CSAT GPRA Client Outcome Measures Tool. File 1: CSAT_GPRA Client Outcome Measures File 2: CSAT_GPRA Client Outcome. HIV Open Data Project: CSAT GPRA Client Outcome Measures for Performance and Results Act (GPRA) to report program outcomes as a. HIV Open Data Project: CSAT GPRA Client Outcome Measures for Discretionary Programs. United States Department Of Health And Human Services.
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The routine collection of drug treatment outcomes to manage quality of care, improve patient satisfaction, and allocate treatment resources is currently hampered by czat key difficulties: This pilot describes precise methods for an economical staff-based routine outcome monitoring ROM system using an item core measure telephone survey.
Standardized procedures for staff training, collecting client contact information, structuring exit interviews and maintaining post-treatment telephone contact produced follow-up rates that improved from Aggregate data was used to improve program delivery and thereby post-treatment substance use and social outcomes. These methods and use of data may contribute to the gra on how to best monitor outcomes.
While treatment efficacy can be hpra quantified using research-driven clinical trial methods under very strict and controlled research parameters, such stringent design requirements—and associated costs—are rarely practical for the typical community-based treatment program.
The goals of routine monitoring are straightforward: For this reason, decades of State and Federal legislation, funder initiatives and accrediting agency criteria include directives to monitor post-discharge program outcomes in addition to those that are obtained while the client is still at the facility.
The extent to which this is accomplished, however, is still less than desired. Discretionary grants include 10—20 percent ccsat for dedicated follow- up activities that are expected to attempt contact with percent of all discharged clients and, minimally, obtain data from 80 percent.
Some states have incorporated NOMs sets in the reporting required for licensing procedures, and fpra few states—California, Minnesota, Connecticut, Delaware, Illinois, and New York—are establishing permanent gpea outcomes monitoring systems. For example, in the California Treatment Outcome Project CalTOP implemented a center, staff-based pilot project with a sophisticated client-tracking database to collect client information at enrollment, 3-months and 9-months post enrollment.
Staff at participating sites randomly selected 20 percent of the 15, admissions for follow-up and produced valuable data regarding services received, outcomes and cost-effectiveness, as well as areas for quality improvement such as gora retention rates and poor matching of severity with type and intensity of services received.
The Minnesota Department of Human Services is required gprz statute to collect sufficient information to evaluate the efficiency and effectiveness of treatment for chemical dependency. Currently, treatment staff submit ggpra data at three points in time: Although the original DAANES design included a 6-month outcomes measure of the percentage of patients who remained abstinent, attempts to obtain this grpa data were hampered by non-compliance and it is not collected at this time.
Insurers can use follow-up data to assess and recommend guidelines for appropriate care. Kaiser Permanente, in a study by Chi et al, determined that a continuing care model yearly primary care visits with specialty referrals as needed improved abstinence or non-problematic use rates and resulted in health plan cost savings. Accrediting agencies have also placed greater attention on outcomes and other quality standards that are aimed at continual quality improvement.
Dsat monitoring also has application in the corporate tpra, as a tool that Fortune companies with large Employee Assistance Program EAP vendors eg, Caterpillar, Archer Daniels Midland, and ConocoPhillips can use for selecting treatment and prevention programs. The Workplace Outcomes Suite WOS can detect statistically significant changes in absenteeism, presenteeism, work engagement, life satisfaction, and workplace distress over day follow-up cswt, and with sample sizes as small as 50 clients.
Where client groups are heterogeneous and treatments are non-protocol driven, such as those found in many out-sourced or external EAPs, a facility-driven routine outcome monitoring effort could return useful data to the EAP. The systematic tracking of clients after they have completed a full course of intervention, when they are operating under minimal supervision as a member of their family, workforce and community, is one of the most convincing methods for demonstrating real-world effectiveness of behavioral health programs.
Despite stated aims to gather meaningful post-discharge data, most performance-monitoring efforts are still in development stages. Limitations to data collection include: A practical way to include quantitative follow-up methods may be attainable within the infrastructure of the growing continuing caat model.
