Abstract This study proposes a model for meeting increasingly mandated outcome research objectives in a university counseling center setting. It is proposed that counseling centers utilize their existing intake forms, along with an annual satisfaction survey to determine the effectiveness of counseling services. Effectiveness is defined as improvement and measured by the reduction of the symptoms or presenting concerns with which the client initially presented. It also introduces the Relative-Change Index (R-Chi) as an objective way to quantify intra-individual change occurring as a result of therapy. This new mathematical procedure allows for a more meaningful assessment of the client's degree of improvement, relative to their potential for improvement. By re-administering the problem checklist, routinely included as part of the initial paperwork for each client at intake, again post-therapy, it is possible to quantify improvement by measuring the difference in distressing concerns. Additionally, including a subjective, retrospective survey question asking the client to indicate their perceived rate if improvement at follow-up provides construct validity and allows for correlational comparisons with R-Chi. Results suggest that student/client ratings of the degree to which the services they received satisfactorily addressed their presenting concerns were significantly rated to their R-Chi score. This model suggests that the framework guiding client outcome research should include measures of the client's level of distress, improvement in reducing the distress, and satisfaction with services.

There are four main components in this thesis: a literature review of program evaluation, a description and discussion of the current status of program evaluation in the crisis intervention literature, results and discussion of the formative evaluation which is the primary element of the thesis, and a report on the use of the Goal Attainment Follow-up Guide (GAFG) (Kiresuk & Sherman, 1968) and the Brief Derogatis Psychiatric Rating Scale (B-DPRS) (Derogatis, 1978) for community-based mobile crisis intervention programs. The data for the evaluation were gathered using both quantative and qualitative methods. There were 150 participants in the study: 89 females and 61 males. The mean age was 35. The GAFG was completed by 81 of the participants; 33 of the participants were administred the B-DPRS. There were three major findings in this evaluation. the participants contacted significantly more community agencies and spent less time in hospital after using the crisis program and the GAFG and B-DPRS were found to be unsuitable as outcome instruments for a community-based mobile crisis program. / xv, 208 leaves : ill. ; 28 cm.

A dissertation submitted in partial fulfillment of the requirements for the degree of Master of Arts in the Department of Psychology, University of Zululand, South Africa, 2006. / The University of Zululand Community Psychology Centre (CPC) is a joint project of the Department of Psychology, Educational Psychology and Industrial Psychology. It was established in response firstly to the University's need to provide relevant training for its post-graduate psychology students and secondly to meet the need within the Zululand community for affordable psychosocial and psycho-educational services. The Centre works in partnership with other local Zululand Mental Health centres. The Centre is accredited with the Professional Board for Psychologists of the Health Professions Council of South Africa (HPCSA). This board ensures that institutions providing psychological services observe ethical codes of conduct and good practice (HPCSA, 2002). The present research was motivated by the fact that the CPC functioning has never been evaluated in terms of service delivery and relevance. The desire to know whether the CPC serves the purposes for which it was established, and to identify areas that need improvement, is a strong motivation. This helps to identify its viability, effectiveness, and value for the University of Zululand and the community served by the University. The aims of the study were to evaluate the CPC in terms of clients' perceptions with regard to effectiveness of the centre in meeting their needs and improving their psychological well-being. An accidental or convenient sample was used. An invitation to volunteer was extended to clients who happened to come for the CPC services. Volunteers completed a questionnaire^ which included a biographical inventory needs analysis questionnaire and RyfTs Scale (1995) of psychological well-being. Participants were pre and post-tested on the variable of psychological well being. The study concluded that the CPC still serves the purpose for which it was established. It is still relevant to the demand of the community. The results revealed that pre and post testing was associated with a significant improvement in total psychological well-being as with special reference to personal growth and positive relations with others. / NRF

