During Treatment
During the course of treatment, our clinical team uses two outcomes measures to monitor client progress and clinical gains. These two are the Symptom Checklist (SCL-90-R) and the Global Assessment of Functioning (GAF).
The Symptom Checklist (SCL-90-R) is a standardized measure inquiring about a broad range of symptoms, including depression, anxiety, psychosis and several other domains. The SCL-90-R is given within a week of admission, and every 60 days during treatment to measure treatment progress.
We use the Global Assessment of Functioning (GAF) scale on every admission, as well as at the time of every discharge. GAF is a numeric scale (0-100) that rates the social, occupational and psychological functioning of adults – how well or adaptively one is meeting various problems in living.
We analyze the percent of change in GAF scores, which is an indication of the improvements and gains made by our clients during treatment. GAF scores have been analyzed by two important variables: diagnosis and length of stay.
Average Change in GAF Scores by Primary Diagnosis |
Asperger’s Syndrome |
9.82% |
Bipolar Disorder |
18.28% |
Depression |
12.49% |
Schizoaffective Disorder |
21.26% |
Schizophrenia |
11.62% |
Average Change in GAF Scores by Average Length of Stay |
1 – 90 Days |
10.56% |
91 – 180 Days |
21.67% |
181 – 270 Days |
12.31% |
271 Days and Over |
18.06% |
Total Average Gain in GAF Score during
treatment: 15.7%
SCL-90-R Global Indices
There are three global indices of distress associated with the SCL-90-R: the Global Severity Index (GSI), the Positive Symptom Distress Index (PSDI), and the Positive Symptom Total (PST). All scores are converted to T-scores based on data from a national standardization sample; these scores have a mean of 50 and a standard deviation of 10.
The GSI is the best single predictor of the current level or depth of the disorder. It combines information concerning the number of symptoms reported with the intensity of perceived distress. Currently, the mean change in GSI T-score for residents at Pasadena Villa is 3.08, and corresponds to a 7% reduction in both the quantity and intensity of self-reported symptoms when compared to other inpatient adults in the national standardization sample.
The PSDI functions as a measure of response style by indicating whether the respondent was augmenting or attenuating symptomatic distress. That is, the PSDI reflects the average level of distress reported for the symptoms that were endorsed; as such, it can be interpreted as a measure of symptom intensity. Currently, the mean change in PSDI T-score for residents at Pasadena Villa is 3.15, and corresponds to a 10% reduction in the intensity of self-reported symptoms when compared to other inpatient adults in the national standardization sample.
The PST is simply a reflection of the number of symptoms endorsed by the respondent, regardless of the level of distress reported. It can be interpreted as a measure of symptom breadth. Currently, the mean change in PST T-score for residents at Pasadena Villa is 3.35, and corresponds to a 3% reduction in the quantity of self-reported symptoms when compared to other inpatient adults in the national standardization sample.
Perhaps more importantly, it should be noted that all of these indices fall well below the expected mean score (i.e., T = 50; the 50th percentile) when compared to those of other inpatient adults in the national standardization sample. Specifically, the GSI (M = 44.77), PSDI (M = 44.04), and PST (M = 46.08) scores for residents at Pasadena Villa fall within the 32nd, 27th, and 34th percentiles, respectively, and suggests that residents receiving treatment at Pasadena Villa report experiencing notably less severe symptomatology than similar patients receiving treatment at other facilities.
Client and Family Satisfaction
We aggressively solicit the feedback of clients and families on many aspects of their experiences in our programs, including several scored items (scale of 1 – 5), and an open narrative for specific feedback. We use this valuable feedback to make programmatic, organization and clinical changes, as needed.
Pasadena Villa® Client and Family Satisfaction Survey Findings – 2010 |
MEASURE |
CLIENT SCORES |
FAMILY SCORES |
How would you rate services provided by your Primary Therapist? |
80% |
88% |
How would you rate services provided by the Nursing Staff? |
84% |
92% |
How would you rate services provided by the Recreational Therapists? |
74% |
94% |
How would you rate the usefulness of the social activities? |
70% |
92% |
How well were treatment plans and goals explained? |
80% |
88% |
Were you comfortable with the discharge planning & process? |
84% |
94% |
Were you pleased with facilities’ cleanliness and appearance? |
84% |
98% |
Were you treated with courtesy and respect? |
89% |
98% |
Was there a feeling of warmth, friendliness and compassion? |
80% |
98% |
Were you pleased with services provided by your psychiatrist? |
72% |
88% |
Was the admissions process clearly explained and smooth? |
82% |
92% |
Would you recommend Pasadena Villa® to a friend or relative? |
72% |
100% |
Transitional Living and Learning Center Survey Results – 2010 |
|
CLIENT SCORES |
FAMILY SCORES |
How would you rate services provided by your Case Manager? |
90% |
95% |
How would you rate the usefulness of recreational and social activities? |
85% |
98% |
How would you rate services provided by your Care Managers? |
90% |
95% |
How applicable were the life skills trainings and classes? |
85% |
95% |
How would you rate the cleanliness of the facility? |
100% |
100% |
Were you treated with courtesy and respect? |
95% |
100% |
Were your complaints or suggestions acted upon by staff? |
95% |
95% |
Were you comfortable with discharge planning and processes? |
100% |
100% |
Were you provided discharge education and follow-up services? |
100% |
100% |
Was the admission process clearly explained and smooth? |
95% |
98% |
Would you recommend the TLLC to a friend or relative (y/n)? |
100% |
100% |
After Treatment
We are committed to not only maintaining, but hopefully improving, the functioning of our clients after discharge from our programs. We use our one-year aftercare service, called OASIS – Outreach and Social Integration Service, to measure functioning at the time of discharge, and again at three and six months post discharge.
We use the Social Adjustment Scale Self-Report, which is a self-report scale that measures instrumental and expressive role performance over the past two weeks. It includes eight categories, which are skip-outs, so that non-applicable items are omitted and not scored. The questions within each area cover performance at expected tasks, friction with people, finer aspects of interpersonal relationships, and feelings and satisfactions.
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