12):810-821Clinical Implications · Clinicians can use sociodemographic characteristics, such as male sex, younger age, and being unemployed, and clinical indicators, such as overall mental health severity and behavioural challenges, to help identify and support people with substance use disorders. · Treatment and support models for co-occurring mental and substance use disorders must include risk management strategies, given the higher prevalence of challenging behaviours within this population. · There is a need for system-wide planning regarding co-occurring mental and substance use disorders. Limitations· Although findings were based on a comprehensive mental health system, the results may not be applicable to every jurisdiction. · Study findings should not necessarily be generalized to acute care, consumer, or peer support programs because they were not included in our study. · Clinical diagnostic interviews were not feasible to validate study criteria for defining co-occurring disorders.

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“…available (e.g., Clifford, Charman, Webb, Craig, & Cowan, 1991;Durbin, Cochrane, Goering, & Macfarlane, 2001;Rothbard, Kuno, Schinnar, Hadley, & Turk, 1999;Seling & Johnson, 1990). As the number of state hospital beds has decreased over the past several decades, an array of residential programs have been developed with varying degrees of staffing support (Budson, 1990;Randolph, Ridgway, & Carling, 1991).…”

mentioning

confidence: 99%

A Service System Planning Model for Individuals With Serious Mental Illness

Kuno

Koizumi

Rothbard

et al. 2005

Ment Health Serv Res

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An institutional-based care system in mental health has been replaced by a network of communitybased services with different levels of structure and support. This poses both an opportunity and a challenge to provide appropriate and effective care to persons with serious mental illnesses. This paper describes a simulation-based approach for mental health system planning, focused on hospital and residential service components that can be used as a decision support tool. A key feature of this approach is the ability to represent the current service configuration of psychiatric care and the client flow pattern within that framework. The strength of the simulation model is to help mental health service managers and planners visualize the interconnected nature of client flow in their mental health system and understand possible impacts of changes in arrival rates, service times, and bed capacity on overall system performance. The planning model will assist state mental health agencies to respond to requirements of the Olmstead decision to ensure that individuals with serious mental illness receive care in the least restrictive setting. Future plans for refining the model and its application to other service systems is discussed. (e.g., Clifford, Charman, Webb, Craig, & Cowan, 1991;Durbin, Cochrane, Goering, & Macfarlane, 2001;Rothbard, Kuno, Schinnar, Hadley, & Turk, 1999;Seling & Johnson, 1990). As the number of state hospital beds has decreased over the past several decades, an array of residential programs have been developed with varying degrees of staffing support (Budson, 1990;Randolph, Ridgway, & Carling, 1991). Additionally, assertive community treatment teams (ACT), intensive case management (ICM), as well as psychosocial rehabilitation programs, have become increasingly available for people with serious mental illness. The importance of implementing community-based services has been further highlighted by the recent Supreme Court decision in Olmstead v. L.C., 119 S. Ct. 2176Ct. (1999, which affirmed that unnecessary institutionalization of individuals with disabilities is discrimination under the Americans with Disabilities Act (ADA). States are now required to have a comprehensive, effective working plan to establish compliance with the ADA (Fox-Grage, Folkemer, & Lewis, 2003). HHS Public AccessIn this era of advanced deinstitutionalization, mental health administrators and planners are faced with the challenge of providing an appropriate and effective mix of residential, ambulatory treatment and support services for persons with serious mental illness. This requires the ability to estimate demand for different levels of care given that severity of illness and accompanying social and instrumental disabilities vary across individuals and change over an individual's lifetime (Group for the Advancement of Psychiatry, 1992;Herman & Mowbray, 1991;Tessler, Bernstein, Rosen, & Goldman, 1982). Shifting away from an institutional-based care system has been a significant step toward implementing an opt...

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Needs-based planning: Evaluation of a level-of-care planning model

Cited by 40 publications

References 32 publications

A Population-based Needs Assessment for Mental Health Services

A Population-based Needs Assessment for Mental Health Services

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

A Service System Planning Model for Individuals With Serious Mental Illness

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