Research at Chestnut Health Systems shows that while telephone follow-up solely for organizational feedback does not appear to improve post-treatment outcomes, 15 15—20 minute telephone-based post-treatment counseling support can be an effective form of step-down treatment that increases engagement and sobriety while lowering relapse rates.
This paper describes a streamlined, telephone-based routine outcome monitoring process conducted within a continuing care gprw. This system is designed to provide meaningful data regarding treatment success that can be used for quality management purposes by a treatment facility. Utilizing a short outcomes survey with scales that focus on core treatment indicators, it is sufficiently simple to fit within the routines of staff at smaller facilities.
Feasible for use by individuals who have not been trained in research methods, this system provides timely feedback to clinicians who may need to intervene with individual cases and, with certain limitations, can contribute to larger, aggregate pools of data used by those involved in basic research, treatment policy and funding decisions.
The purpose of this study was to evaluate the efficacy of a post-treatment Routine Outcome Monitoring ROM system as a tool for measuring, and improving, results from drug rehabilitation services. Although CSAT gpta other performance efforts require contact with all clients regardless of discharge reason, this first phase of developing a quality assurance system was gpga only to cst who completed the residential treatment plan.
A Simplified Method for Routine Outcome Monitoring after Drug Abuse Treatment
Narconon International and Psychometric Technologies Incorporated collaborated to develop a scientifically grounded methodology that would result in data that would be useful to treatment providers. The project included construction of a short, psychometrically-validated assessment of drug abuse treatment outcomes, and it built on enrollment, case management and client follow-up systems that were already in place at Narconon. The international Narconon network includes nearly facilities and makes use grpa secular materials developed by the philosopher and humanitarian, L.
The complete Narconon rehabilitation program involves ten distinct therapeutic modalities: Key aspects of the Narconon Drug Rehabilitation program were advantageous to developing the follow-up methodology and questionnaire:.
The follow-up assessment program was implemented as part of normal operation, and a system was developed to report findings back to the participating treatment center for quality management purposes. Congruent with a behavioral and social skills approach to rehabilitation, aftercare staff provide support for any sub-clinical problems or difficulties which, if left unchecked, might ultimately result in drug reversion.
Should drug reversion occur, aftercare staff can help make arrangements for the client to re-enter treatment.
Approximately one week before program completion and final discharge, a trained staff member who is not involved in treatment helps the client formulate an individualized community re-entry plan following a standardized outline. The re-entry plan is developed by: Staff and client keep signed copies of the plan, which includes follow-up telephone calls at these intervals: During each follow-up call the specialist discusses progress or obstacles regarding each of the goals defined in the discharge plan.
Changes are made in the plan if necessary. Key data and any recommendations are recorded in the client records. If the individual does not move successfully into his new life, the Aftercare specialist will help the client work out how to apply the relevant skills by referring to program manuals that the client used while at Narconon and now has at home as reference materials.
If the situation is severe enough to warrant it, the staff member will encourage the graduate to return to the Narconon center so that the difficulties can be reviewed, addressed in depth, and corrected.
It should be noted that this also triggers a management review to identify possible flaws in the delivery and supervision of specific modules of the program.
At the start of this project, Community Reintegration follow-up was hampered by difficulty contacting clients. To more easily maintain contact with clients once they leave the facility, the project implemented a client tracking system to include:. For systematic and quantitative measurements, clients were contacted to complete the Routine Outcome-Monitoring ROM questionnaire within one month of the six-month anniversary of Narconon program completion.
Key steps for obtaining meaningful outcomes included:. Completed survey forms, coded only by an internal tracking number, were submitted to a statistical analysis group for scanned data entry and analysis. A quarterly report returned to the facility provided interpretation of the aggregate findings. The outcome questionnaire, presented in Figure 1was developed by isolating core questions from the item GPRA CSAT treatment outcome module 5 and including those that addressed key recovery goals additional to cessation of substance use: Ten items were thought to obtain clinically relevant information during a short telephone interaction.
