This study seeks to extend from two to five years a longitudinal treatment outcome project that is ongoing in Colorado. It investigates the effects of a major system reform occurring in Denver upon the treatment outcomes experienced by types of chronically mentally ill (CMI) individuals. The reform involves the restructuring of the mental health system in Denver and the development of intensive case management and other services intended to more successfully engage the most seriously mentally ill clients. It is sponsored by the Robert Wood Johnson (RWJ) Foundation Nine City Demonstration Program and is facilitated by additional state resources targeted for the Denver system. A cluster analytically derived client typology is used to classify clients into one of four groups that reflect their demographic and clinical characteristics. Outcomes of clients served in Denver will be contrasted with those of individuals served in Colorado Springs and Pueblo (The Peaks). A multiperspective data collection approach is used in which data are collected form clients, collaterals and clinicians. Outcome data involve the client's status in eight outcome domains. A series of measures assessing unmet treatment and support needs as well as mental health services received will be used to elaborate site differences. Hypotheses: system reform will result in fewer unmet needs, greater volume and differing types of services in Denver than the Peaks; outcomes will be positively related to these improved services which reflect the system reform; and outcomes will be consistently related to client type and type by site interactions reflecting the differential impact of system reform on the heterogenous CMI population. Initial data on 786 client, 560 collaterals and 650 clinicians indicate that the study procedures and instrumentation are working as planned and that initial site differences are infrequent. The research is coordinated with the RWJ national evaluation and other university based researchers. Collaborators will provide detailed information regarding the system level impact of the reform and comparative client outcome data from other RWJ sites. This collaboration and the extension of the project to be coextensive with the life of the demonstration will fully exploit an opportunity to document the impacts of this system reform on differing types of CMI individuals.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Treatment Development and Assessment Research Review Committee (TDA)
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Colorado State Department of Institutions
United States
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Shern, D L; Wilson, N Z; Coen, A S et al. (1994) Client outcomes II: Longitudinal client data from the Colorado treatment outcome study. Milbank Q 72:123-48