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Article Excerpt
All segments of the behavioral healthcare system are increasingly being called upon to demonstrate the effectiveness of their treatment. This article outlines a type of research study, the effectiveness study, that can be implemented quite easily and inexpensively and can provide a measure of treatment success. The article discusses choice-points for engaging in an effectiveness study and gives suggestions for research decisions. A small-scale study conducted at a partial hospitalization unit for eating disorders is used as an example. The information on designing and implementing a research program and the example provided are intended to assist practitioners and program administrators who are considering engaging in their own outcome research.
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All segments of mental healthcare have felt the effects of changes in healthcare funding. Treatment programs are increasingly being called upon to demonstrate the effectiveness of their interventions in order to receive managed care contracts or insurance reimbursement for treatment (Lennox, 1995; Sexton, 1996). Programs and professionals who cannot demonstrate their successes may find themselves unable to survive in the current competitive environment (Burlingame, Lambert, & Reisinger, 1995).
In spite of these pressures, there has been some resistance among mental healthcare providers to demonstrate program effectiveness. Some providers have argued that the invasion of accountability into mental healthcare has negatively impacted therapeutic decision making (Sherman, 1992). Still others argue that time spent in evaluation could be better used in treatment or that the therapeutic process is simply not quantifiable (Mirin & Namerow, 1991). Finally, there is a growing voice in the literature that specific interventions do not lead to specific outcomes. Rather a common-factors or curative-factors approach supports the belief that transtheoretical therapeutic factors are primarily responsible for client change. From this perspective, research that leads to specific empirically supported treatments for specific disorders misses the mark (Wampold, 2001). Regardless of these philosophical objectives, the financial reality remains. Few practitioners could survive financially without managed care or other insurance contracts (Granello & Granello, 2001).
Of course, not all practitioners are resistant to demonstrations of effectiveness. However, even among those who are open to conducting such research, there appears to be a widespread reluctance to initiating such research. Practitioners may erroneously believe that the task will be overwhelming (Plante, Couchman, & Diaz, 1995), or that a program of research will necessarily be costly, complex, and time-consuming (Granello, Granello, & Lee, 1999). What has become apparent is that many mental health practitioners have not received the training they need to conduct such research. Research methods courses in university programs may focus on understanding laboratory research with true experimental designs that often are not possible in real-world assessment (Sandell, Blomberg, & Lazar, 1997). Thus, there are some practitioners who may be ill prepared to conduct their own outcome research, regardless of their willingness to do so.
Because of these problems with conducting research, many programs rely on published research studies to demonstrate treatment successes. Clearly, published research plays a significant role in determining appropriate treatment interventions and the efficacy of various modalities, but bridging the gap between research and practice is essential (Sexton, 2000). Research on one's own program effectiveness, in conjunction with already published research to support general program interventions, increases the quality of the information provided to practitioners, the public, and the funding sources (Granello & Granello, 2001).
Measuring treatment effectiveness need not be a difficult or cumbersome task. Simple measures of effectiveness can be implemented quite easily, and the demonstrated outcomes from such research can be a very effective tool to provide evidence of treatment success. Further, measures of program effectiveness can be used to enhance client satisfaction and, if used properly, can be used proactively to improve client care (Burlingame et al., 1995).
This article outlines a specialized type of research, the effectiveness study, that can be used by many different types of behavioral treatment facilities to demonstrate treatment success. The focus on this research was in an eating disorders program, but many of the components of this type of research are generalizable to other types of intervention programming. The purpose of this article is to assist mental health program administrators and clinicians who wish to demonstrate treatment effectiveness yet may be reluctant to engage in research that is costly, that requires manipulation of the treatment program, or that has experimentally complex designs. The effectiveness study is one approach that can be used to provide a measure of treatment success to the public, managed care and other insurance companies, and the clinical staff. This article outlines the choice-points for engaging in an effectiveness study and gives suggestions for research decisions. A small-scale study conducted at a partial hospitalization unit for eating disorders is used as an example. The information on designing and implementing a research program and the example provided are intended to assist program administrators who wish to begin their own outcome research.
METHODOLOGY
Effectiveness Research
Mental health administrators wishing to collect research data need to be aware of the differences between field or "effectiveness" research and laboratory or "efficacy" research. Administrators and clinicians working with patients in the field must face fiscal, ethical, and demographic realities that are often outside of their control. This reality differs significantly from laboratory research in which experimental manipulation is easier. The distinction is important for individuals wishing to conduct outcome research outside of the laboratory and merits a brief discussion.
Efficacy studies use random assignment to treatment and control groups, manualized treatment, and subjects who meet criteria for a single diagnosed disorder (Seligman, 1995; Wampold, 1997). They provide useful information and are appropriate designs for laboratory studies (Sandell et al., 1997) or settings in which highly controlled manipulation of variables is possible (Kazdin, 1980; Lambert, Huefner, & Nace, 1997). However, they are beyond the scope of most mental health treatment programs to implement.
Effectiveness studies such as the current one attempt to answer how...
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