MRSAP Preliminary Report on "Wave 1"
Clinical, Consumer and Family Assessments

All of the assessments for Wave 1 have been completed and entered into the database. The assessment data will be used in two ways. First, each individual assessment will be distributed to the appropriate facilitator/recorder team to be used during the Community Support Planning meetings. Second, the easily quantified (or counted) responses are being summarized in reports and presentations for the Steering Committee, Assessment/Discharge Committee, Stakeholder’s Meetings, and others, to be used as discussion and planning tools.

The five counties selected 38 patients to participate in this first “wave” of assessments.

• 38 clinical assessments have been completed and entered into the database
• 35 consumer assessments have been completed and entered into the database

- 3 individuals have not participated to date

- 3 other assessments were not completed entirely, despite multiple attempts

• 18 family assessments have been received and entered into the database

- 15 individuals (40% of the 38) had at least one family member complete an assessment

- 3 individuals had 2 family members each participate in the assessment process

• Of the 38 individuals selected, 30 (79%) of assessments were with Allegheny County consumers, 4 (11%) were with Beaver County, 1 (3%) was with Lawrence County, and 3 (8%) were with Washington County.

Initial results indicate that some questions/sections were interpreted differently than intended by the Committee and results, therefore, are not valid. The majority of the assessment questions appear to have captured the information the Committee sought and will be essential for the facilitated Community Support Planning meetings.

The differences between the clinical, consumer and family assessments are not surprising based on previous projects. The facilitated process of developing the Community Support Plans is essential for resolving these differences and arriving at a plan that is supported by all and reflects the consumer’s preferences as much as possible.

The initial results are presented in this report. The results are organized according to the domains covered in the assessments: housing, cognitive abilities, education and work, social and relationships, and supports. Because the relapse prevention domain contained open-ended questions and very individualized responses, no analysis on this domain has been completed.

Because the family assessments were completed for only 40% of the consumers, comparisons between the totals for all three assessment tools cannot be made accurately. The tables below represent the clinical and consumer assessment totals. The text includes comparisons of all three assessments for those 15 individuals who had family member(s) complete an assessment (18 family assessments).

Domain 1: Housing

Table 1. Clinical and Consumer Assessments: Housing Preference Comparisons

How much do you want/do you recommend each of the following living arrangements?
	Very much	A little	Not at all	Missing	Total
Clinical: Independent setting by self	2		31	5	38
Consumer: Independent setting by self	14	1	19	1	35
Clinical: Independent setting with family	3	2	27	6	38
Consumer: Independent setting with family	17	1	16	1	35
Clinical: Independent setting with roommate	3	4	25	6	38
Consumer: Independent setting with roommate	8	8	18	1	35
Clinical: Transitional group setting	13	3	19	3	38
Consumer: Transitional group setting	9	2	23	1	35
Clinical: Permanent group setting	27	3	5	3	38
Consumer: Permanent group setting	6	3	25	1	35
Clinical: Nursing home	2	4	24	8	38
Consumer: Nursing home	2		30	3	35

Note: Respondents can prefer more than one arrangement “very much”.

Table 1 shows that the clinical teams recommended permanent group settings “very much” in 71% of assessments, compared to only 17% of consumers preferring this arrangement “very much.” Consumers preferred the independent settings “very much” (40% by self, 49% with family, 23% with roommates).

About one third of clinical teams recommended transitional group settings “very much,” presumably for individuals to learn additional skills and develop supports in a structured residential program for a period of time before moving to a more independent setting. About 25% of consumers preferred this arrangement “very much.”

Clinical teams tended not to answer how much professional support individuals would need in housing arrangements they did not recommend. Consumers were more likely to answer how much professional support they would need in housing arrangements other than permanent group settings. Answers varied, with some stating they would need daily, weekly or monthly help, and some stating they would need no professional support.

A majority of assessments recommended consumers have their own room. There were high non-response rates for questions on preferences/recommendations for sharing a living space (apartment/house, supervised setting).

For the 15 consumers who also had family members complete assessments, the following housing preferences were expressed:

· The clinical teams and the family members tended to agree that independent settings (without family or roommates) were not appropriate.

· The consumers and the family members tended to prefer family settings “very much” or “a little” when compared to clinical teams, although the family members appeared to be more ambivalent about this arrangement. About 40% of family members recommended independent settings with roommates “very much.”

· Family members were evenly split in recommending permanent group settings “very much” or “not at all.” This is in contrast to the clinical teams where 67% recommended permanent group settings “very much” and 73% of consumers preferred permanent group settings “not at all.”

