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					Evaluation of CDEs
             Experimental Design


Treatment      O   O   O   X   O   O


Comparison     O   O   O   Y   O   O
  Quasi-Experimental Design


Treatment   O   O   Y   O     O
  Hypothesis Testing:
  Dependant and Independent Variables
Independent Variable   Dependant Variable
Counseling             Crime Reduction
Substance Abuse        PT Bookings
Individual             PT Convictions
Group                  PT Type of Crime
                       PT Most Serious Crime
Hospital Inpatient
                       Committed
Jail Inpatient         Days in Jail
  Hypothesis Testing:
  Dependant and Independent Variables

Independent Variable   Dependant Variable
Counseling             Mental Health
Substance Abuse        GAF
Individual             Alcohol Problems
Group                  Drug Problems
Hospital Inpatient
Jail Inpatient
  Hypothesis Testing:
  Dependant and Independent Variables
Independent Variable                 Dependant Variable
Planning & Development for the       Personal Functionality
Future
Plan Development                     PT GAF
Developing a Support System          PT Living Arrangements
Phychosocial Rehab Center            PT Employment Status
Socialization                        PT Conservatorship
Development of Educational Goals
Vocational Services
Contact with Employers
Prepare MIO to Participate in Post
Release Program
      Hypothesis Testing:
      Dependant and Independent Variables
Independent Variable          Dependant Variable
Temporal Help                 Personal Functionality
Helps Find Medical Services   PT GAF
Helps Find Dental Services    PT Substance Abuse
Helps Find Housing            PT Living Arrangements
Helps Find Financial          PT Employment Status
Assistance
Jail Inpatient                PT Conservatorship
     ACT Hypothesis: Dependent and
         Independent Variables
Independent Variable              Dependant Variable
Medication Support                Improved Mental Health
                                  Reduction of Criminal Justice
                                  Index
                                  Improved Personal Functionality
Order medication from
pharmacies
pick up and deliver medications
to clients
provide education about
medications
monitor medication compliance
     ACT Hypothesis: Dependent and
         Independent Variables
Independent Variable             Dependant Variable
Housing Assistance               Improved Living Arrangement
                                 Score
find suitable shelter
secure leases and pay rent

purchase and repair household
items
develop relationship with
landlord
improve housekeeping skills of
clients
     ACT Hypothesis: Dependent and
         Independent Variables
Independent Variable                Dependant Variable
Work Opportunities                  Employment Status
                                    Living Arrangements
                                    Financial Assistance
help to find volunteer and
vocational opportunities
provide liaison with employers
about hiring the mentally ill
serve as a job coach for clients
provide vocational guidance
counseling (e.g., voc ed testing,
resume development, job
seeking strategies
     ACT Hypothesis: Dependent and
         Independent Variables

Independent Variable                Dependant Variable
Entitlements                        Financial Assistance
assist clients complete/fill out    Living Arrangements
documentation
accompany clients to entitlement
offices
help client to manage food stamps
assists clients with
redetermination of benefits
Questions for Those Who Know
   What differences are there in data collection
    between treatment and comparison groups?
   How long does data collection continue after
    treatment ends for members of the treatment
    group?
   How long does data collection continue after
    treatment ends for members of the
    comparison group?
PRELIMINARY OUTCOMES
             Client “N”

 Total “N” of merged intake,
  intervention, and outcomes
  databases = 2,218
 Useable numbers are still small at
  this point
 Only inferences can be made right
  now
         How Will We Measure
             “Success?”

 The number of *new* bookings
  during treatment will be taken as
  an indication of success or failure
 The number of days in jail

 The number and type of
  convictions
 Quality of life variables
     How Did Enhanced Treatment
     Affect New Bookings Overall?

   52% of the treatment as usual group had
       new bookings during treatment
   39% of the enhanced treatment group had
       new bookings during treatment
   This is an improvement of 13% with a total
       N of 369
        What May Have Reduced New
                Bookings?

   Difficult to identify specific intervention
    affecting new bookings
       Correlational methods show relationships, not
        clear
       More data needed for cause-effect analyses
   Interesting trends do appear to be
    developing
Minutes Spent Developing a Support
System versus New Bookings During
            Treatment
Providing Transportation for Clients
   versus new Bookings During
            Treatment
         Number of Days in Jail

         Treatment   Enhanced
          as Usual   Treatment

Mean        28          19

Median      2           0
S.D.        45          37
“N”        355         393
A.C.T. FIDELITY
          DACT Scales
Program Criteria for Fidelity to ACT


