“It is not just about the alcohol”: service users’ views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence

Abstract

BackgroundThe involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised.MethodsA focus group was conducted and data were analysed using a framework synthesis approach.ResultsService users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0–20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments.ConclusionsPatients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.

Clients with different problems are different and questionnaires are not blood tests: A template analysis of psychiatric and psychotherapy clients' experiences of the CORE‐OM

“…In line with earlier studies (Alves et al, ; Unsworth, Cowie, & Green, ), both samples said the person offering the questionnaire should be a mental health professional, but the hospital participants put more stress on the impartiality of that person and tended to specify exactly which staff member they preferred for this task.…”

“…A number of such studies have focused on the widely used CORE‐OM measure (Evans et al, ; Evans et al, ) and include work in inpatient (Alves, Sales, & Ashworth, ; Guerra et al, ; Perry, Barkham, & Evans, ) and outpatient settings (Börjesson & Boström, ; Kelly, Holttum, Evans, & Shepherd, ), with methods including semi‐structured interviews and focus groups, and with different epistemological and theoretical approaches. Themes that appeared in these studies concerned understanding the measures, their purpose and consequences for treatment, and the characteristics of the staff member who offered the measure [CORE‐OM] to the patient.…”

“…One purely quantitative exploration (Barkham, Gilbert, Connell, Marshall, & Twigg, ) reported psychometric explorations of the CORE‐OM in both primary care and secondary care in the UK, but it would appear that few, if any, of the secondary care participants had psychotic experiences and all secondary care participants were receiving psychological therapies. Of the five qualitative studies of the CORE‐OM listed above, four were conducted in psychiatric hospital settings and three included participants who had a diagnosis within the schizophrenia spectrum (Alves et al, ; Guerra et al, ; Kelly et al, ; Perry et al, ). Hence, most qualitative studies of client's experiences of the CORE‐OM have neglected the experience when using outcome and change measures of participants in other nonhospital settings and not presenting psychotic experiences.…”

“There Are Things I Want to Say But You Do Not Ask”: a Comparison Between Standardised and Individualised Evaluations in Substance Use Treatment

“…However, as patients stated it in a previous study (Alves, Sales & Ashworth, 2016), it was not "just about the alcohol" (p. 4) and drugs. Besides their substance use, people made use of individualised outcome measures to express other concerns, such as their financial situation or difficulties in relating with their family members.…”

How Routine Patient‐Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single‐Case Study

“…Have to look individually" (Norman et al, 2014, p. 586). By including items indicated by patients themselves, PQ and other outcome PGM allow monitoring progress on case-specific issues that are not captured by their nomothetic counterparts they introduce novelty (Ashworth et al, 2007;Sales, Neves, Alves, & Ashworth, 2017) that is valued and used by therapists (Antunes et al, 2018;Barkham, 2016), while also perceived by patients as useful for promoting self-reflection (Alves, Sales, & Ashworth, 2016;Guerra, Sales, & Pereira, 2018). Besides IPPS, which uses PQ, the MFT-PRN (Johnson et al, 2017) also offers this possibility, by including in the intake questionnaire the top three presenting problems indicated by each family member, which are scored for intensity on a weekly basis.…”