May 2008 COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY. Recovery Self-Assessment of the County Mental Health System

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1 May 2008 COUNTY OF SAN DIEGO HEALTH AND HUMAN SERVICES AGENCY Recovery Self-Assessment of the County Mental Health System

2 Table of Contents Table of Contents Introduction... 3 Key Findings for Preliminary RSA Data... 4 Goals of Comprehensive use of the Recovery Self Assessment... 5 Who will participate?... 6 How will they participate?... 7 Recovery Self Assessment (RSA) Description... 8 Introduction... 8 Description... 9 Utility Instruments Person in Recovery Version Community Member Version Provider Version Administrator Version Published Data Preliminary Client Data RSA Subscales Life Goals Involvement Diversity of Treatment Options Choice Individually Tailored Services RSA Subscale Means RSA Subscale Means by Gender RSA Subscale Means by Race/Ethnicity RSA Subscale Means by Diagnosis RSA Subscale Means by Reporting Unit RSA Subscale Means by RU Type Recovery Self Assessment of the County Mental Health System 2

3 Introduction Introduction This report serves to explain how San Diego County Mental Health Service s comprehensive use of the Recovery Self Assessment (RSA) instrument will be implemented to evaluate changes in recovery orientation of the system. The report will also: Introduce the constructs evaluated by the Recovery Self Assessment (RSA) Present the four versions of the instrument as they would be distributed to persons in recovery, community members/advocates, providers and administrators Provide previous data obtained by the authors of the instrument Summarize preliminary San Diego County client data from the May 2008 supplement to the Mental Health Statistics Improvement Program (MHSIP) survey Recovery Self Assessment of the County Mental Health System 3

4 Key Findings Key Findings for Preliminary RSA Data RSA Subscales: Life Goals (how the system encourages clients to pursue individual goals and interests) Involvement (how the system allows clients to become involved in recovery oriented programs) Diversity of Treatment Options (how the system offers a range of treatment options and styles) Choice (how the system takes into account client preferences and choices during the recovery process) Individually Tailored Services (how the system helps clients tailor their treatment program to their individual needs) 1. The Involvement subscale was the only subscale with a rating less than 50% (fewer than 50% agree or strongly agree responses.) Items within this scale with less than 50% positive ratings include those assessing involvement with agency advisory board and management meetings, staff helping clients become involved with activities that give back to the community, and development of leisure interests and hobbies as a primary focus of services. 2. The system was rated highest on the item stating Agency staff do not use threats, bribes, or other forms of coercion to influence my behavior or choices. The highest proportion of respondents agreed or strongly agreed (83.35%) with this statement, compared to any other single item. 3. Compared to the Persons in Recovery data from the Connecticut Department of Mental Health and Addiction Services study, mean RSA scores for the San Diego County Mental Health System were points lower in each subscale and almost 0.4 points lower for the overall total RSA score. 4. On average, San Diego County Mental Health Services system was rated highest in the Life Goals and Choice subscales, and lowest for the Involvement subscale. This is consistent with trends from the Connecticut Department of Mental Health and Addiction Services study. 5. When comparing RSA subscale means by gender, males rated the system higher than females across all subscales. 6. When comparing RSA subscale means by race/ethnicity, African Americans and clients in the Other category rated the system higher across all subscales except Treatment Diversity as compared to Asian, Caucasian, Hispanic, or Native American respondents. 7. Clients with Bipolar Disorder and Other Psychotic disorders rated the system highest across all subscales. There were no consistent patterns among the lowest average system scores. 8. There were differences between reporting units in mean RSA subscales. Case management programs were rated consistently higher than outpatient programs across all subscales Recovery Self Assessment of the County Mental Health System 4

