Computerized target complaints and inpatient outcomes.

摘要

Enormous costs associated with severe mental illness support the need for improved inpatient care. Better assessment procedures for treatment planning and outcome evaluation have considerable potential to improve that care. Research supports the utility of individual patient problems, or target complaints, for planning and evaluating inpatient treatment. Practical issues and methodological problems, however, have often limited their use. Computerized interviews, such as the Computerized Assessment System for Psychotherapy Evaluation and Research (CASPER), address many of these limitations by reducing clinician time and standardizing target complaint collection. Because research supports the target complaints identified by CASPER as valuable and valid information, they have the potential to improve treatment outcome. However, no previous studies have evaluated whether providing clinicians with information about target complaints identified by CASPER actively affects treatment. This study addressed this knowledge gap by evaluating whether providing hospital staff with CASPER target problem reports improves treatment outcome. Seventy-five patients (71% male) on the admissions unit of a psychiatric hospital completed the CASPER interview and a well-validated written questionnaire. Participating patients had an average age of 35.3 (SD = 11.2) with approximately 47% Caucasian, 36% African-American, and 18% representing other racial groups. Primary disorders of patients included 36% psychotic, 29% mood, 15% substance use, and 19% other disorders. Patients in four treatment teams were assigned to one of two conditions. Each condition consisted of two types of phases: either feedback or no-feedback. During the no-feedback (control) phase participating patients completed CASPER, but staff did not receive copies of the reports. During the feedback (intervention) phase patients had copies of their reports given to their treatment team and ward staff. Two teams received report information for two phases; the other two teams received reports during only one phase. Results did not support providing the CASPER problem reports to staff as a significant predictor of outcome functioning. Data from qualitative interviews, however, supported CASPER as an important and valuable tool for treatment and discharge planning. Results also demonstrated the validity of CASPER as a measure pre- and post-treatment functioning and supported CASPER as a sensitive measure of change due to inpatient treatment.