 Structure & Composition of Human
  Resources
 Organizational Boundaries

  (Responsibilities)
 Nature of Services
             DACT Scales
       Human Resources Variables
   Caseload: client/provider ratio
   Team Approach: number of individual client
    contacts with multiple staff members
   Program Meeting: frequency with which
    program staff meet to plan services and review
    progress of clients
   Practicing Team Leader: extent to which the
    team leader actually provides front line services
    to client (as opposed to focusing on
    administrative processes)
                 DACT Scales
            HR Variables -continued-
   Continuity of Staffing: turnover
   Staff Capacity: number of unstaffed positions
   Psychiatrist on Staff: number of FTEs
   Nurse on Staff: number of FTEs
   Substance Abuse Specialist on Staff: number
    of FTEs
   Vocational Specialist on Staff: number of FTEs
   Program Size: number of FTE staff
HR Structure by Program
HR Structure and
Composition Facet
              DACT Scales
        Organizational Boundaries
      (Comprehensiveness of Responsibilities)
   Explicit Admission Criteria: well defined
    criteria to identify and screen out (or in)
    inappropriate/appropriate clients; identification
    of target treatment population
   Intake Rate: monthly client intake rate
   Full Responsibility for Treatment Services:
    comprehensiveness of services offered
        Organizational Boundaries
               continued
   Responsibility for Crisis Services: extent of
    availability of crisis services
   Responsibility for Hospital Admissions:
    number of clients for which program initiates
    hospital admissions
   Responsibility for Hospital Discharge:
    number of clients for which program participates
    in hospital discharge decisions
   Time-Unlimited Services: length of time during
    which program services are available to clients
Organizational Boundary
  Scores by Program
Organizational Boundary
       by Facet
                DACT Scales
         Nature of Services Variables
   In-vivo services: extent to which client
    services are delivered in the community (as
    opposed to program offices/premises)
   No Dropout Policy: retention rate
   Assertive Engagement Mechanisms:
    extent to which program actively recruits
    clients versus clients come to or are
    assigned to the program
     Nature of Services Variables
             -continued-

   Intensity of Service: amount of time
    spent with clients
   Frequency of Contact: number of
    program contacts with client
   Work with Support System: extent
    to which non-program support
    resources are used to aid clients
Service Scores by Program
Nature of Service Facets
Overall ACTness Scores by
       Program No.
      Commonly Provided Categories of
         Services in the ACT Model
1. Rehabilitative approach to daily
   living skills
      grocery shopping and cooking
      purchase and care of clothing
      use of transportation
      help with social and family relationships
                                      Chart 1
                                      Chart 2
 Commonly Provided Categories of
    Services in the ACT Model

2. Family Involvement
    crisis management
    counseling & psychoeducation with
     family and extended family
    coordination with family service
     agencies
                                 Chart 1
                                 Chart 2
  Commonly Provided Categories of
     Services in the ACT Model

3. Enhancing Work Opportunities
    help to find volunteer and vocational
     opportunities
    provide liaison with and educate
     employers
    serve as job coach for consumers
                                   Chart 1
                                   Chart 2
  Commonly Provided Categories of
     Services in the ACT Model
4. Assisting with Entitlements
  assisting with completing
   documentation
  accompanying consumers to
   entitlement offices
  managing food stamps
  assistance with redetermination of
   benefits                     Chart 1
                                 Chart 2
  Commonly Provided Categories of
     Services in the ACT Model

5. Promoting Good Health
    provides preventive health education
    conducts medical screening
    schedules health maintenance visits
    provides liaison for acute medical care
    provides reproductive counseling and
     sex education                 Chart 1
                                   Chart 2
  Commonly Provided Categories of
     Services in the ACT Model

6. Medication Support
  orders medications from pharmacy
  delivers medications to clients
  educates clients in proper use of
   medication
  monitors medication compliance and
   side effects                   Chart 1
                                  Chart 2
  Commonly Provided Categories of
     Services in the ACT Model
7. Providing Housing Assistance
     finding suitable shelter
     securing leases
     paying rents
     purchasing household items
     repairing household items
     developing relationships with
      landlord/helping client to do same   Chart 1
     improving housekeeping skills
                                           Chart 2
  Commonly Provided Categories of
     Services in the ACT Model
8. Assisting with Financial
   Management
   planning budgets
   troubleshooting financial problems
   assisting with bills
   teaching money management skills
                                   Chart 1
                                   Chart 2
      Commonly Provided Categories of
         Services in the ACT Model
9. Counseling
     using problem-oriented approach
     integrating counseling into continuous work
     ensuring that client goals are addressed by all
      team intervention members
     promoting skills in communicating with others
     providing counseling as part of a
      comprehensive rehabilitative approach Chart 1
                                              Chart 2
         Possible Contributions to the
        Fund of Knowledge Regarding
                     ACT
   Does a strong vocational focus add to ACT’s
    effectiveness?

   Do social skills training and development of social
    networks add to ACT’s effectiveness?

   Do programs heavily loaded with “ACTness” yield
    less involvement with the criminal justice system
    than programs with relatively little “ACTness”?
Drug Testing by Program
Mental Health Court
   by Program
24/7 by Program
                Probation Officer
                 to Client Ratios
 Mean                          39.6   33.5
 Standard Deviation            26.0   13.9
 N                             14     13
 Minimum Number of
 Clients/PO                    15     15
 Median Number of Clients/PO
                               36     32
 Maximum Number of
 Clients/PO                    120    61

1 Outlier=120
                      Case Manager
                     to Client Ratios
Mean                            14.7    10.1
Standard Deviation              12.6    4.2
N                               15      13
Minimum Number of Clients/CM     3       3

Median Number of Clients/CM     10      10

Maximum Number of               50      15
Clients/CM
2 Outliers= 40,50
QUESTIONS?
Rehabilitation Scores
                      Back
    by Program
Rehabilitation Facets Analysis
                          Back
Involvement Scores
                     Back
    by Program
Involvement Facets   Back
Work by Program   Back
Work Facets   Back
Entitlements by Program
                      Back
Entitlements Facets   Back
Health by Program   Back
Health Care Facets
                     Back
Medication Support
   by Program        Back
Medication Support Facets
                       Back
Housing Scores by Program
                       Back
Housing Facets   Back
Financial Management
     by Program        Back
Financial Management Facets
                       Back
Counseling   Back
Counseling Facets
                    Back