5 Goals of Recovery Self Assessment Goals of Comprehensive use of the Recovery Self Assessment The San Diego County Mental Health Services (SDCMHS) is a leader in mental health outcomes analysis of its services. With an increased budget due to the Mental Health Services Act (MSHA), the county implemented new programs such as Full Service Partnerships (FSPs) that changed the way that mental health care is provided. While these programs increase quality of life of our consumers, it is worth determining that they are cost effective and promote recovery. As a system, SDCMHS is interested in a recovery model. While some projects are already recovery oriented or in progress to improve their recovery orientation, we are interested in measuring whether these changes are improving the recovery orientation of the system. We will be assessing the recovery orientation in several domains to identify strengths and weaknesses. The Recovery Self Assessment (RSA) instrument measures the degree to which recovery supporting practices are evident in a system and offers clearly defined guidelines reflective of a recovery oriented environment. The instrument has four versions available: the Persons in Recovery Version, the Family/Community Advocate Version, the Provider/Clinician Version, and the Agency Director/Administrator Version. The Persons in Recovery Version of the RSA is already employed in the bi annual SDCMHS consumer state survey (preliminary data is provided in this report). We are interested in implementing a confidential system to utilize the other three versions of the Recovery Self Assessment along the same timeline as the current consumer state surveys. The first round of comprehensive survey administration (including all four versions of the RSA distributed within the same time frame) will serve as a baseline to compare San Diego with other mental health systems. Future rounds of questionnaires will be used to evaluate improvements in the system as a result of recovery minded changes. It is important to note that all answers will be used to improve the system as a whole, not to evaluate individual clinic care or consumer outcomes. Responses are extremely confidential and will be used strictly for the purposes of improving services. The county has contracted UCSD to manage the data so clinics need not be concerned with the county seeing individual responses. Your help with this endeavor is greatly appreciated and we hope that you will participate honestly and objectively to improve the environment that SDCMHS affords its consumers Recovery Self Assessment of the County Mental Health System 5

6 Participants Who will participate? 1) Persons in Recovery Version Implemented bi annually in the current SDCMHS state survey 2) Family/Community Advocate Version Family members Interested community members Community advocates Members of the Quality Review and Older Adult Councils 3) Provider/Clinician Version Clinicians at each county funded reporting unit Fee for service providers treating county funded patients 4) Agency Director/Administrator Version CEOs/administrators of clinics at each reporting unit Administrators at central county mental health Contract representatives Recovery Self Assessment of the County Mental Health System 6

7 Methods of Administration How will they participate? 1) Persons in Recovery Version Paper based SDCMHS state survey 2) Family/Community Advocate Version Paper based survey with self addressed envelopes attached Distributed by consumers Fliers containing the website for electronically based surveys Available in clinics and on the San Diego County Mental Health website for interested community members 3) Provider/Clinician Version Paper based survey with self addressed envelopes attached Appropriate packets distributed to each clinic by UCSD Web based survey available for interested participants Note: Providers are asked additional demographic information such as type of clinic, area of city, training/education, years providing service, and a question on how much they personally feel that they are recovery oriented in their own treatment. 4) Agency Director/Administrator Version Paper based survey with self addressed envelopes attached Appropriate packets distributed to each clinic by UCSD Web based survey available for interested clinics Note: Administrators are asked additional demographic information such as type of clinic, area of city, training/education, years providing service, and a question on how much they personally feel that they are recovery oriented in their own treatment Recovery Self Assessment of the County Mental Health System 7

