Intoduction to Primary Outcomes

The goal of this working document is to define, for each domain treated in adult mental health services, a list of examples of primary (or sometimes perhaps, ultimate outcome measures for use in Treatment Planning in any domain, depending on an individual's goals and objectives, and functional impairments. Proposed here are outcomes that would be measured using significantly similar tools, including:

• Accomplishment
• Self-rating scales
• Standard instruments that have been developed and tested by others and are readily available from various sources
• Action Lists

This strategy does not propose that there are not other, intermediate outcomes in a plan (learning skills, overcoming barriers to the ultimate outcome, etc.) but each plan should contain as an ultimate outcome in domains treated, a standardized outcome like those proposed below.

Six-by-Six

Ratings in the 6X6 Functional Assessment, if reliable and used, are one method we can use to assess progress. To examine historical 6X6 ratings, use the 6X6 ratings history report found in plan and review services to look back at past ratings and progress.

Primary Outcome Examples

Not necessarilly all potential standardized outcomes are included here - this is a work in progress and should be a team effort. Clinical supervisors should consider this list, and addtions/clarifications as a primary responsibility of their job. Also, not necessarily all of the suggestions proposed here are necessarily as objectively measurable as we might like, and may not belong on this list or may need modificaion.

Some of them include outcomes we are asked to report on twice annually in the Mental Health Information System, or MHIS.

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These outcome examples are not intended for copy and paste, rather guidance on identifying primary outcomes. Some may need to customized for how they look to specific individuals.

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Mental Health

SubDomain	Status	Outcome	Measurement
Mental Health Services	Disengaged from needed service	Engaged	Action Items Functional Assessment
Mental Health Services	Dissatisfied with current provider(s)	Satisfied	Satisfaction Scale
Symptom Management	History of frequent MH hospitalization or inpatient treatment	Sustained reduction or no hospitalization or inpatient treatment	Recorded hospitalizations
Symptom Management	Reported impact of symptoms	Reported reduction in impact of symptoms	Standardized instruments like the PHQ-9, WHODAS, or IMR (already in TabsTM at Outcome and EBP Assessments) or those here from psychiatry.org (allowed without restriction for clinical use) or other sources

Health

SubDomain	Status	Outcome	Measurement
Health and Dental Care	Impact of physical or mental health symptoms on daily living activities	Reduced impact	WHODAS-36
Health and Dental Care	Not receiving regular preventative healthcare	Receiving regular preventative healthcare	Necessary preventative care measures specific to the individual Action list - Managed
Health and Dental Care	Not receiving regular dental care	Receiving regular dental care	Accomplishment Action list - Managed
Health and Dental Care	Has serious health condition - not receiving treatment	Receiving treatment	Accomplishment Action list - Managed, Resolved, or In Remission
Health and Dental Care	Has treatable serious health condition	Health condition managed, resolved or in remission	Accomplishment Action list - Managed, Resolved, or in Remission
Health and Dental Care	Specific condition - unmanaged	Condition managed	Accomplishment Action list - Managed, Resolved or In Remission
Health and Dental Care	Dissatisfied with provider(s)	Satisfied	Satisfaction Scale
Medications and Physicians Orders	Not compliant or unsure of compliance with physician orders	Compliant with physician orders or confident	Accomplishment Action list - Managed or Confidence or Frequency scale
Fitness or diet	Wants to improve fitness or diet	Reports improved fitness or diet or improved satisfaction	Agreement or Satisfaction Scale
Substance Use	Desires to quit or cut down	Reduced use or quit	Scale or accomplishment
Substance Use	Needs/wants treatment	Successfully completes treatment	Accomplishment Action list - Managed
Substance Use	Urges and impact of urges	Reduced frequency, intensity, or impact of urges to use	Urges to Use (in TabsTM at Outcome and EBP) or other simpler scale
Tobacco Cessation	Wants to quit	Has quit	Accomplishment

Home

SubDomain	Status	Outcome	Measurement
Financial	Basic needs unmet occassionally or regularly	Basic needs met, or will be met	Frequency or Confidence scale
Financial	Wants to save money or pay down debt	Saves a targeted amount or pays down debt	Accomplishment
Housing	Homeless	Housed	Accomplishment >> Cross reference MHIS outcomes data
Housing	Unstably housed	Stably housed	Accomplishment >> Cross reference MHIS outcomes data
Housing	Dissatisfied with current housing	Satisfied	Satisfaction Scale
Housing	At risk of losing housing	Stably housed	Accomplishment >> Cross reference MHIS outcomes data
Housing	Living in a non-independent setting	Living in a setting with higher independence	Accomplishment >> Cross reference MHIS outcomes data
Self Care and Independent Living	Reports dissatisfaciton with self-care and personal hygiene routine or skills	Reports satisfaction or regularity with self-care and hygiene routine	Satisfaction or Frequency Scale
Transportation	Unable to access or use reliable transportation	Accesses and reliably uses transportation	Scale (Confidence, Agreement, Satisfaction, Frequency) or Accomplishment