During the project, Aftercare and Case Management staff provided valuable feedback regarding survey length and important clinical questions. Items were added to address lastday drug-related emotional status and lastday health status, as these important problem areas do not necessarily track with changed misuse of substances. The final survey consists of six items directed at self-reported drug and alcohol use in the past 30 days, two items directed at general drug use since leaving treatment, five items directed at quality of life issues in the past 30 days, one item inquiring about use of other treatment services, three items inquiring about living conditions and one item inquiring about general health status.
Finally, the instrument includes three qualitative interview questions that obtain clinically relevant information. Twice each project year between andnon-clinical staff compiled a list of all individuals for whom the current month marked the six-month anniversary of their discharge. This compilation excluded program graduates who elected to remain on location to participate in post-treatment staff training.
The list was given to the Aftercare specialist team, who completed the ROM surveys by telephone interview within two weeks. Any incomplete surveys were marked as missing data. During the first three sampling periods, —5, telephone contact was attempted for both the graduate and their closest relative, for purposes of verifying the graduate csag and evaluating the viability of relying on family member reports. After the third sample period, collateral correlation was analyzed see results section and it was determined that the graduate data ypra reliable.
Following this test, data was obtained from gra graduate only, or by surveying a relative or close associate only if the graduate was not available after three contact attempts.
Staff also noted those cases where collaterals did not have recent contact with program clients; data was not acquired if the collateral could not give a cwat report and the case was categorized as missing data.
Observing Federal and local confidentiality rules, de-identified data coded only by a site-assigned, unique identification number was sent to Psychometrics Technologies Incorporated for entry into an Excel spreadsheet.
A Simplified Method for Routine Outcome Monitoring after Drug Abuse Treatment
All data was then imported into SPSS for further analysis. Three elements of feasibility are examined: Treatment center and staff feedback is also described. A total of subjects were identified who completed the program and returned to their uncontrolled, natural environment. Table 1 presents the means and standard deviations of the ASI scores at intake for all subjects as well as ASI means based on source of follow-up data.
The Narconon treatment group appears to be generally consistent with clients seen in private residential treatment settings. Relatively low scores on Medical and Psychological subscales likely reflect the fact that clients or their families are attempting to address abuse-related problems before they have become debilitating, chronic conditions. There were no statistical differences in baseline ASI characteristics when analyzed by source of outcomes data: Initial addiction severity score differences does not associate with unavailability for follow-up interview.
Data was obtained from of the subjects who returned to their community; leaving The first sampling point had an inadequate follow-up rate. By reviewing the successful actions of Desmond et al, 31 improvements were made as follows: Fpra a result of these improvements, post-treatment contact rate consistently bpra to upwards of 80 percent.
Follow-up rates and respondent mix for each sampling point are presented in Table 2. Staff turnover had some influence on follow-up rates. There were new Aftercare staff in second quarter and first quarter ; in first quarter and first quarter there was only one Aftercare staff person. Construct validity is tested by the extent to which similar, yet distinct, measures of treatment effectiveness give consistent answers.
Although not all patients are expected to show positive outcomes on all measures, there should be a fair degree of association between measures—that is, there should be a general pattern or movement in a direction that reflects the success or lack of success of the drug abuse treatment.
Such positive correlations are evidence of construct validity. Table 3 presents the bivariate correlations between thirteen measures.
Although the intercorrelations are not particularly large, there is sufficient commonality among the responses to support the inclusion of each variable in a broad measure of drug abuse-related quality of life.
Taken together, the results presented in Table 3 support the validity of the data collected by staff over the telephone at the six-month follow-up. As the questionnaire uses mostly single-item measures, attempting to define latent constructs from these items was deemed risky both because they are very disparate and because they were not designed to measure an underlying structure. The authors contend that factor analysis of latent variable analysis without a prior structures procedure would be inappropriate.
To verify self-reported measures of drug abuse, the first three sampling periods included data collected by both self-report and collateral family reports.
HIV Open Data Project: CSAT GPRA Client Outcome Measures for Discretionary Programs
Csaf 91 pairs of self and collateral reports were available for the 10 sets of drug-related problems included in the original survey. Due to the fact that the six-point Likert format is not considered an interval-scale of measurement, we used the Spearman rank-order correlations in our analysis of the validation data.
Table 4 presents the Spearman rank correlation coefficients r and significance levels p for these ten variables.