8 Instrument Description Recovery Self Assessment (RSA) Description Note: All four versions of the actual RSA instrument are provided below. Introduction Aim: In conjunction with the Connecticut Department of Mental Health and Addiction Services (DMHAS) recovery initiative, the Recovery Self-Assessment (RSA) (O Connell, Tondora, Croog, Evans, & Davidson, 2005) was developed by the authors to assess the degree to which recovery-supporting practices are evident in the Connecticut Department of Mental Health and Addiction Services agencies. The authors wanted to move beyond the rhetoric of recovery by operationalizing principles of recovery into standards and practices that could be observed, measured, and fed back to mental health organizations in ways that allowed these organizations to use data to inform program improvement and organizational change efforts. Conceptual Foundation: The RSA contains 36 items associated with nine principles of recovery identified through extensive literature review and input from persons in recovery, family members, service providers, and administrators. These principles are: renewing hope and commitment; redefining self; incorporating illness; being involved in meaningful activities; overcoming stigma; assuming control; becoming empowered and exercising citizenship; managing symptoms; and being supported by others (O Connell et al. 2005). Development: Davidson, O Connell, Sells, and Staeheli (2003) conducted an extensive literature review of recovery from mental illness and addictions to identify common principles of recovery and recovery-oriented practices. As noted above, based on the literature, 9 principles of recovery were identified and used to generate the initial 80-items (Davidson et al.). Experts in clinical and community psychology, consumers and direct service providers of mental health and addiction services, and family members provided feedback and suggestions for the revision and/or addition of new items. The items were then edited, balanced with regard to conceptual domain, and selectively eliminated to generate the current, 36-item version of the RSA. The RSA was adapted for completion by CEO/agency directors, providers, persons in recovery, and family/significant others/advocates. Principle components factor analysis revealed five primary factors, all with good to excellent levels of internal consistency: Life Goals, Involvement, Diversity of Treatment Options, Choice, Individually Tailored Services. Stakeholders Involved in Instrument Development: Consumers/survivors, family/friends of consumer/survivor, members of racial and ethnic minority groups, providers, researchers, advocates, and administrators Recovery Self Assessment of the County Mental Health System 8

9 Instrument Description Description Items and Domains: The RSA contains 36 items. The instruments are constituted of five subscales that measure the domains: Life Goals, Involvement, Diversity of Treatment Options, Choice, and Individually- Tailored Services. Domains were developed by Principal Components Factor Analysis with Varimax rotation. All items are rated using the same 5-point Likert scale that ranges from strongly disagree to strongly agree. Also included is the option of marking not applicable for any given item. RSA Sample Items Person in Recovery Version: Staff focus on helping me to build connections in my neighborhood and community. Response options: 1 = Strongly Disagree - 5= Strongly Agree or N/A CEO/Directors Version and Provider Version: Helping people build connections with their neighborhoods and communities is one of the primary activities in which staff at this agency are involved. Response options: 1 = Strongly Disagree - 5= Strongly Agree or N/A Family/Significant Other/Advocate Version: Staff focus on helping people in recovery to build connections in their neighborhood and community. Response options: 1 = Strongly Disagree - 5= Strongly Agree or N/A Populations: The RSA is intended for use with programs/services for adults who have been diagnosed with a serious mental illness, dual diagnosis, or substance abuse. The RSA has been tested with individuals diagnosed with serious mental illness, dual diagnosis, or substance abuse from various ethnic/racial populations: Black or African Americans, White, and Hispanic or Latino. During testing, respondents also included mental health and addiction service providers, family members or significant others, and administrators/directors of state-funded mental health and addiction services. Subgroup analyses by ethnicity/race or by diagnosis have not been conducted to establish whether differences exist across groups Recovery Self Assessment of the County Mental Health System 9

10 Instrument Description Service Setting: The RSA is intended for use with individuals who receive and/or provide services in inpatient settings, outpatient settings, peer-run programs, residential programs, and social programs. The RSA has been tested in the previously mentioned settings and is designed to assess recovery-oriented practices regardless of setting. There are some settings where some of the items may be more or less applicable (e.g., most services take place in the community may not be applicable to an inpatient or criminal justice setting); however, it is argued that the RSA items may reflect more ideal recovery-supporting practices that could be applied in any setting. Methods of Administration: 1) Self administered 2) Mail administration Administration Time: Less than 10 minutes. Qualification/Training Requirement: None, the instrument is self-administered. Utility Quality Improvement Uses: The RSA operationalizes the principles of recovery, identifying objective practices that can be assessed from multiple perspectives. The RSA illustrates how research can be translated into everyday practice through the use of self-assessment and structured feedback. Data from the RSA can be utilized to create a Recovery Profile for an agency that would help agency personnel and stakeholders review their relative standing in comparison to other agencies, their relative strengths, and areas of improvement. Intended Level of Analysis: Data are intended to be analyzed at the Program Level and/or System Level. Current/Past Uses: The RSA has been used to conduct a statewide assessment of recovery-oriented practices in Connecticut. It has also been used in several organizations nationally as a self-evaluative tool. These organizations include mental health centers, Veterans Administration hospitals, social-rehabilitation programs, and other state mental health evaluations. The RSA has recently been selected for use by the V.A. as a measure of system recovery-oriented practices Recovery Self Assessment of the County Mental Health System 10

