Adoption of strategies to improve decision support in community mental health centers

Abstract

Objective Assessment of specific skills acquired during training of a new practice is important in understanding adoption, but often difficult to do. This project summarizes information from a clinical skills assessment over one year post training of a program to increase treatment decision support by staff for individuals receiving mental health services. Method Training and implementation on a Decision Support Toolkit (Pat Deegan & Associates) was provided and supported by a managed behavioral health care organization to interested providers. Individuals in service and staff at four community mental health centers completed a skills and practices survey where they rated how often 18 activities occurred during their clinical sessions on a Likert scale. To examine subscales, an exploratory factor analysis was conducted using the Principal Axis Factoring method for non-normally distributed data with Promax rotation to account for correlations among subscales. Results Surveys were completed by 41 staff at baseline, 43 at 6 months, 40 at 12 months and 300 individuals in service at baseline, 352 at 6 months, and 347 at 12 months. Three subscales were derived: Clinical (e.g., establish goals, discuss medication instructions), Empathy (e.g., offer empathy, support individual-clinician communication), and Information (e.g., provide information, educate families on mental health). Confirmatory factor analysis yielded chi-square p-value = 0.09 indicating a good fit. Staff ratings for Empathy were significantly higher at 12 months v. baseline (p = 0.008) and on average were higher than individual report (p = 0.004). The same pattern was seen for Information (p = 0.007), but on average staff ratings were lower than reported by individuals (p < 0.0001). Clinical skills were not expected to change and did not. Discrepancies between staff and individual reports will be further investigated. Statement Assessment of specific skills acquired during training can be monitored and compared to report from those receiving services to confirm adoption of a new practice and discover needed improvements.