Community-oriented mental health care: Assessing diversity in clinical practice.

Abstract

The delivery of community-oriented mental health care was compared in two multi-site Deparment of Veterans Affairs (VA) demonstration programs: an outreach program for homeless veterans with substance abuse or other psychiatric problems and an intensive case management program for severely mentally ill high hospital users. Comparisons were made using both periodic patient-specific progress summaries and a one-time clinician questionnaire, Jerrell and Hargreaves' Community Program Philosophy Scale (CPPS). Program differences were considered to be substantial only when data from patient-specific progress summaries and from thematically related CPPS scores both revealed statistically significant differences between the two programs. Patient summaries showed that the homeless outreach program was characterized by a shorter duration of involvement and focused primarily on initiating treatment for underserved, more highly functioning substance abusers, many of whom had never been hospitalized. The intensive case management program, in contrast, provided longer-term community support to more severely disabled patients suffering from serious psychiatric disorders who tended to be hospital dependent. CPPS scores of 7 of the 20 subscales (substance abuse treatment, vocational emphasis, interest in CMI patients, family treatment, emergency services, medication, and longitudinal focus) were consistent with patient progress summaries, but three CPPS subscales (outreach orientation, referral advocacy, and de-emphasis of psychotherapy) apparently contradicted trends suggested by the progress summaries. This study shows that the CPPS is able to discriminate between different programs. It also reveals a greater diversity in the operation of community-oriented mental health programs, when they are applied to different populations, than has been previously described.