Field test of the feasibility and validity of using the Hoosier Assurance Plan Instrument for Adults in a state mental health program.

The current paper reports on the feasibility of using the HAPI-A, an instrument designed to assess a person's level of functioning in the community: (1) to help determine eligibility to receive behavioral health services, (2) to assign reimbursement case rates; and (3) to provide data for a service provider report card. A 3-year field study of the use of the instrument across an entire state mental health system explored the effectiveness of methods to enhance data accuracy, including annual training and a professional clinical record audit, and the ability of the test to detect differences in improvement rates within risk-adjusted groupings. The combination of training and auditing produced statistically significant, cumulative reductions in data errors across all 3 years of the field test. The HAPI-A also was sensitive in detecting differences among service providers in outcome improvements for six of six risk-adjusted groups rated at the moderate level of impairment and for five of six groups rated at the mild level of impairment, but was inconsistent in detecting outcome differences for persons rated at the severe level of impairment.

The Hoosier Assurance Plan Instrument for Adults (HAPI-A): the psychometric properties of a level of functioning assessment instrument designed for use in a state managed care mental health program.

The psychometric properties of the HAPI-A were examined at intake and 90-day follow-up in consumers with mental illness (MI) or chronic addiction (CA) being served at one of 11 treatment facilities (n = 1168). A 4-factor subscale structure was confirmed and factor invariance tests indicated a single model for the CA and MI samples. Internal consistency and inter-rater reliability were good (ICCs = 0.72-0.88). Factor scores correlated with GAF ratings and predicted membership in severity/cost groupings proposed for setting reimbursement rates. Sensitivity to change was confirmed for all four factors for the CA sample and for three of four factors for the MI sample.

Adjusting for patient characteristics and selection effects in assessment of community mental health centers.

OBJECTIVE: The objective of this study was to determine the effect of patient socioeconomic characteristics and center selection of patients on measured performance of community mental health centers. DATA SOURCE/STUDY SETTING: Data were taken from the administrative records of Indiana's public mental health system for 16,516 adults with severe, persistent mental illness treated in 30 community mental health centers. Center performance was compared using longitudinal information on patient functioning. METHODS: A mixed random-effects model that is suitable for fitting data with a hierarchical structure was used to assess relative performance. PRINCIPAL FINDINGS: Measured performance was found to depend significantly on patient education, income, marital status, race, ethnicity, and baseline health (P<0.05). Results also indicated centers that were more successful at maintaining patients in treatment were unfairly underranked by unadjusted performance scores. CONCLUSIONS: Both the socioeconomic background of patients and patient selection by centers impact apparent performance in community mental health care. If observational data are used to evaluate community-based providers, analysts might need to account for both effects to ensure comparisons of relative performance are accurate.

Demographic and clinical correlates of client motivation among substance abusers.

Understanding the role of motivation in substance abusers' acceptance of treatment is critically important to improving treatment outcomes. To examine this phenomenon a cohort of substance abuse treatment clients was recruited from two treatment programs whose services are funded by a state managed care system. Motivation at treatment entry was examined. Better motivation was consistently associated with severity of substance use. Neither the coercion that accompanies legal system involvement nor self-referral was significantly related to measured levels of motivation. Motivation was not related to alcohol and drug use severity six months later. The severity associated with motivation at treatment entry was, for the most part, not related to clients' success six months later. Implications for social work practice with substance abusers are discussed.