11 Instrument (Person in Recovery Version) Person in Recovery Version Instruments Recovery Self Assessment of the County Mental Health System 11

12 Instrument (Person in Recovery Version) Recovery Self Assessment of the County Mental Health System 12

13 Instrument (Community Member Version) Community Member Version Recovery Self Assessment of the County Mental Health System 13

14 Instrument (Community Member Version) Recovery Self Assessment of the County Mental Health System 14

15 Instrument (Provider Version) Provider Version RECOVERY SELF ASSESSMENT The San Diego County Mental Health Services (SDCMHS) is a leader in mental health outcomes analysis of its services. With an increased budget due to the Mental Health Services Act (MSHA), the county implemented new programs such as Full Service Partnerships (FSPs) that changed the way that mental health care is provided. While these programs increase quality of life of our consumers, it is worth determining that they are cost effective and promote recovery. As a system, SDCMHS is interested in a recovery model. While some projects are already recoveryoriented or in progress to improve their recovery orientation, we are interested in measuring whether these changes are improving the recovery orientation of the system. We will be assessing the recovery orientation in several domains to identify strengths and weaknesses. The Recovery Self Assessment (RSA) instrument measures the degree to which recovery supporting practices are evident in a system and offers clearly defined guidelines reflective of a recovery oriented environment. The instrument has four versions available: the Persons in Recovery Version, the Family/Community Advocate Version, the Provider/Clinician Version, and the Agency Director/Administrator Version. The Persons in Recovery Version of the RSA is already employed in the bi annual SDCMHS consumer state survey. We are interested in implementing a confidential system to utilize the other three versions of the Recovery Self Assessment along the same timeline as the current consumer state surveys. The first round of surveys will serve as a baseline to compare San Diego with other mental health systems. Future rounds of questionnaires will be used to evaluate improvements in the system as a result of recovery minded changes. It is important to note that all answers will be used to improve the system as a whole, not to evaluate individual clinic care or consumer outcomes. Responses are extremely confidential and will be used strictly for the purposes of improving services. The county has contracted UCSD to manage the data so clinics need not be concerned with the county seeing individual responses. Your help with this endeavor is greatly appreciated and we hope that you will participate honestly and objectively to improve the environment that SDCMHS affords its consumers. What type of clinic do you work for? Which area of the city is your clinic in? Which of the following best describes your education/training? How long have you been providing these types of services? Personally, how much do you feel that your treatment methods are recovery oriented? Recovery Self Assessment of the County Mental Health System 15

