Assessment of Client Functioning in Residential Settings

Abstract

Residential treatment settings for the chronically mentally ill, including mental hospitals, mental health centers, and community residential facilities, provide 24-hour care and treatment. Although this restriction of the clients’ freedom allows comprehensive and intensive treatment commensurate with the severity of the clients’ disability, it also requires, on both humanitarian and economic grounds, research to increase our understanding of the disorders and our knowledge of effective treatment. Residential treatment requires more complex organization and entails greater risks of abusing the legal and ethical rights of both clients and staff than do outpatient treatment programs. To assure that the multitude of decisions made every day in residential settings for the chronically mentally ill reflect these clinical, managerial, legal/ethical, and scientific considerations, accurate information based on objective and reliable assessment is required. Following the logic and terminology of Mariotto and Paul’s (this volume) detailed description of these decisions, the information required to make the decisions, and the criteria for evaluating procedures for obtaining that information (i.e., the “four R’s”), this chapter will summarize the assessment approaches typically used to obtain one informational domain, that of client functioning. I shall also describe a new, cost-efficient assessment technology designed to provide replicable and representative information on client functioning relevant to the broad range of decisions required in residential settings for the chronically mentally ill.