The Connecticut Mental Health Center Patient Profile
Project: application of a service needs index
Matthew J. Chinman
Associate Behavioral Scientist, Rand, Santa Monica, California, USA
Janis Symanski-Tondora
Clinicians, Connecticut Mental Health Center, New Haven, Connecticut, USA
Avon Johnson
Clinicians, Connecticut Mental Health Center, New Haven, Connecticut, USA
Larry Davidson
Associate Professor, Department of Psychiatry, Yale University School of
Medicine, New Haven, Connecticut, USA
Introduction
Research and evaluation commonly occur at
the conclusion of program planning and
implementation within mental health care
systems (Armstrong et al., 1992). However,
they also can be critical components during
an initial stage of planning when a system
aims to conceptualize and implement those
programs that will best meet the needs of the
patients served. An essential starting point
in this process is to understand exactly
who these patients are, what their lives are
like, and how their lives may be improved.
It is imperative that the characteristics
and the needs of the target population be
clearly defined as a prerequisite to the
development of new programs and policies
in mental health (Rosenblatt, 1998;
Rosenblatt et al., 1998) and in other fields as
well (e.g. Wandersman et al., 2000). This
article presents the ``Patient Profile Project''
of the Connecticut Mental Health Center
(CMHC) as an illustration of the use of
research and evaluation to inform both
administrative decisions and clinical
program development.
Background
The CMHC, a collaborative endeavor of the
State of Connecticut's Department of Mental
Health and Addiction Services and the
Department of Psychiatry at the Yale
University School of Medicine, serves nearly
2,400 patients with serious psychiatric
disorders and little or no income across 16
programs, in five buildings set in several
different locations throughout the city of
New Haven, Connecticut. In addition to
providing a comprehensive array of
inpatient, partial hospital, intensive
outpatient, assertive community treatment,
homeless outreach, specialty Hispanic, and
conventional outpatient clinical and case
management services, the CMHC serves as
the area's Local Mental Health Authority,
managing an integrated community-based
network consisting of residential,
psychosocial, and vocational rehabilitative
services.
Given the size and diversity of the CMHC,
it has been difficult to characterize its
population and that population's level of
service needs accurately. Clinicians
providing direct care to patients voiced
concerns that the administration lacked a
clear picture of the degree of need among
their patients, particularly among certain
sub-groups such as individuals dually-
diagnosed with psychiatric and substance
use disorders. They maintained that this
degree of need warranted both the
development of innovative clinical programs
as well as a redistribution of caseloads to
reflect patient acuity.
These concerns were brought before the
Patient Care Committee, an organizational
group that includes representation from all
levels within the CMHC, including senior
management, clinicians, information
management specialists, and mental health
clients. As a starting point to address these
concerns, the committee recognized the
integral role of a center-wide effort to define
systematically the characteristics and acuity
level of the entire patient population. They
made it a top priority to design a
comprehensive, yet easy to use ``patient
profile'' measure that would be completed by
clinicians for every individual served by the
CMHC. By answering the question ``who are
our patients?'', the profile would provide data
necessary to inform management decisions
regarding both clinical caseloads and service
development.
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[29]
International Journal of Health
Care Quality Assurance
15/1 [
2002
] 29±39
# MCB UP Limited
[
ISSN 0952-6862
]
[
DOI 10.1108/09526860210415597
]
Keywords
Mental health, Evaluation,
Service, Quality assurance
Abstract
This article describes a quality
assurance effort aimed at defining
the characteristics of the patient
population of the Connecticut
Mental Health Center, a state-
funded agency that provides
comprehensive clinical and
rehabilitative services to persons
with mental illness. Also described
is how this information guided
management decisions in both
caseload distribution and clinical
service development. This
``Patient Profile Project'' was
informed by research principles
which view evaluation as
continual, rather than terminal
activity that involves key
stakeholders from all levels within
the mental health system of care
and makes maximum use of data
in ongoing performance
improvement initiatives. The
service-need index that the
project produced represents our
first efforts to accurately capture
service need and use it in clinical
decision making. This review of
the Connecticut Mental Health
Center Patient Profile Project
illustrates the utility of a
continuous evaluation system in
promoting improvements in a large
mental health treatment system.