Table 2. Consumer Assessments: Proximity to Resources/Amenities

Do you prefer to be in walking distance of this place or is it OK to take a bus to get there?
	Walking distance	Bus ride	No response
See family and friends	34%	43%	23%
Bus stop	71%	11%	17%
Open spaces/parks	54%	26%	20%
Church, synagogue, mosque, etc.	40%	40%	20%
Malls/shopping areas	20%	63%	17%
Food bank	31%	46%	23%
Library	46%	37%	17%
Grocery store	57%	23%	20%
Pharmacy	54%	34%	11%
Post office	51%	37%	11%
Museums	14%	69%	17%
Sport/fitness centers	29%	46%	26%
Drop-in centers	46%	26%	29%
Drug/alcohol counseling	26%	40%	34%
Medical services	26%	57%	17%
Dentist	29%	57%	14%
Mental health clinic	26%	60%	14%
Housing supports	26%	54%	20%
Self-help	34%	37%	29%

Clinical teams often seemed to interpret these questions as “do you think the person can walk (unsupervised) or take the bus (unsupervised)” rather than what amenities are important to the consumer and should be in close proximity. Because of the high non-response rate and questionable interpretation, clinical results are not reported. Similarly, about one third of family members did not respond to these questions so results are not reported here.

Domain 2: Cognitive Abilities

The two tables below illustrate that there are some very clear differences between clinical teams’ evaluation of consumers’ cognitive abilities and consumers’ evaluation of their own abilities. For the 15 consumers who also had family members complete assessments, family members and consumers gave a similar evaluation of reading, writing and math skills. Also, the proportions of family members who thought an individual had a particular cognitive skill were more similar to the clinical answers than the consumer answers.

Table 3. Clinical and Consumer Assessments: Reading, Writing and Math Skills

	Basic skills	Advanced skills	No known skills (missing values)
Clinical: Reading	63%	11%	26%
Consumer: Reading	69%	23%	9%
Clinical: Writing	74%	3%	24%
Consumer: Writing	66%	26%	9%
Clinical: Math	53%	3%	45%
Consumer: Math	71%	20%	9%

Table 4. Clinical and Consumer Assessments: Other Cognitive Questions

	% No	% Yes
Clinical: Pay attention to time?	34.2%	65.8%
Consumer: Pay attention to time?	17.1%	82.9%
Clinical: Understand his/her illness?	73.7%	26.3%
Consumer: Understand your illness?	22.9%	77.1%
Clinical: Understand his/her symptoms?	81.6%	18.4%
Consumer: Understand your symptoms?	40.0%	60.0%
Clinical: Recognize dangerous situations?	60.5%	39.5%
Consumer: Recognize dangerous situations?	20.0%	80.0%
Clinical: Express/verbalize his/her needs?	13.2%	86.8%
Consumer: Express/verbalize needs?	20.0%	80.0%
Clinical: Understand responsibilities?	60.5%	39.5%
Consumer: Understand responsibilities?	28.6%	71.4%
Clinical: Comprehend his/her rights?	55.3%	44.7%
Consumer: Comprehend rights?	31.4%	68.6%
Clinical: Understand how to take medication?	65.8%	34.2%
Consumer: Understand how to take medication?	22.9%	77.1%
Clinical: Able to plan his/her day by him/herself?	71.1%	28.9%
Consumer: Able to plan your day by yourself?	14.3%	85.7%
Clinical: Able to plan ahead for him/herself a week at a time?	89.5%	10.5%
Consumer: Able to plan ahead for yourself a week at a time?	40.0%	60.0%
Clinical: Able to solve problems on his/her own?	86.8%	13.2%
Consumer: Able to solve problems on your own?	37.1%	62.9%
Clinical: Able to solve problems with help?	39.5%	60.5%
Consumer: Able to solve problems with help?	20.0%	80.0%

Domain 4: Education and Work

Clinical and consumer assessments reported similar rates of work and volunteering history. For individuals with a family assessment, the three assessments reported similar rates of work and volunteering history. Clinical teams stated they know consumers can work with symptoms and can work and keep their benefits. Fewer consumers and family members are aware of these facts. Clinical teams recommended paying jobs or job training/education less often when compared to the number of consumers expressing interest in work and training. Consumers gave a wide range of ideas for the types of work they would be interested in.