16 Instrument (Provider Version) Recovery Self Assessment of the County Mental Health System 16

17 Instrument (Provider Version) Recovery Self Assessment of the County Mental Health System 17

18 Instrument (Administrator Version) Administrator Version RECOVERY SELF ASSESSMENT The San Diego County Mental Health Services (SDCMHS) is a leader in mental health outcomes analysis of its services. With an increased budget due to the Mental Health Services Act (MSHA), the county implemented new programs such as Full Service Partnerships (FSPs) that changed the way that mental health care is provided. While these programs increase quality of life of our consumers, it is worth determining that they are cost effective and promote recovery. As a system, SDCMHS is interested in a recovery model. While some projects are already recoveryoriented or in progress to improve their recovery orientation, we are interested in measuring whether these changes are improving the recovery orientation of the system. We will be assessing the recovery orientation in several domains to identify strengths and weaknesses. The Recovery Self Assessment (RSA) instrument measures the degree to which recovery supporting practices are evident in a system and offers clearly defined guidelines reflective of a recovery oriented environment. The instrument has four versions available: the Persons in Recovery Version, the Family/Community Advocate Version, the Provider/Clinician Version, and the Agency Director/Administrator Version. The Persons in Recovery Version of the RSA is already employed in the bi annual SDCMHS consumer state survey. We are interested in implementing a confidential system to utilize the other three versions of the Recovery Self Assessment along the same timeline as the current consumer state surveys. The first round of surveys will serve as a baseline to compare San Diego with other mental health systems. Future rounds of questionnaires will be used to evaluate improvements in the system as a result of recovery minded changes. It is important to note that all answers will be used to improve the system as a whole, not to evaluate individual clinic care or consumer outcomes. Responses are extremely confidential and will be used strictly for the purposes of improving services. The county has contracted UCSD to manage the data so clinics need not be concerned with the county seeing individual responses. Your help with this endeavor is greatly appreciated and we hope that you will participate honestly and objectively to improve the environment that SDCMHS affords its consumers. What type of clinic do you work for? Which area of the city is your clinic in? Which of the following best describes your education/training? How long have you been providing these types of services? Personally, how much do you feel that your clinic s treatment methods are recovery oriented? Recovery Self Assessment of the County Mental Health System 18

19 Instrument (Administrator Version) Recovery Self Assessment of the County Mental Health System 19

20 Instrument (Administrator Version) Recovery Self Assessment of the County Mental Health System 20

21 Published Data Published Data Creators of the Recovery Self Assessment (RSA) conducted a study to evaluate the degree to which recovery oriented practices were perceived to be implemented in mental health and addiction agencies funded by the Connecticut Department of Mental Health and Addiction Services, as assessed by the RSA. The study used all four versions of the RSA to assess recovery orientation from multiple perspectives. Nine hundred and seventy four individuals (29% individual response rate) were surveyed from 78 facilities (39% agency response rate). The final number of respondents from the 78 agencies was: 68 directors, 344 providers, 326 persons in recovery, and 229 family members/significant others/advocates. A summary of RSA means for the five subscales and overall RSA score are shown in the table below: REFERENCE: O Connell, M., Tondora, J., Croog, G., Evans, A., Davidson, L. (2005). From Rhetoric to Routine: Assessing Perceptions of Recovery Oriented Practices In a State Mental Health and Addiction System. Psychiatric Rehabilitation Journal, 24(4), Recovery Self Assessment of the County Mental Health System 21

22 Preliminary Client Data Preliminary Client Data The spring 2008 Supplemental State Survey, distributed from May 12, 2008 to May 23, 2008, contained the persons in recovery version of the Recovery Self Assessment (RSA). The data presented below is a baseline analysis of the first implementation of this client RSA. To fully utilize the instrument in assessing changes in the recovery orientation of the system, future distributions of RSA surveys will include all four versions over the same window of administration. Compiling the RSA data with other parts of the state survey and other data sources (including INSYST), produced an analysis of Recovery Self Assessment scores by gender, race/ethnicity, diagnosis, and reporting unit type. RSA items contained answer choices based on a 5 point Likert scale with the following coding system: 1= Strongly Disagree 2= Disagree 3= I am Neutral 4= Agree 5= Strongly Agree A Not Applicable option was provided; however, these answers were not included in the analysis below. RSA items are grouped into 5 subscales: Life Goals Involvement Diversity of Treatment Options Choice Individually Tailored Services Each subscale is an average of the individual items within that domain. An RSA total score is assigned as an average of all 36 questions in the RSA instrument Recovery Self Assessment of the County Mental Health System 22