The goal of this dissertation is to examine the utility of screening for common mental disorders in primary care in low and middle income countries. Screening for common mental disorders in primary care is often considered as an important step in addressing the mental health treatment gap in low and middle income countries. Nevertheless, there is insufficient evidence to support routine mental health screening in primary care in these countries. Even in high income countries, there is a lack of consensus on the effectiveness of routine mental health screening in primary care, especially screening for depression. Challenges to screening include the high rates of false positive diagnosis, poor evidence on outcomes for people identified by screening, and potential harms due to screening. The specific aims of this dissertation are to: 1) synthesize evidence from low and middle income countries on the current practices of screening for common mental disorders in primary care and the use of screening instruments; 2) understand the significance of a positive screen for common mental disorder in primary care, specifically the distribution and the stability of ICD-10 diagnosis for screened positive patients, their clinical course over a period of one year, and the factors associated with the clinical course; 3) examine the factors associated with antidepressant prescriptions for patients screened positive for common mental disorders in primary care and evaluate the appropriateness of antidepressant prescriptions following screening. Based on our review of literature, evidence to support routine screening for common mental disorders in primary care in low and middle-income countries is inadequate. We highlight concerns about the fidelity with which screening is implemented, especially the flawed use of screening instruments. Introducing depression screening and physician notification in these settings seldom results in improved access to care or appropriate care. The majority of patients identified by screening in primary care have contextual, and probably non-pathological psychological distress (see page iii, for definition of key terms) which is often temporary and self-limiting. Patients with persistent distress symptoms identified by repeated screening, and those with moderate to severe depression may benefit from screening in the presence of evidence based stepped care interventions that are easily accessible and acceptable. Although, the long term effects of these interventions and the sustainability of such primary care based programs in low and middle income countries are uncertain. Our analysis of data from a cluster randomized control trial in India confirmed that a significant proportion of patients screened positive for common mental disorders in primary care has psychological distress that is temporary and self-limiting. However, a smaller, albeit important share of patients also experienced psychological distress that persisted throughout one-year follow-up. Persistent distress was predicted by psychosocial and economic disadvantage. Thus, psychosocial support systems and structural interventions have a larger role to play in addressing psychological distress. We found poor diagnostic stability for ICD-10 based diagnoses, and the most stable and prevalent diagnosis was mixed anxiety and depressive disorder. Further, we found that antidepressants are widely prescribed following screening especially for women and older adults. While many patients with moderate to severe depression could benefit from antidepressants, it is problematic that a significant proportion of patients with less severe disorders also received anti-depressant prescription despite the availability of non-pharmacological treatment options. In summary, there is a lack of empirical evidence to support routine screening for common mental disorders in primary care in low and middle income countries as an effective strategy to identify those in need of treatment; instead screening could lead to over diagnosis and inappropriate antidepressant prescriptions. To address psychological distress in primary care and the unmet need for treatment in low and middle income countries, there is an urgent need to focus on locally driven and culturally relevant approaches to case finding and intervention.

The purpose of the study was to explore the inter-rater reliability of the Multi-Dimensional Outcome Measure (MDOM) in the following areas: overall reliability, differences in reliability between samples, differences in reliability between scales, and increasing reliability over time. The study was to assist mental health professionals by clarifying the technical properties of an evaluation tool which could be used to document program outcomes for policy makers and to develop more effective treatment methodologies. The MDOM was administered to two groups, a mentally and emotionally disturbed sample of thirty-five Subjects from an inpatient facility and a normal sample of thirty-three community college Subjects. The MDOM was given in back-to-back interviews by two interviewers alternating in first interviewer, second interviewer roles. The data indicated acceptable inter-rater reliability for the Multi-Dimensional Outcome Measure. For anyone sample, all twelve scales showed acceptable reliability according to the criterion of a .75 product moment correlation coefficient. However, four scales did not meet the .75 level: Productivity I (.55), Productivity II (.74), Interpersonal Isolation--Family (.71) when administered to the inpatient sample, and Drug Abuse (.74) when administered to the community college sample. Assessment of the differences in reliability between samples showed higher reliability for the community college sample than for the inpatient sample with the exception of the Drug Abuse scale. Exploration of the differences in reliability between scales showed some scales contained items which were more relevant for the college student than for the inpatient. Other scales included items which were ambiguous or worded in an awkward manner which may have contributed to their lower reliability. Reliability could be increased as a result of the increased skill and clarification of questionable items. Scales which demonstrated unacceptable reliability the first weeks of the study indicated an acceptable level the last week. The data suggested that interviewers should be trained to insure acceptable reliability. The MDOM was seen to be suitable for monitoring the functioning of a community based sample; however, consideration should be given to the inherent limitations before administering the instrument to an inpatient sample.