Table 5. Clinical and Consumer Assessments: Work and Volunteering History

Before coming to Mayview, did the patient/did you ever work a paying job or volunteer?
	Yes	No	Unsure	Missing	Total
Clinical: Previous Work	20	9	9	0	38
Consumer: Previous Work	16	13	4	2	33
Clinical: Previous Volunteer Activity	2	19	16	0	37
Consumer: Previous Volunteer Activity	9	21	3	2	33

Table 6. Clinical and Consumer Assessments: Vocational Knowledge

	Yes	No	Unsure	Missing	Total
Clinical: Know can work with symptoms?	38	0	0	0	38
Consumer: Know can work with symptoms?	26	3	4	2	33
Clinical: know can work and keep benefits?	38	0	0	0	38
Consumer: Know can work and keep benefits?	19	11	3	2	33

In the family assessments, three family members were unsure that individuals can work with symptoms and six were unsure that individuals can work and keep their benefits.

Table 7. Clinical and Consumer Assessments:

Preferences on Working, Volunteering, Education/Job Training after Discharge

	% Yes	% No	% Unsure	% Missing
Clinical: Recommend paying job	21%	61%	16%	3%
Consumer: Would like to have paying job	54%	26%	14%	6%
Clinical: Recommend volunteer job	21%	55%	21%	3%
Consumer: Would like to have volunteer job	23%	51%	20%	6%
Clinical: Recommend training or education	13%	61%	24%	3%
Consumer: Would like to have training or education	26%	63%	6%	6%

In the family assessments, six (33%) family members recommended a paying job, seven (40%) did not, and five (28%) were unsure. Eight (44%) recommended volunteer work, four (22%) did not, and six (33%) were unsure. Twelve (67%) recommended education/job training, 3 (17%) did not, and 3 (17%) were unsure.

Domain 5: Social and Relationships

The majority of these questions are open-ended and not easily analyzed. Many consumers had limited or no relationships with family members or friends.

· 63% of consumers reported they had family members they wanted contact with

· 79% of clinical assessments recommended family contact post-discharge

· Fifteen of the family members interviewed wanted contact with their family member after discharge (three responses were left blank)

· 70% of consumers reported that they have at least one person they have meaningful contact with (aside from staff)

· 82% of clinical assessments reported that consumers have at least one person they have meaningful contact with (aside from staff)

· 100% of family assessments reported that consumers have at least one person they have meaningful contact with (aside from staff)

· A small percentage of individuals have relationships with friends, according to all three assessments

Domain 6: Supports

When scanning the clinical and consumer assessments, several “profiles” emerged. First, some clinical and consumer profiles indicated a need for daily help in nearly all areas. Second, some consumer profiles indicated they did not need or want help in almost all areas post-discharge. The remainder of clinical and consumer profiles indicated a variety of needs post-discharge.

For each individual support, clinical assessments were more likely to recommend daily help after discharge, and consumer assessments were more likely to prefer no help after discharge. Recommended supports in family assessments were more similar to clinical recommendations that to consumer preferences. The detailed counts for the clinical and consumer assessments are reported below; because of the smaller number of family assessments, family counts are not reported in the tables.

Some of the supports questions had high rates of missing responses. Respondents did not answer these questions for several reasons:

· Respondents didn’t think the support was a practical option for the consumer. For example, many clinical teams thought individual consumers should not have driver’s licenses so therefore would not need help getting a license.

· Respondents didn’t think the consumer was interested in a particular support.

· Respondents didn’t have an opinion or didn’t know the answer.

When family members were asked what supports they needed, the most common response for individual types of help was “don’t need help.” Several did express an interest in linking with other families, learning about hotlines, family psycho-education, and understanding SS, SSI and other benefits. Ten family members (56%) wanted to learn about dosage, side effects, and purposes of medications.

Table 8. Clinical and Consumer Assessments: Supports Needed After Discharge (Part 1)

Note: Clinical team assessment results are shaded in grey.

