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Statistical and Consensus-Based Strategies for Grouping Consumers in Mental Health Level-of-Care Schemes

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Abstract

Mental health Level-of-Care schemes differ in the emphasis placed on statistically based versus consensus-based strategies for delineating consumer groups. Statistical strategies define groups on the basis of empirical distinctions within the caseload. Consensus strategies group consumers according to an a priori framework of consumer characteristics determined by experts to differentiate the appropriate types and intensities of service. This article compares the performance of two grouping strategies—one statistical and one consensus—on three criteria: programmatic relevance, measurement adequacy, and homogeneity of consumer groups. It explores the advantages of integrating elements of each strategy.

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REFERENCES

  • American Psychiatric Association. (1994a). Practice guideline for the treatment of patients with bipolar disorder. American Journal of Psychiatry, 151(12 Suppl.), 1-36.

    Google Scholar 

  • American Psychiatric Association. (1994b). Diagnostic and statistical manual of mental disorders (4th ed.) (DSM-IV). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1997). Practice guideline for the treatment of patients with schizophrenia. American Journal of Psychiatry, 154(4 Suppl.), 1-63.

    Google Scholar 

  • Assessing mental health treatment outcome measurement techniques. Department of Health and Human Services Publication No. (ADM) 86-1301. Washington, DC: U.S. Government Printing Office.

  • Barker, S., Barron, N., & McFarland, B. (1994). A community ability scale for chronically mentally ill consumers: II. Applications. Community Mental Health Journal, 30, 459-472.

    Google Scholar 

  • Bartko, J.J. (1991). Measurement and reliability: Statistical thinking considerations. Schizophrenia Bulletin, 17, 483-489.

    Google Scholar 

  • Bartsch, D., Shern, D., Coen, A., & Wilson, N. (1995). Service needs, receipt, and outcomes for types of clients with serious and persistent mental illness. The Journal of Mental Health Administration, 22(4), 388-402.

    Google Scholar 

  • Braucht, G.N., & Kirby, M.W. (1986). An empirical typology of the chronically mentally ill. Community Mental Health Journal, 22, 3-20.

    Google Scholar 

  • Community Psychiatric Clinic. (1992). Problem severity summary scales: Preliminary report on reliability, validity and appropriateness for special populations. Seattle, WA: Managed Care Services.

    Google Scholar 

  • Crismon, ML., Trivedi, M., Pigott, T.A., Rush, A.J., Hirschfeld, R.M, Hakn, D.A., DeBattista, C., Nelson, C., Nierenberg, A.A., Sackeim, H., & Thase, M.E. (1999). The Texas Medication Algorithm Project: Report of the Texas Consensus Conference Panel on medication treatment of major depressive disorder. Journal of Clinical Psychiatry, 60(3), 142-156.

    Google Scholar 

  • DeLiberty, R., Newman, F., & Ward, E. (1999, October). Risk adjustment in the Hoosier Assurance Plan: Impact on providers. Presented at the Southern Regional Conference on Mental Health Statistics.

  • Eisen, S., Dill, D., & Grob, M. (1994). Reliability and validity of a brief patient-report instrument for psychiatric outcome and evaluation. Hospital and Community Psychiatry, 45, 242-247.

    Google Scholar 

  • Ellis, R.H., Wackwitz, J.H., & Foster, M. (1991). Uses of an empirically derived client typology based on level of functioning: Twelve years of the CCAR. Journal of Mental Health Administration. 18(2), 88-100.

    Google Scholar 

  • Ettner, S.L., Frank, R.G., McGuire, T.G., Newhouse, J. P., & Notman, E.H. (1997, October). Risk adjustment of mental health and substance abuse payments. Paper presented at the Annual Meeting of the American Public Health Association, New York, NY.

  • Garcia-Peltoniemi, R.E. (1990). Epidemiological perspectives. In National Institute of Mental Health, mental health services for refugees (pp. 24-41). Department of Health and Human Services Publication No. (ADM) 91-1824. Washington, DC: U.S. Government Printing Office.

