Adopting innovations--lessons learned from a peer-based hospital diversion program.

Moves to bridge the gap between research and practice have heightened interest in how service innovations are adopted. This paper reports on a peer-based hospital diversion program that provided short-term respite care, clinical monitoring, connection or re-connection to other mental health services, and peer support. The program was successful in providing services to the target population and was viewed as highly desirable by service recipients and clinical agencies. However, full adoption of this innovation was not realized and it closed barely a year after opening. Lessons learned from both the "life" and "death" of this program are offered.

Professional appraisal of professionally led and self-help groups.

A survey of almost 1,100 mental health professionals found they routinely viewed professionally led groups more positively than they did self-help groups on a number of dimensions. Analyses suggested that the curative factor associated with professionally led groups was valued over factors associated with self-help groups. The implications of the findings are discussed, and an alternative framework for professionals' evaluation of consumer-initiated interventions suggested.

Dose-effect relationship in children's psychotherapy services.

Concerns about session limits imposed by behavioral health care organizations (BHOs) have prompted an examination of the dose-effect relationship in psychotherapy. This study of the dose-effect relationship in child psychotherapy used multiple outcome measures and standardized data-collection points and addressed the confound between dose, effect, and initial severity. Data obtained from 567 outpatient children who participated in the Fort Bragg Evaluation Project were used. Probit and longitudinal growth curve analyses found no evidence of a general dose-effect relationship. Implications of these findings are discussed, especially the need for BHOs to justify use limits and suggestions for clinicians to justify use requests.

Rejoinder to Mordock's critique of the Fort Bragg Evaluation Project: the sample is generalizable and the outcomes are clear.

The Fort Bragg Evaluation Project (FBEP) showed that children in a well implemented and expensive continuum of care had no better clinical outcomes than those experiencing more traditional and fragmented services. In an article published in this journal that was critical of the evaluation, Mordock argued that the FBEP results be viewed with skepticism because of what he perceived to be methodological, design, measurement, and analytic failures of this study. We think it is important to respond to Mordock's critique since it contributes to the great reluctance to seriously consider the study's findings and their implications.

Clinical outcome, consumer satisfaction, and ad hoc ratings of improvement in children's mental health.

Mental health clinics and managed care organizations assess treatment effectiveness with consumer satisfaction measures and ad hoc measures of improvement obtained from a single informant; some of these measures are as simple as asking clients whether they improved during treatment. In the present correlational study of 199 treated adolescents, we used a multitrait-multimethod analysis to examine psychometrically measured pathology change (pre- and postassessment of symptoms and functioning), consumer satisfaction, and perceived improvement reported by multiple informants. Confirmatory factor-analytic results indicate that (a) outcome variance due to multiple informants cannot be ignored, (b) consumer satisfaction is unrelated to pathology change, and (c) parent-reported perceived improvement ratings are more akin to satisfaction than to pathology change.

Consumer empowerment in mental health organizations: concept, benefits, and impediments.

This article proposes a framework for promoting consumer empowerment in mental health organizations. Consumer empowerment involves consumer participation in organizational decision-making, program development and evaluation, access to resources, and opportunities for consumers to develop and run services as well as to maintain personal dignity and integrity. The benefits include increased service innovation, responsiveness to changes in the market place, accountability, as well as the enhancement of quality of care, the protection of consumer rights, among others.

Measuring quality in mental health services.

This article introduces the special issue on measuring quality of care. The overall purpose of this issue is to encourage an increased presence of evaluators in quality-of-care research. The sections of this special issue are devoted to conceptual issues concerning quality and the future of quality measurement. They include a description of current governmental and private efforts in measuring quality, a brief report on quality measurement efforts in Great Britain, and four quality-of-care research reports.

Validating quality indicators. Quality as relationship between structure, process, and outcome.

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.

Somatic sensations, anxiety, and control in panic disorder.

This case study of a woman with panic disorder with agoraphobia illustrates the relationships among somatic sensations, anxiety, and the subjective sense of control, and of these three factors to panic disorder. Helping the client alter her caffeine intake and dietary habits led to a significant reduction in panic attacks, but had less impact on her anxiety levels and sense of control. In the second stage of treatment, enhancing the client's sense of control through problem-solving training led to lower levels of anxiety. Implications for treatment and the prevention of relapse in panic disorder are discussed.