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*192. Client and Family Preferences Regarding Outcomes of Treatment for Severe, Persistent Mental Illness

JA Cradock, VISN 22 MIRECC; AS Young, VISN 22 MIRECC; SL Forquer, Value-Options Healthcare

Objectives: Evaluations of outpatient psychiatric treatment of persons with severe mental illness (SMI) have frequently found problems with quality of care, suggesting the need for efforts to improve treatment quality. Considering that resources to support this care are often limited, there may be a need to prioritize outcomes and focus treatment service provision. Since clinicians, clients, family members, and society may have different opinions regarding the importance of various outcome domains, it is essential for all parties to collaborate in determining a treatment plan. Toward this end, the present study examined which treatment outcomes are most valued by clients and family members.

Methods: Two types of data were collected. Qualitative data was obtained during focus groups, which were held across Colorado and New Mexico, in March and May of 1998. Three groups of clients (N=31) and one group of family members (N=14) talked about quality of life, recovery and treatment issues. These groups also discussed the characteristics they believed clinicians should have in order to help clients achieve certain outcomes. Quantitative data was collected from these groups via an Outcome Preference Survey, which was developed for this project. This survey asks participants to rank 12 types of treatment outcomes in order of importance. The same outcomes were then rated in terms of how easy or difficult the participant believed it would be for the clientís mental health provider organization to improve the outcome.

Results: Clients and family members agreed in several domains. Both believed that a good support system, such as family and friends, was a very important treatment outcome. Effective medication with few side effects was also highly valued. Both groups rated a supportive clinician as a key outcome, and most reported being pleased with their current clinician. Some families indicated they would prefer increased contact with their family memberís treating clinician. Differences between groups were seen when family members ranked outcomes such as sobriety, safe and stable living situation, and staying out of jail, as more important than clients did. Overall, both groups reported wanting to be more directly involved in making treatment decisions for the client.

Conclusions: Clients and family members have definite views and preferences regarding treatment outcomes. Both groups agreed that the most valued outcomes are those which facilitate improvement and enhance the quality of life, such as social support, effective medication, and good clinicians. These outcomes empower clients in a realistic way, which recognizes limitations and encourages independence. Outcomes valued differently between groups should be explored further, in order to work towards collaboration regarding treatment decisions.

Impact: Understanding what clients value as important outcomes can strengthen the therapeutic relationship and facilitate effective interventions, thereby providing better quality of care. However, clinician, client, and possibly family membersí views must first be reconciled in order to work effectively toward treatment goals.