    Google Scholar 

  • Glazer, W., & Gray, G. (1996). Psychometric properties of a decision-support tool for the era of managed care. The Journal of Mental Health Administration, 23(2), 226-233.

    Google Scholar 

  • Goldman, H.H., Pincus, H.A., Taube, C.A., & Regier, D.A. (1984). Prospective payment for psychiatric hospitalization: Questions and issues. Hospital and Community Psychiatry, 35, 460-464.

    Google Scholar 

  • Herman, S.E., & Mowbray, C.T. (1991). Client typology based on functioning level assessments: Utility for service planning and monitoring. Journal of Mental Health Administration. 18(2), 101-115.

    Google Scholar 

  • Holohean, E., Banks, S., & Maddy, B. (1995). System impact and methodological issues in the development of an empirical typology of psychiatric hospital residents. The Journal of Mental Health Administration, 22(2), 177-188.

    Google Scholar 

  • Hughes, D., Seidman, E., & Williams, N. ( 1993 ). Cultural phenomena and the research enterprise: Toward a culturally anchored methodology. American Journal of Community Psychology, 21(6), 687-704.

    Google Scholar 

  • Hui, H., & Triandis, H.C. ( 1989 ). Effects of culture and response format on extreme response style. Journal of Cross-Cultural Psychology, 20(3), 296-309.

    Google Scholar 

  • Kazarian, S., Joseph, L., & McCabe, S. (1996). A brief method of assessing adult inpatients' level of need for community support systems. Psychiatric Services, 47(6), 654-656.

    Google Scholar 

  • Leff, H.S., Graves, S., Natkins, J., & Bryan, J. (1985). A system for allocating mental health resources. Administration in Mental Health, 13, 43-68.

    Google Scholar 

  • Leff, H.S., Mulkern, V.M., Lieberman, M., & Raab, B. (1994). The effects of capitation on service access, adequacy, and appropriateness. Administration and Policy in Mental Health, 21, 141-160.

    Google Scholar 

  • Lehman, A., Steinwachs, D., and the co-investigators of the PORT project. (1998). At issue: Translating research into practice: The schizophrenia patient outcomes research team (PORT) treatment recommendations. Schizophrenia Bulletin, 24(1), 1-10.

    Google Scholar 

  • Milner, K.K., & Valenstien, M. (2002). A comparison of guidelines for the treatment of schizophrenia. Psychiatric Services, 53(7), 888-890.

    Google Scholar 

  • Minsky, S., & Kamis-Gould, E. (1991, April). Classification of persons with severe and/or persistent mental disorders: The New Jersey experience. Paper presented at the meeting of the Northeastern Mental Health Systems Improvement Project. New York, N.Y.

  • Newman, F.L., Ciarlo, J.A., & Carpenter, D. (1999). Guidelines for selecting psychological instruments for treatment planning and outcome assessment. M.E. Mariush (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 153-170). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  • Newman, F.L, Griffin, B.P., Black, R.W., & Page, S.E. (1989). Linking level of care to level of need: Assessing the need for mental health care for nursing home residents. American Psychologist, 44, 1315-1324.

    Google Scholar 

  • Newman, F.L., Tippett, M.L., & Johnson, D.A. (1992, November). A screening instrument for consumer placement in level of CSP: Psychometric characteristics. Paper presented at the meeting of the American Evaluation Association. Seattle, WA.

  • Pandiani, J.A., Gordon, L.R., Wilson, S.F., & Carling, P.J. (1983). Statistical properties of the Vermont alternative care assessment: A technical report to the Vermont Department of Health. Vermont: Department of Health.

    Google Scholar 

  • Rush, A.J., Trivedi, M., Shriger, D., & Petty, F. (1992). The development of clinical practice guidelines for the diagnosis and treatment of depression. Special section: Developing guidelines for treating depressive disorders in the primary care setting. General Hospital Psychiatry, 14, 230-236.