23 RSA Subscales 1. Life Goals RSA Subscales Question Q 25 Q 29 Q 33 Q 26 Q 24 Q 23 Q 22 Q 36 Q 20 Q 14 Q 16 Item wording Staff actively assist me with the development of career and life goals that go beyond symptom management and stabilization. Staff routinely assist me in the pursuit of my educational and/or employment goals. The role of agency staff is to assist me, and other people in recovery with fulfilling my individually defined goals and aspirations. Agency staff are diverse in terms of culture, ethnicity, lifestyle, and interests. If the agency cannot meet my needs, procedures are in place to refer me to other programs and services. Staff play a primary role in helping me to become involved in non mental health/addiction related activities, such as church groups, special interest groups, and adult education. Staff use a language of recovery (ie., hope, high expectations, respect) in everyday conversations. Agency staff believe that I can recover and make my own treatment and life choices. The achievement of my goals is formally acknowledged and celebrated by the agency. Staff at this agency encourage me to take risks and try new things. Staff are knowledgeable about special interest groups and activities in the community. Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 23

24 RSA Subscales 2. Involvement Question Q 30 Q 27 Q 15 Q 12 Q 21 Q 31 Q 32 Q 35 Item wording I am/can be involved with agency staff on the development and provision of new programs and services. I am/can be involved with agency advisory boards and management meetings. I am/can be involved with facilitating staff trainings and educational programs at this agency. This agency provides structured educational activities to the community about mental illness and addictions. I am/can be routinely involved in the evaluation of the agency's programs, services, and service providers. Agency staff actively help me become involved with activities that give back to my community (ie., volunteering, community services, neighborhood watch/cleanup). This agency provides formal opportunities for me, my family, service providers, and administrators to learn about recovery. The development of my leisure interests and hobbies is a primary focus of my services. Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 24

25 RSA Subscales 3. Diversity of Treatment Options Question Q 18 Q 34 Item wording This agency actively attempts to link me with other persons in recovery who can serve as role models or mentors by making referrals to self help, peer support, or consumer advocacy groups or programs. Criteria for exiting or completing the agency were clearly defined and discussed with me upon entry to the agency. Q 8 I am given the opportunity to discuss my sexual and spiritual needs and interests. Q 19 Q 17 Q 28 I am able to choose from a variety of treatment options at this agency (ie., individual, group, peer support, holistic healing, alternative treatments, medical.) Groups, meetings, and other activities can be scheduled in the evenings or on weekends so as not to conflict with other recovery oriented activities such as employment or school. At this agency, participants who are doing well get as much attention as those who are having difficulties. Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 25

26 RSA Subscales 4. Choice Question Item wording Q 3 I have access to all my treatment records. Q 13 Agency staff do not use threats, bribes, or other forms of coercion to influence my behavior or choices. Q 10 Staff at this agency listen to and follow my choices and preferences. Q 6 Q 11 I can choose and change, if desired, the therapist, psychiatrist, or other service provider with whom I work. Staff at this agency help to monitor the progress I am making towards my personal goals on a regular basis. Q 7 Most of my services are provided in my natural environment (ie., home community, workplace). Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 26

27 RSA Subscales 5. Individually Tailored Services Question Q 2 Item wording This agency offers specific services and programs to address my unique culture, life experiences, interests and needs. Q 9 Staff of this agency regularly attend trainings on cultural competency. Q 1 Staff focus on helping me to build connections in my neighborhood and community. Q 4 This agency provides education to community employers about employing people with mental illness and/or addictions. Q 5 My service provider makes every effort to involve my significant others (spouses, friends, family members) and other sources of natural support (ie., clergy, neighbors, landlords) in the planning of my services, if this is my preference. Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 27

28 RSA Subscale Means RSA Subscale Means Life Goals Involvement Treatment Diversity Choice Individual Total N Mean SD *NOTE: Data presented on a Likert scale ranging from 1 = Strongly Disagree to 5 = Strongly Agree. Dataa Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 28