Evaluative research in the field of mental health is carried out pursuant to several goals. One is to study a very particular intervention on a very particular client (or client population) in a controlled way with the aim to test a theory of intervention. This form of research requires basically an experimental research design. It also requires rigorously defined and measured intervention and a good control for factors other than intervention. The requirements for this form of research are stringent and the number of such projects reported is, therefore, rare. The present study was done as a pilot study for the Elahan Center for Mental Health and Family Living (formerly Clark County Mental Health) in Vancouver, Washington. This agency has recently undergone much change. About eighteen months ago there was a change of Directors. At about the same time, though unrelated, the agency was involved in a public scandal around the drug program. As a result of much inter-agency strife and the change in administration, few employes from the old staff remain. The new administration is dedicatedly behaviorist in therapeutic orientation, as are some of the therapists. Use of para-professionals in professional capacities is high and most of tile para-professionals follow the behavioristic bent of the administration.

Increasing prevalence and severity of undergraduate psychopathology, combined with heightened burden on college campus counseling centers and the potential for sustained distress and self-harm, has necessitated comprehensive, vertically integrated on-campus mental health services. Initiatives include preventive interventions that: 1) foster resilience and adaptive coping, 2) ameliorate sub-threshold symptoms of pathology as secondary prevention, and 3) foster well-being and meaningful student experiences for greater fulfillment and thriving. A growing body of supportive data has led to some expansion of mental health and wellness services on college campuses, including the use of spiritually integrated mind-body practices to promote well-being. While college campuses’ wellness initiatives show promise, structured spiritual-mind-body (SMB) interventions have yet to be formally tested in either open or controlled clinical trials. The primary aim of this open-trial pilot study was to evaluate the feasibility and acceptability of an eight-session SMB-integrated wellness intervention, Awakened Awareness for Adolescents (AA-A), adapted specifically for late adolescent (ages 18 - 25) college students from Awakened Awareness for adults (AA) to support spiritual development and individuation. A secondary aim was to obtain preliminary data on changes in undergraduate students’ mental health and spiritual well-being across the AA-A intervention. Participants consisted of 77 non-clinically-referred undergraduates aged 18 - 24, who attended an average of M = 5.75 (SD = 1.42) out of the eight sessions. Measures included common psychopathology symptoms, spiritual well-being, psychological, and psychosocial variables using validated self-report assessments. Additionally, we explored the effect of spiritual well-being variables’ change scores as predictors of post-AA-A psychopathology symptom scores, controlling for pretest symptom scores. Differential effects between participants with high and low baseline depression symptoms were examined on outcome measures. Preliminary findings support the feasibility and acceptability of the AA-A intervention for college student’s mental health and spiritual well-being. Results include significant reductions in depression, anxiety, post-traumatic stress (PTS) symptoms, and significant improvements in numerous spiritual well-being, psychological, and psychosocial variables. Further, a recovery process from high rates of PTS symptomatology and spiritual decline may be initiated by SMB interventions that foster enhanced spiritual perception and build awareness of personal and relational spirituality.

[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organization’s Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.

The purpose of the study is to develop a foundation of knowledge that could improve the current policies and procedures with regards to their implementation within the mental health services provided by the Children's Bureau.

The purpose of this study is to test the utility of Talcott Parsons' AGIL Model, i.e., Adaptation, Goal Attainment, Integration, and Latency (Pattern Maintenance) in evaluating the program effectiveness of a community mental health center (CMHC). The model provided a conceptual framework for the selection of appropriate variables. The dependent variable in this study is the overall evaluation of the CMHC as measured through the perception of community leaders. Fourteen hypotheses were constructed to identify and test the relationship among the AGIL criteria and the use of a selected set of independent variables. Data for this study were collected from primary and secondary sources. Secondary data were obtained from the Texas Department of Mental Health and Mental Retardation in Austin and the CMHC center in Eton. Primary data were collected through personal interviews of general community leaders and influential persons in health-related activities in the community. The selected independent variables included the scope of leadership, the attitude towards this community, socio-economic status, knowledge of the CMHC, and the commitment and involvement in the CMHC. Data indicated that Parsons' criteria for evaluating the CMHC's program were comprehensive and related to each other both positively and negatively. Among the selected independent variables, the type of leader was found to be the best predictor of program evaluation of this CMHC. Overall, generalized community leaders were more defensive and favorable to the CMHC's program compared with the specialinterest leaders. The leaders also differed in their emphasis of the AGIL criteria. The generalized community leaders were conservative in emphasizeing the evaluative criteria of adaptation, integration, and pattern maintenance; the special-interest leaders gave more emphasis to the goal attainment function of CMHC. It was concluded that Parsons' AGIL model was useful for evaluating a CMHC. The variant direction of relationship among AGIL criteria indicated differences in the perception of community leaders in the evaluation of the CMHC.