CASIG: a consumer-centered assessment for planning individualized treatment and evaluating program outcomes.

This paper reports the psychometric characteristics of a measure that assesses the treatment outcomes of individuals with serious and persistent mental illness. Unlike other outcome measures, this one is designed to be embedded in the clinical process of planning and evaluating treatment. It collects individualized data, structures how the data are used to plan and evaluate a client's treatment, and produces aggregate information relevant for research and program purposes. Two parallel versions were developed: one for the client's self-report, and one for an informant's report. The self-report measure was administered by peer-interviewers to 244 community interviewees, and by inpatient peer-interviewers to 93 inpatient interviewees. The community interviewees also completed the BASIS-32 and SF-36. Informants for 103 of the community interviewees completed the informant version of the measure, and the CCAR. Inpatient staff completed the informant version for 161 inpatient residents without regard for matching the 93 inpatient interviewees. The two versions had acceptable internal consistency, test--retest, and interrater reliabilities. Correlations of the community interviewees' and informants' results with the BASIS-32, SF-36, and CCAR provided evidence of convergent and discriminant validity, as did contrasts between community and inpatients interviewees. The usefulness of the instrument for clinical, program and research purposes is discussed, with emphasis on the characteristics that enhance its value in clinical practice --- assessment of meaningful outcomes, operationalization of client empowerment, comprehensiveness, easy administration, and continuity across time and provider. Also discussed is a computer-based program to summarize and present the results in a rapid, clinically meaningful manner.

Informed consent: assessment of comprehension.

OBJECTIVE: The authors designed and evaluated a structured and rigorous informed consent procedure involving subjects with schizophrenia. METHOD: Informed consent forms were read and explained to 49 schizophrenic patients participating in ongoing clinical treatment research trials. The subjects answered a questionnaire relating to each research protocol. Protocol procedures were reiterated until the patients answered 100% of the questions correctly. Subjects were asked the same questions 7 days later to ascertain how much of the information they had retained. RESULTS: The patients' median score on the first trial of the informed consent questionnaire was 80% correct. To achieve 100% correct responses, 53% of the patients required a second trial of the questionnaire, and 37% of them required three or more trials. Scores improved between the first trial and the trial on day 7. Ninety-six percent of the subjects felt adequately informed, 66% reported participating in the research protocol for personal reasons, and 34% reported participating at the suggestion of others. CONCLUSIONS: These findings demonstrate that when adequate informed consent procedures are established, schizophrenic research subjects are able to understand and retain critical components of informed consent information.

Psychosocial treatments for schizophrenia.

Based upon educational and social learning principles, social skills training and family management modalities have been validated as effective in improving coping skills and symptomatic course and outcome of schizophrenia. Combined with judicious doses of antipsychotic medication, these modalities have been designed from the conceptualization of schizophrenia as a stress-related, biomedical disorder, with those afflicted having enduring vulnerability to the emergence or exacerbation of psychotic symptoms with associated social disability. Behaviorally oriented modalities require integration with a comprehensive psychiatric service delivery system to confer protection against relapse.

Behavioral family management for serious psychiatric illness.

A description of the various elements that characterize a behavioral family management approach is presented in this chapter. The goal is to teach techniques to families for reducing the stress that their vulnerable relative might face.

Evaluating the capacity to work of the mentally ill.

This study explored the relationship between psychiatric symptomatology and the functional capacity to work. Subjects were diagnosed using DSM-III criteria and were grouped into categories of psychotic or nonpsychotic, and disabled or nondisabled, in regard to adjudication for mental impairment from the Social Security Administration (SSA). There were significant relationships between disability status and work capacity, in the direction of better performance for the nondisabled subjects. This finding reflected concordance between the evaluation procedure used in the study and the SSA's disability determination process. There was considerable overlap in work performance among subjects, however, suggesting that a functional assessment of work capacity might improve disability determination in certain cases. Results suggested that these work assessments might be as short as one or two days.

Assessment of social skills.

Deficiencies in social skills, important in the functional adjustment and rehabilitation of persons with schizophrenia, derive from inadequate learning experiences, disuse, anxiety, cognitive disturbances, and amotivational states. Social skills training programs should be specifically organized to compensate for these varied sources of deficiency in interpersonal competence. Assessment of social skills deficits can proceed along topographical, functional, and information-processing lines. Assessment technology is in its early stages of development and will require attention to the psychometric properties and multidimensional focus of evaluative instruments.