Session number: 1137
Abstract title: Models of Standard and Intensive Outpatient Care in Mental Health
C Timko - Center for Health Care Evaluation
JM Sempel - Center for Health Care Evaluation
RH Moos - Center for Health Care Evaluation
Objectives: Generally, intensive mental health outpatient treatment has not demonstrated
better patient outcomes than standard treatment, possibly because many models
exist of standard and intensive care. Our purpose was to describe the range of
VA mental health outpatient programs systemwide and compare standard and
intensive programs on staffing, management practices, and services.
Methods: Surveys were completed on 176 substance abuse and 515 psychiatric VA outpatient
programs nationwide (92% of all programs). Programs were identified as standard
or intensive according to VA guidelines which concern days per week and hours
per day of program attendance.
Results: Psychiatric: Staff-to-patient ratios were comparable between standard and
intensive programs. Intensive programs were more likely to have clinician
performance monitoring, single case managers coordinating a patient's care,
weekly staff meetings with case review, and patient outcome follow-ups and
satisfaction surveys. Intensive programs were less likely to offer counseling
to patients, couples counseling, or family psychoeducation, and more likely to
offer social or daily living skills training, occupational therapy, and
vocational rehabilitation. Higher percentages of patients in intensive programs
were found to use skills training, occupational therapy, and vocational services
when programs offering these services were compared; and, on average, patients
in intensive programs used these services for more hours per week.
Substance abuse: Nursing, addiction therapist, and "other direct care"
staff-to-patient ratios were higher, but professional staff-to-patient ratios
were lower, in intensive than in standard programs. Standard and intensive
programs did not differ on management practices or on whether they offered a
variety of services.
Conclusions: Within psychiatric care, patients and their families in intensive programs were
less likely to receive basic counseling services, and more likely to receive
help with developing life skills. Intensive psychiatric programs were more
likely to have management practices reflecting system demands for accountability
in service delivery. Standard and intensive substance abuse outpatient programs
showed no such differences on services or practices.
Impact statement: These findings showing the similarity of standard and intensive substance abuse
programs, and the relative lack of basic counseling services in intensive
psychiatric programs, suggest why intensive programs have not yielded superior
patient outcomes than standard programs. Mental health system planners should
consider differentiating intensive programs using broader criteria, based on
management, staffing, and services, for example, than those in current