Connection

SubDomain	Status	Outcome	Measurement
Interpersonal Functioning	Dissatisfied with current key relationship(s) (family, significant other, friends)	Satisfied	Satisfaction Scale
Parenting	Parenting status at risk (CIP involvement)	CIP case closed	Accomplishment
Parenting	Separated from minor children - desiring reunification	Reunified	Accomplishment
Parenting	Dissatisified or with parenting success	Satisfied	Satisfaction Scale
Self Advocacy	Dissatisified with one or more relationships with provideras	Satisfied	Satisfaction Scale
Socialization and Recreation	Dissatisfied with current socialization and recreational life	Satisfied	Satisfacion Scale

Purpose

SubDomain	Status	Outcome	Measurement
Civic and community involvement or volunteering	Not involved - seeking involvement	Involved	Accomplishment
Employment/Education	Unemployed - desiring employment	Employed	Accomplishment >> Cross reference MHIS outcomes data
Employment/Education	Dissatisfied with current employment	Satisfied	Accomplishment >> Cross reference MHIS outcomes data
Employment/Education	Not in school - desiring to be in school	In school	Accomplishment >> Cross reference MHIS outcomes data
Employment/Education	In school - not satisfied or not confident of success	Satisfied or confident	Satisfaction or confidence scale

Samples and Examples for Scales for Use in Measuring Self-Reported Outcomes

This is not a comprehensive list.

Scale	Scale	Scale
Agreement 1 - Strongly disagree 2 - Somewhat disagree 3 - Neutral or unsure 4 - Somewhat agree 5 - Strongly agree	Ambivalence 1 - Not interested in change 2 - Unsure about change 3 - Considering change 4 - Desiring change 5 - Actively engaged in change	Confidence 1 - Very unconfident 2 - Somewhat unconfident 3 - Neutral or unsure 4 - Somewhat confident 5 - Very confident
Frequency 1 - Never 2 - Rarely or infrequently 3 - Mixed 4 - Sometimes to frequently 5 - Always	Satisfaction 1 - Very dissatisfied 2 - Somewhat dissatisfied 3 - Neutral or unsure 4 - Somewhat satisified 5 - Very satisified	Symptom Impact 5 - Profound 4 - Severe 3 - Significant 2 - Mild 1 - None
Mental Health Information System (MHIS) Outcomes Where scales are available in items listed above for MHIS outcomes data use the MHIS scales associated with the item or Use Accomplishment for achieving a desired status.	Pain Use any version of of the common standard visual pain scales (the ones with grimacing/crying to smiling faces) you find in your doctor's office). A customized Pain Scale with modified descriptors may also be useful in rating severity or impact of mental health symptoms.	Customize Scales Advanced practitioners: Work with individuals to develop custom scales using language that they choose and that works with them. Make efforts to assure these scales are closely aligned with the examples here.

How to Write an Outcome Using a Scale

Use the Cumulative or Scaled statement type. While this method appears much like an accomplishment, is better practice to use this outcome as ratings or averages that grow nearer to the target remain measurements of progress. Here is an example:

What will the individual do? (I will, John will...)	I will reach and maintain an average of
How much/many will be done?	4
Describe?	or higher on my Satisfaction with Relationships scale for two months (It is important to define a time period during which the average will be measured. Without this,it might be implied that the average will be taken for the entire duration of the plan, and depending on the goal, this might require immediate success to achieve the average.)
By when?	Select date

Remember to include the individual's rating scale (numbers and descriptions, if applicable) in the Techniques and methods. It is acceptable to use a simple scale without descriptors using a line/bar as follows:

Worst--------------------------------Best

1---------2---------3---------4---------5

or simply:

1-----------------------------------------5

Convert 5-Point to 10-Point Scale

The examples above use 1-5 scales. Using a 1-10 scale is always acceptable for individuals who desire more granularity, but expanding beyond 10 is not recommended. If you're using a scale with descriptors, they are are not necessary for every 10-point number.

5-Point Rating	10-Point Rating	5-Point Rating	10-Point Rating
(0.5)	1	3	6 (Use descriptor from 3)
1	2 (Use descriptor from 1)	(3.5)	7
(1.5)	3	4	8 (Use descriptor from 4)
2	4 (Use descriptor from 2)	(4.5)	9
(2.5)	5	5	10 (Use descriptor from 5)

Worst----------------------------Best

1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10

-or-

Best----------------------------Worst

1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10

Bottom Line: Be Person-Centered

Whether or not the smaller number is worst and larger best or vice versa, most important is to use the method that works best for the individual with whom you are working.

Unless you are using standard scales and descriptors, such as MHIS scales, it is the best practice to use recipient self-rating scales rather than scales rated by providers. Exceptions to this are circumstances where you can assure inter-rater reliability if more than one provider will be recording progress.

Feedback or Questions about this Chapter

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