Models of Standard and Intensive Outpatient Care in Mental Health

Session number: 1137

Abstract title: Models of Standard and Intensive Outpatient Care in Mental Health

Author(s):
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 guidelines.