A Consumer-Led Intervention that Improves Clinical Competencies of Providers

Young AS, Chinman M, Knight E, Vogel H, Cohen A, Miller A, Forquer S. A Consumer-Led Intervention that Improves Clinical Competencies of Providers. Paper presented at: VA QUERI National Meeting; 2003 Dec 10; Washington, DC.

Objectives: Patient-centered care is a central goal of medicine. It may be particularly important, and challenging, in vulnerable populations such as persons with severe and persistent mental illness. Although recent treatment and rehabilitation approaches substantially improve outcomes for people with these illnesses, they are not widely used. Many current mental health providers lack core clinical competencies, especially in the areas of recovery and empowerment that are at the heart of rehabilitation. This project implemented and evaluated an innovative intervention designed to improving provider quality. Developed and led by consumers, the intervention includes intensive education, structured clinician-consumer dialogues, ongoing consultation, and technical assistance regarding self-help.Methods/Approach: This was a one-year controlled trial of the effect of the intervention on provider competencies (knowledge, skills, attitudes), care processes, and the formation of mutual support groups. The setting was five large community mental health organizations with 16 sites in two western states. Participants included 269 providers. Outcomes were assessed using previously validated instruments (the Competency Assessment Instrument and Recovery Attitudes Questionnaire), and semi-structured interviews with clinic staff and consumers. Change over time was compared between the intervention and control groups using covariance analyses.Results/Findings: Compared to controls, clinicians at intervention sites improved significantly (P < .05) in holistic approach (F = 4.0), rehabilitation methods (F = 5.6), natural supports (F = 4.5), team-work (F = 5.1), education about care (F = 8.4), overall competency (F = 6.5), and recovery orientation (F = 4.4). Magnitude of exposure to the intervention was correlated with improvement for each of these competencies (P < .05, r = 0.17 to r = 0.28). Rehabilitation techniques were incorporated into practice at intervention clinics. Eleven mutual support groups formed.Implications: A feasible intervention improves self-help and clinical competencies necessary for the provision of high quality care. This intervention could help VA organizations move to consumer-centered care models that support recovery.