	Daily help AFTER discharge	Weekly help AFTER discharge	Don't need help AFTER discharge	Missing Answers	Total
1. Cooking	35	0	1	2	38
1. Cooking	9	1	23	2	35
2. Menu planning	36	0	1	1	38
2. Menu planning	9	3	20	3	35
3. Using appliances	32	0	4	2	38
3. Using appliances	6	2	25	2	35
4. Cleaning	23	8	7	0	38
4. Cleaning	4	6	23	2	35
5. Shopping	26	8	3	1	38
5. Shopping	7	4	21	3	35
6. Use of the telephone	14	1	21	2	38
6. Use of the telephone	3	1	29	2	35
7. Use of locks and keys	14	1	20	3	38
7. Use of locks and keys	5	1	26	3	35
8. Roommate issues	19	7	7	5	38
8. Roommate issues	6	5	20	4	35
9. Providing for personal safety	33	1	3	1	38
9. Providing for personal safety	6	2	23	4	35
10. Learning about the neighborhood	28	4	2	4	38
10. Learning about the neighborhood	7	3	22	3	35
11. Working with landlord	17	7	0	14	38
11. Working with landlord	5	6	18	6	35
12. Getting and keeping a job	17	3	2	16	38
12. Getting and keeping a job	6	3	23	3	35
13. Going back to school/job training	13	2	2	21	38
13. Going back to school/job training	4	5	20	6	35
14. Reading	10	3	21	4	38
14. Reading	3	4	25	3	35
15. Writing	10	3	21	4	38
15. Writing	3	4	26	2	35

Table 9. Clinical and Consumer Assessments: Supports Needed After Discharge (Part 2)

Note: Clinical team assessment results are shaded in grey.

	Daily help AFTER discharge	Weekly help AFTER discharge	Don't need help AFTER discharge	Missing Answers	Total
16. Making/following a daily schedule	33	3	2	0	38
16. Making/following a daily schedule	5	5	23	2	35
17. Keeping appointments	34	2	1	1	38
17. Keeping appointments	10	4	18	3	35
18. Getting a driver's license	6	0	1	31	38
18. Getting a driver's license	9	4	13	9	35
19. Taking the bus	22	1	1	14	38
19. Taking the bus	6	2	22	5	35
20. Making friends	23	4	7	4	38
20. Making friends	2	2	26	5	35
21. Visiting family	18	5	8	7	38
21. Visiting family	2	2	24	7	35
22. Finding things to do	32	3	3	0	38
22. Finding things to do	8	4	19	4	35
23. Meeting neighbors	21	6	4	7	38
23. Meeting neighbors	5	2	23	5	35
24. Connecting with religious center	15	9	5	9	38
24. Connecting with religious center	1	1	28	5	35
25. Joining a sports team	8	1	7	22	38
25. Joining a sports team	1	3	24	7	35
26. Joining a club	12	6	4	16	38
26. Joining a club	1	2	26	6	35
27. Getting medical and dental care	32	5	0	1	38
27. Getting medical and dental care	6	5	20	4	35
28. Personal hygiene	18	6	13	1	38
28. Personal hygiene	2	1	28	4	35
29. Seek/ask for help when needed	15	3	19	1	38
29. Seek/ask for help when needed	2	4	25	4	35

Table 10. Clinical and Consumer Assessments: Supports Needed After Discharge (Part 3)

Note: Clinical team assessment results are shaded in grey.

	Daily help AFTER discharge	Weekly help AFTER discharge	Don't need help AFTER discharge	Missing Answers	Total
30. Outpatient mental health care (case management, counseling, management of mental illness, etc.)	34	1	0	3	38
30. Outpatient mental health care (case management, counseling, management of mental illness, etc.)	6	11	15	3	35
31. Outpatient drug and alcohol care (counseling, case management, management of relapse, etc.)	14	5	2	17	38
31. Outpatient drug and alcohol care (counseling, case management, management of relapse, etc.)	5	2	20	8	35
32. Learning about dosage, side effects, purpose of medications	28	4	0	6	38
32. Learning about dosage, side effects, purpose of medications	3	8	21	3	35
33. Getting and taking medication	34	1	0	3	38
33. Getting and taking medication	6	5	21	3	35
34. Connecting with self-help groups	18	12	1	7	38
34. Connecting with self-help groups	5	5	22	3	35
35. Getting exercise	23	8	7	0	38
35. Getting exercise	3	1	28	3	35
36. Safe sexual practices	16	3	7	12	38
36. Safe sexual practices	2	0	28	5	35
37. Getting and keeping SS, SSI, insurance and other benefits	26	10	1	1	38
37. Getting and keeping SS, SSI, insurance and other benefits	5	4	22	4	35
38. Paying bills	27	8	1	2	38
38. Paying bills	7	7	18	3	35
39. Banking	23	10	1	4	38
39. Banking	4	6	18	7	35
40. Legal money manager (payee)	24	8	2	4	38
40. Legal money manager (payee)	5	2	23	5	35
41. Legal problems	17	5	3	13	38
41. Legal problems	6	2	24	3	35