Matthew Chinman

Getting to outcomes: a results-based approach to accountability

Abstract Getting to outcomes: methods and tools for planning, evaluation, and accountability (GTO) was developed as a guidebook to help practitioners plan, implement, and evaluate their programs to achieve results. GTO is based on answering 10 accountability questions about needs and resources, goals, science and best practices, fit, capacity, plan, implementation, outcome evaluation, continuous quality improvement, and sustainability.

Toward the Implementation of Mental Health Consumer Provider Services

Encouraged by the New Freedom Commission, mental health systems such as the Veteran Administration (VA) are now becoming more recovery-oriented. Consumer providers (CPs)—those with serious mental illness who are further along in recovery who provide services to others with similar mental health problems—are viewed as a key part of this change. However, organizational change theories suggest that careful consideration of implementation issues is critical when disseminating new and sometimes controversial services into existing organizations. Therefore, to guide the dissemination of CP services, the literature on the effectiveness of CPs was reviewed, and interviews, focus groups, and a brief survey of 110 administrators, providers, and patients were conducted at three large VA clinics in Southern California. Questions focused on their perceptions of feasibility and acceptability of CP services. Using literature and study findings, an organizational change framework and other strategies to overcome potential implementation challenges of CP services are suggested.

Toward a Model of Adolescent Empowerment: Theoretical and Empirical Evidence

Empowering adolescents can serve as a preventive intervention for many of the problems that confront this population. While much of the literature on empowerment has focused on adults, this paper offers a model of empowerment for adolescents that draws from appropriate developmental theory, bonding and social control theory, and rolelessness. Literature that supports the adolescent empowerment model is reviewed. Popular interventions and activities are assessed using their “empowerment potential” as a yardstick. Common features that are consistent with the adolescent empowerment model are identified; and future directions for research are discussed.

Chronicity Reconsidered: Improving Person-Environment Fit Through a Consumer-Run Service

In the past, the term “chronic” referred to people who had serious mental illness and who typically received long-term care in a state mental hospital. Although this term recently has fallen out of favor, we resurrect the term here, not to revive a demeaning euphemism, but rather to redefine it as the result of a poor person-environment fit between the complex and challenging needs of those with serious psychiatric disorders and a community-based service system that often is ill-equipped to treat them. Previous research indicates that recurrent acute hospitalizations and an inability to establish or maintain tenure in the community may be due to a disconnection from community-based services and supports, social isolation, and demoralization. One promising approach to addressing these issues is that of peer support. To illustrate the potential utility of peer support in improving person-environment fit and decreasing the chronicity of the subsample of people who continue to have difficulty in establishing viable footholds in the community, we describe a peer support-based program, the Welcome Basket, developed, staffed, and managed entirely by mental health consumers. Preliminary analyses that evaluate Welcome Baskets effectiveness are included, and we discuss the implications of these data for future research and program development in this area.

Homelessness, Mental Illness and Citizenship

Assertive mental health outreach to homeless persons, which operates under the premise that mental illness must be understood and treated within the individual’s social and economic environment, points towards the goals of community membership and ‘citizenship’—a connection to the rights, responsibilities, roles, and resources that society offers through public and social institutions and informal ‘associational life’—for homeless persons. We argue that the concept of citizenship is a useful framework for approaching these goals. We review the principles of assertive mental health outreach and relevant aspects of contemporary citizenship theory; present a case example of outreach leading to a ‘citizenship project’; and discuss the potential benefits and pitfalls of a citizenship framework, including strategies and recommendations for program administrators, researchers and policy makers.

How are we doing? A statewide survey of community adjustment among people with serious mental illness receiving intensive outpatient services

Although mental health consumers often prefer community living, the factors influencing community outcomes are not well understood. In order to address this issue in Connecticut, the Department of Mental Health and Addiction Services (DMHAS) commissioned a statewide study of 6,800 clients receiving the most intensive community-based mental health services funded by the state. DMHAS clinicians provided the ratings for their clients on a variety of variables including demographics, diagnosis, clinical stability, current psychotic symptomology, adherence to prescribed medications, substance abuse, history of violent crime, community trouble-making or victimization, likelihood of threatening behavior, frequency of social contacts, and difficulty in adjusting to life in the community. Also, the total length of stay and total number of admissions during a two year period were taken from the statewide management information system for each client in the study. Descriptive data analysis included frequencies and means to describe the demographic, the diagnostic, and the clinical profile of the DMHAS clients. A stepwise hierarchical multiple regression analysis (MRA) was performed to determine what factors predict a composite score of overall functioning, community adjustment, and psychiatric impairment. Clients with better composite scores were those who had a prescription for medications, adhered more to their medication regimen, perceived to be less threatening, and had more frequent social interactions. Implications of these findings for outpatient treatment are discussed.

Trauma and adaptation in Severe Mental illness: The role of self-reported abuse and exposure to community violence

ABSTRACT The authors examined the role of self-reported physical and/or sexual abuse and recent exposure to community violence on three adaptation outcomes in Severe Mental Illness (SMI): psychotic symptoms, demoralization, and substance abuse. One hundred and nine (109) individuals with SMI were administered an extensive protocol that included the pertinent variables. Structural Equation Modeling analyses indicated that abuse predicted psychotic symptoms and demoralization, whereas exposure to community violence predicted substance abuse. These findings point to different possible trauma-adaptation configurations, and suggest that both past and present trauma complicates the adaptation of people with SMI.

Getting to Outcomes Guide for Teen Pregnancy Prevention

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RANDs publications do not necessarily reflect the opinions of its research clients and sponsors.

Evidence-Based Practices: Community-Based Interventions to Reduce Alcohol Use and Misuse

This chapter is a literature review highlighting effective community-based prevention initiatives for reducing and preventing adolescent substance use and misuse. Findings are presented from the research literature on multicomponent prevention initiatives and environmental strategies/policies implemented by communities that have a consistent evidence base of positive results. For these sections, the authors integrate findings from two recent publications, (1) Planning Alcohol Interventions Using NIAAA’s College AIM Alcohol Interventions Matrix (National Institute on Alcohol Abuse and Alcoholism (NIAAA). Planning alcohol interventions using NIAAA’s College AIM Alcohol Interventions Matrix (NIH Publication No. 15-AA-8017). Bethesda, MD: National Institutes of Health, 2015), and (2) Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health (U.S. Department of Health and Human Services, Office of the Surgeon General. Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. Washington, DC: U.S. Department of Health and Human Services, 2016). This update also includes a brief review of research literature on positive youth development (PYD), a holistic approach that focuses on developmental characteristics that can lead to positive outcomes including a reduction in negative behaviors among youth such as substance use. The chapter concludes by providing several recommendations to promote high-quality implementation to increase the likelihood of positive results. As funding for comprehensive evaluation efforts of community-based efforts becomes scarce, a communities’ capacity to ensure high-quality implementation should be prioritized.