Tim D. Aubry

Special Issue

Comprehensive Costing of Support Services for Vulnerable Populations: A Case Study

Authors:
Pages:
25-38

Comprehensive costing of human services remains an understudied issue in evaluating health and social services. Evaluations done to date have considered either only some of the services offered to clients or restricted the examination to costs borne by programs. Most studies to date have been conducted in the United States and Britain, countries that have different systems of health and social services than Canada. This article presents a case study of the use of a “comprehensive costing approach" in a Canadian context. The approach examines the full range of costs of health and social services and other supports associated with assisting a person with severe and persistent mental illness to live in the community. The case study represents a pilot program (funded by the Ministry of Health in Ontario) to provide specialized support services for a consumer to live in the community. Cost comparisons developed around the initiation of the pilot program in the present evaluation examined the initial months of the consumer in the program and a period prior to entering the program when the consumer was receiving standard care in the community including a period of hospitalization. Costs were compared according to different domains such as accommodation, social benefits and health and social services. Perspectives of program planners on the impact of costing evaluations for a case study are provided, followed by limitations and future directions for the methodology.

Validation d'une version française du Outcome Questionnaire et évaluation d'un service de counselling en milieu clinique

Authors:
Pages:
57-74

The first purpose of this study was to assess the psychometric quality and validity of the Mesure d'Impact-45 (MI-45) and the Mesure d'Impact-22 (MI-22), French translations of 45-item and 22-item versions, respectively, of the Outcome Questionnaire (Lambert & Burlingame, 1996a, 1996b). The second purpose was to evaluate, by means of the MI-22, a French-language counselling program located in a clinical setting in Quebec, which provided additional information on the sensitivity to change and clinical utility of the MI-22. Eleven counsellors served a total of 216 clients (80% women) during the period of the study. The MI-22 had good internal consistency (coefficient alpha = .88) and correlated well with a criterion measure, the SCL-10, a short form of the SCL-90-R (Derogatis, 1993). Ninety clients who had taken part in at least 8 counselling sessions made clinically and statistically significant progress. Of 107 clients completing counselling during the study period, 37% recovered, 29% improved, 24% experienced no change in functioning, and 10% deterioriated. Seventy clients who had completed a post-counselling telephone interview expressed a high level of satisfaction with the program, while also making suggestions for service improvement. The MI-22 was seen as useful by both clients and counsellors.

Fall

An Evaluation of Outpatient Clinic Services for Patients with Panic Disorder

Authors:
Pages:
93-114

The study is an evaluation of treatment services that are provided to patients with panic disorder at an outpatient mental health clinic A mail survey was used to contact patients who had completed therapy at the clinic between January 1987 and October 1989. Responses were obtained from 21 individuals (representing a 70% response rate). Results indicated that 14 of 21 patients (66%) no longer meet diagnostic criteria for panic disorder. However, even among these successfully treated patients, some continued to have occasional panic attacks, and others acknowledged a significant level of psychological distress. in general, patients expressed high levels of' satisfaction with the clinic services, and they provided important feedback concerning the effectiveness of different treatment modalities. On the basis of these results the authors discuss a number of suggestions for improving the operation of the clinic.