29 RSA Subscale Means Comparison of RSA Persons in Recovery Means Life Goals Involvement Treatment Diversity Choice Individual Total Connecticut San Diego *NOTE: Data presented on a Likert scale ranging from 1 = Strongly Disagree to 5 = Strongly Agree. A comparison of RSA persons in recovery means derived from the Connecticut study using the RSA and the San Diego County supplemental survey shows that RSA means for clients in San Diego are lower in each subscale than for clients in the Connecticut sample. Dataa Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 29

30 RSA Subscale Means by Gender RSA Subscale Means by Gender Male Female Life Goals (N=248) (N=250) Involvement (N= =230) (N= =211) Treatment Diversity (N=258) (N=257) Choice (N=279) (N=296) Individual (N= =252) (N= =246) Total (N=266) (N=266) A comparison of RSA subscale means by gender showss that on average, male clients in San Diego County reported consistent ly higher scores than female clients. Dataa Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 30

31 RSA Subscale Means by Race/Ethnicity RSA Subscale Means by Race/Ethnicity African American Asian Caucasian Hispanic Native American Other Life Goals (N=70) (N=24) (N=265) (N=113) (N=3) (N=15) Involvement (N=65) (N=21) (N=239) (N=96) ( N=3) (N=11) Treatment Diversity (N=74) (N=25) (N=276) (N=115) (N=2) (N=15) Choice Individual (N=78) (N=67) (N=28) (N=28) (N=308) (N= =268) (N=129) (N= =109) (N=3) (N=2) (N=20) (N=17) Total (N=74) (N=25) (N=285) (N=120) (N=3) (N=17) When comparing RSA subscale means by race/ethnicity, African Americans and clients in the Other category reported higher average scores across all subscales except Treatment Diversity as compared to Asian, Caucasian, Hispanic, or Native American respondents. Dataa Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 31

32 RSA Subscale Means by Diagnosis RSA Subscale Means by Diagnosis Life Goals Involvement Treatment Diversity Choice Individual Total Schizophrenia and Schizoaffective (N=148) (N=140) (N=150) (N=165) (N=157) (N=157) Major Depression Disorders (N=145) (N=123) (N=149) (N=172) N=141) (N=158) Bipolar Disorder (N=85) (N=78) (N=88) (N=97) (N=83) (N=89) Anxiety Disorder (N=28) (N=21) (N=30) (N=35) (N=31) (N=31) Substance Abuse Disorder (N=2) (N=1) (N=2) (N=2) (N=0) (N=2) Other Psychotic Disorders (N=21) (N=18) (N=22) (N=22) (N=18) (N=22) Other Depression Disorders (N=37) (N=33) (N=36) (N=43) (N=35) (N=38) No/Deferred Diagnosis (N=38) (N=33) (N=44) (N=46) (N=40) (N=43) Clients with Bipolar Disorder and Other Psychotic disorders reported the highest average scores across all subscales. Clients with Bipolar Disorders reported the highest average scores on the Life Goals, Choice, and Individual subscales, while those with Other Psychotic Disorders reported the highest average scores in the Involvement, and Treatment Diversity subscales as well as the highest overall RSA scores. There were no consistent patterns among the lowest reported average scores. *Substance abuse results not included in this summary due to small sample sizes. Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 32

33 RSA Subscale Means by Diagnosis Dataa Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 33

34 RSA Subscale Means by Reporting Unit RSA Subscale Means by Reporting Unit RU N Life Goals Involvement Treatment Choice Individual Total Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 34

35 RSA Subscale Means by Reporting Unit Type RSA Subscale Means by RU Type Case Management Life Goals (N=53) Involvement (N=51) Treatment Diversity (N=57) Choice Individual Total (N=59) (N=53) (N=58) Outpatient (N=424) (N=372) (N=434) (N=490) (N=423) (N=450) A comparison of RSA subscale means by RU type reveals that on average, clients in San Diego County Case Management programs reported consistently higher scores than outpatient clients. Data Sources: Supplemental State Survey (5/2008), UBH (7/2008 download) Source: HSRC (AL, BL) 35

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