    Google Scholar 

  • Sanderson, W. (1998). The case for evidence-based psychotherapy treatment guidelines. American Journal of Psychotherapy, 52(3), 382-387.

    Google Scholar 

  • Schneider, C., & Struening, E.L. (1983). SLOF: A behavioral rating scale for assessing the mentally ill. Social Work Research and Abstracts, 19, 9-21.

    Google Scholar 

  • Sciacca, K. (1991, Summer). An integrated treatment approach for severely mentally ill individuals with substance disorders. New Directions for Mental Health Services, 50, 69-85.

    Google Scholar 

  • Seed, P. & Kaye, G. (1994). Handbook for assessing and managing care in the community. London: Jessica Kingsley.

    Google Scholar 

  • Shrout, P.I., & Fleiss, J.L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological Bulletin, 86, 420-427.

    Google Scholar 

  • Smith, M.E., & Loftus-Rueckheim, P. (1993). Service utilization patterns as determinants of capitation rates. Hospital and Community Psychiatry, 44, 49-53.

    Google Scholar 

  • Smith, T., & Docherty, J. (1998). Standards of care and clinical algorithms for treatment schizophrenia. The psychiatric clinics of North America, 21(1), 203-220.

    Google Scholar 

  • Smith, T.E., & Docherty, J.P. (1998). Standards of care and clinical algorithms for treating schizophrenia. Psychiatric Clinics of North America, 21(1), 203-220.

    Google Scholar 

  • Smukler, M., Sherman, P., Srebnik, D., & Uehara, E.S. (1996). Developing local service standards for managed mental health services. Administration and Policy in Mental Health, 24(2), 101-116.

    Google Scholar 

  • Sowers, W., George, C., & Thompson, K. (1999). Level of care utilization system for psychiatric and addiction services (LOCUS): A preliminary assessment of reliability and validity. Community Mental Health Journal, 35(6), 545-563.

    Google Scholar 

  • Spector, P.E. (1992). Summated rating scale construction: An introduction. Newbury Park, CA: Sage.

    Google Scholar 

  • Srebnik, D., Uehara, E.S., & Smukler, M. (1998). Field test of a tool for level of care decisions in community mental health. Psychiatric Services, 49, 91-97.

    Google Scholar 

  • Srebnik, D., Uehara, E.S., Smukler, M., Russo, J.E., Comtois, K.A., & Snowdon, M. (2002). Psychometric properties and utility of the problem severity summary for adults with serious mental illness. Psychiatric Services, 53, 1010-1017.

    Google Scholar 

  • Uehara, E.S., Smukler, M., & Newman, F.E. (1994). Linking resource use to consumer level of need in a local mental health system: Field test of the LONCA case mix method. The Journal of Consulting and Clinical Psychology, 62, 695-709.

    Google Scholar 

  • Weed, L.L. (1991). Knowledge coupling: New premises and new tools for medical care and education. New York: Springer-Verlag.

    Google Scholar 

  • Westermeyer, J., Vang, T.F., & Neider, J. (1983). Refugees who do and do not seek psychiatric care: An analysis of pre-migratory and post-migratory characteristics. The Journal of Nervous and Mental Disease, 171, 86-91.

    Google Scholar 

  • Wood, W., & Beardmore, D.F. (1986). Prospective payment for outpatient mental health services: Evaluation of diagnosis-related groups. Community Mental Health Journal, 22, 286-291.

    Google Scholar 

  • Zarin, D., Seigle, L., Pincus, H., & McIntyre, J. (1997). Evidence-based practice guidelines. Psychopharmacology Bulletin, 33(4), 641-646.

    Google Scholar 

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Uehara, E.S., Srebnik, D. & Smukler, M. Statistical and Consensus-Based Strategies for Grouping Consumers in Mental Health Level-of-Care Schemes. Adm Policy Ment Health 30, 287–306 (2003). https://doi.org/10.1023/A:1024080532651

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