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, StakeholderÕs Meetings, and others, to be used as discussion and planning tools. 

The five counties selected 38 patients to participate in this first ÒwaveÓ of assessments. 

-       3 individuals have not participated to date

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

-       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

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 consumerÕs 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 Òvery muchÓ.

 

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

About one third of clinical teams recommended transitional group settings Òvery much,Ó 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 Òvery much.Ó

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:

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

á               The consumers and the family members tended to prefer family settings Òvery muchÓ or Òa littleÓ 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 Òvery much.Ó

á               Family members were evenly split in recommending permanent group settings Òvery muchÓ or Ònot at all.Ó  This is in contrast to the clinical teams where 67% recommended permanent group settings Òvery muchÓ and 73% of consumers preferred permanent group settings Ònot at all.Ó

 

 

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 Òdo you think the person can walk (unsupervised) or take the bus (unsupervised)Ó 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 teamsÕ evaluation of consumersÕ cognitive abilities and consumersÕ 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%