Residential and Treatment Facilities

Introduction

During the last decades there has been a trend towards building down inpatient care, but still many persons receive treatment in residential facilities. However, there are few assessment instruments measuring dimensions of such facilities and there are few empirical studies. Assessments of facilities should aim at the three basic questions of whom, what and how: (1) Who is the facility serving? (2) What kind of treatment are the patients offered? (3) How are the patients doing? (Or: What is the success rate of the programme?)

Who is the Facility Serving?

This basic question can be measured by simple aggregate data for patients like age, gender, diagnoses and a global measure of severity of the illness or state of the patient. It might be useful to aggregate data of the following instruments that most often are used to evaluate single patients.

The Health of the Nation Outcome Scales (HoNOS) (Wing et al., 1998) are designed to be rated by the clinician in every day clinical practice. They can be used to get a profile of the patients on twelve key dimensions comprising problems concerning behaviour, self-injury, drinking or drug-taking, cognition, physical illness, psychotic symptoms, depressed mood, relationships, activities of daily living, living conditions and occupation.

The Global Assessment of Functioning Scale (GAF) is used extensively as a global instrument (Endicott et al., 1976). However, it is important to keep in mind that without proper training and monitoring of reliability, the scores may easily [Page 826]become so inaccurate that they are nearly worthless (Loevdahl & Friis, 1996). To improve reliability, a new version of the scale has been suggested, with separate scales for assessment of severity of symptoms and severity of functional impairment (Goldman et al., 1992).

In many settings, it may also be relevant to add a scale like the SCL-90 (Derogatis et al., 1976) to give a measure of the level of perceived distress. However, this scale is not applicable for the most severely ill patients, like those with chronic psychoses. Many of these patients are either unable to complete the form or tend to score in the range of normal controls.

Karterud et al. (1998) give an example of how such aggregate data can be used to monitor units within a network of day hospitals.

What Kind of Treatment are the Patients Offered?

Only recently a systematic description and categorization of facilities has been published. The European Service Mapping Schedule (ESMS) has been developed by an international expert panel to classify the whole range of adult mental health services, including residential units with various intensities and types of care (Johnson et al., 2000). The instrument can be used to describe and study services, as well as differences and gaps in services. This is especially useful for describing and analysing systems of services, but it may also be used for describing and comparing dimensions of individual residential facilities. The map of the service tree has three main branches: residential services, day services and structured activities, and out-patient and community services. Within each branch the services are classified according to characteristics such as acute/non-acute, hospital/non-hospital, time limited/indefinite, mobile/non-mobile and different levels of intensity of services. Characteristics, structure, functions and range of services can be described, and levels of service use can be measured for each type of service. A glossary defines all terms in the instrument so that they can be used in the same way in different studies. A recent study in Spain shows how the instrument can be used and includes a discussion on reliability and validity (Salvador-Carulla et al., 2000).

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