Improving the competency of clinicians providing care to people with severe mental illness

Young AS, Forquer SL, Chinman MJ, Rowe M, Miller A, Knight E. Improving the competency of clinicians providing care to people with severe mental illness. Paper presented at: VA Career Development Award Program Annual Conference; 2002 Feb 13; Washington, DC.

Background and Objectives: People with severe mental illness frequently receive poor quality care, and the clinicians caring for them often lack competencies necessary to provide appropriate treatment. Interventions are needed that improve clinicians' competencies and treatment quality. In this project we test the effectiveness of an intervention designed to (a) improve rehabilitation and empowerment competencies in clinicians providing services to clients with severe, persistent mental illness, and (b) increase client use of self-help. The intervention focuses on 15 of 37 competencies previously identified as necessary to provide high quality care to this population. Methods: This is a twelve month controlled trial in two western states of (a) intensive education, structured group dialogues and consultation to improve clinical competencies; and (b) support and technical assistance to facilitate the formation of self-help services. Two provider organizations were assigned to the intervention and 3 to usual care. Clinicians' competencies were evaluated using a new, validated instrument. Organizational changes were characterized. Results: The intervention has been successfully implemented. Clinician participation rates have been high (79%). There was competency improvement at 2 weeks in rehabilitation (p < .001), holistic approach (p = .045), optimism (p = 0.022), and recovery orientation (p = .001); and trends towards improvement in most other competencies and in overall competency (p = .065). Eleven self-help groups have formed. One-year outcomes will be assessed in early 2002. Conclusions: Clients often do not have access to effective medical and rehabilitative services. This intervention shows promise for improving clinical competencies that enhance client outcomes. Impact statement: Very few interventions have been shown to improve the competency of clinicians caring for people with severe mental illness. If successful, the approach used in this project may be broadly applicable at publicly financed mental health clinics.