The FACE Recording and Measurement System: a scientific approach to person-based information.

Modern health care systems increasingly require clinicians to provide person-based information for purposes of outcomes and resource management. These demands have traditionally been met by the establishment of parallel data collection activities that can place an excessive burden on both clinicians and the organization. The author describes an approach to information that integrates clinical recording with measurement in a manner that both provides the required information for management purposes and supports day-to-day clinical activity. The Functional Analysis of Care Environments (FACE) Recording and Measurement System integrates clinical, management, and regulatory requirements. In so doing, it also has the potential to provide a basis for effectiveness research and protocol development that can both support and enhance clinical knowledge and practice.

A simple method of evaluating patients' perceptions of their treatment and care.

Surveys of patient satisfaction have become commonplace in mental health services. However, questions about the appropriateness of "satisfaction" as a concept and its use as an approach to evaluating the quality of service provision remain as pertinent as ever. Although surveys of patients of mental health services routinely generate high levels of apparent satisfaction, noncompliance with treatment and medication continues to be a major difficulty in psychiatric care. To evaluate services properly, there is a need to access patients' dissatisfaction to determine whether it is a more valid indicator of quality of services and a better predictor of noncompliance. However, a method that is not time consuming and costly is also required. The authors introduce a new patient evaluation tool, "Your Treatment and Care," which requires patients to report on their direct experience of care according to a set of principles of good practice. The tool forms part of a broader package for obtaining patients' views of their own problems, need for care, quality of care received, and health and social outcomes. The authors also report the results of a survey using this tool. Responses of 75 patients of a psychiatric hospital in the United States are presented and compared with results from a similar survey in the United Kingdom. The comparisons show striking differences in patients' perceptions of quality of treatment and care, both within each population and across clinical contexts.

Measuring disability and outcomes in routine practice with the FACE Core Assessment.

The authors describe the results of an outcome study of 87 psychiatric inpatients and outpatients using a generic assessment and outcome measurement tool, the FACE Core Assessment. The results suggest that the multiaxial structure of the assessment tool has the potential to be used for the routine measurement of clinical outcomes as well as for multidisciplinary assessment.

The How Are You? scale: a quality-of-life outcomes measure for routine practice.

The How Are You? scale, a quality-of-life outcomes self-report measure to be completed by patients, was developed to address the concerns of the mental health consumer movement. Specific concerns included using less technical language in assessing mental health problems and developing a collaborative dialogue between clinician and patient. The How Are You? scale is a user-friendly instrument that allows patients to be actively involved in their assessment and treatment process. To implement the How Are You? scale into a recording and measurement system, its psychometric properties were assessed using two samples: (1) An employee group from The Menninger Clinic was used to assess internal consistency and stability, and (2) a patient group from The Menninger Clinic was used to assess known-group and discriminant validity, as well as sensitivity to change. The How Are You? scale was found to have good internal consistency and stability and good known-group and discriminant validity. It was also found to be sensitive to change. Although data continue to be collected at The Menninger Clinic, initial indications are that the How Are You? scale is a psychometrically sound outcomes measurement tool.

The influence of depression on the processing of personal attributes.

Depressed, schizophrenic and normal subjects were tested for incidental recall and recognition of lists of positive and negative personal attributes. It was hypothesised that depressives would show a deficit in recall and recognition of words of which they had been asked a self-referential encoding question, but would show equivalent performance to controls on words of which they had been asked an other-referential, semantic or structural encoding question. The experiment was designed to enable a decision to be made between two possible explanations of the expected deficit: Davis's (1979) suggestion that it is due to disorganisation of the self-schema in depression, and the hypothesis of Beck et al (1979) that depression is characterised by the predominance of a negative self-schema. The expected deficit was observed on the recall but not on the recognition task. However, the precise pattern of the results raises problems for both of the above interpretations, and alternative explanations are considered.