Outcome evaluation and service user involvement

Here are references relating to different types of therapeutic interventions we can offer and different types of mental health issues, developmental disorders and other presenting problems.
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miriam
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Outcome evaluation and service user involvement

Post by miriam »

Thinking about effectiveness of interventions is key in the NHS at the moment, and something I'd recommend to read up about before interviews. The key text in this area is "What Works for Whom?" by Fonagy and Roth which explores the evidence base for different treatment methods. Also Principles for Best Practice in Clinical Audit

In my mind the key question for "is this effective treatment?" is "does this treatment significantly increase positive outcomes for this person?" By that I mean, that any treatment that can be proved consistently more effective than doing nothing (which includes natural remission and chance effects). Then the treatment needs to be shown as equivalently or more effective than alternative treatments for the same condition (eg CBT vs drugs). It is only if two alternative treatments are similarly successful that cost/patient preference/availability etc become significant factors (eg if ADHD responds similarly to Ritalin and to behavioural intervention then the drug may be cheaper and some families may opt for one treatment over the other).

It is not possible to measure treatment success in any absolute way (it worked vs it didn't work). After all, it may be that even a small change can make a big difference to someone's life - for example if they are suicidal and your intervention stops the most serious/risky self-harm but the patient is still depressed that in my eyes would still be a significant success.

So, for example, in OCD (and this is off the top of my head, so don't quote these figures without checking them) it might be that 3/4 of people who are referred would continue to show symptoms without treatment, of which half would have constant symptoms that restricted their life. With CBT manualised treatment approaches maybe a third of people have no symptoms after treatment, a third have mild symptoms on and off that don't interfere much with their life and a third have more significant symptoms and may need booster sessions or medication to ensure they don't restrict quality of life. Now to me that means that most people end up with less symptoms and more quality of life, even though the percentage of people "cured" is quite low...

Our service uses SDQ, CGAS, and the CHI to get user satisfaction data. I don't know anything about how regularly the first two are used (as I don't often see people from first appointment to last, as I do a lot of indirect work and assessment and not that much therapy at the moment) but I've sent out an adapted CHI to audit user satisfaction with one of the clinics I do and quite liked it. I added some more specific and qualitative questions at the end. An AP and I also evaluated satisfaction with a consultation service I offered to one of the local social work teams (its published in Clinical Psychology). I'm also part of a working group to look at outcome measures with LAC, and in a previous post I was HONOSCA trained

There is a strong drive at the moment to increase user involvement, and to justify effectiveness. The difficulty for me is in whether it is a token gesture, or whether it actually benefits clinicians or service users. I mean, even if every survey said that parking at the hospital is a problem, or that they wanted a shorter wait or an out of hours service, is there anything we could actually do about it? And what happens if users are not satisfied, or don't make significant measureable improvement?

Kari added: SDQ, CGAS and CHI are used widely in CAMHS services as they are part of the standard questionnaires used in CORC (CAMHS Oucome Research Consortium- see http://www.corc.uk.net/index.php for more info). The service I work in also uses the PIP and PedsQL as we are a paediatric service. We have been collecting this data for quite a few years now and we are only now begining to analyse this data- I will be presenting some of the results at a Paeds conference later this year.

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Last edited by miriam on Sun Jul 15, 2007 3:57 pm, edited 3 times in total.
Miriam

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