Mental Health Outcome Evaluation. By David C. Speer. San Diego: Academic Press, 1998.
The evolution of managed care from a singular focus on cost containment to an interest in value has generated a great deal of interest in the enthusiasm for measuring outcomes of behavioral healthcare interventions. In fact, both players and accrediting organizations now routinely require provider organizations to assess clinical and organizational outcomes. With this increased interest has come a variety of books on the topic.
David Speer's book is a useful primer in the application of outcomes to the evaluation of service effectiveness. The book uses a relatively narrow definition of the measurement and methods involved in outcomes evaluation and thereby maintains its focus on evaluating change that may result from mental health service intervention. As such, there is no attention to decision support or outcome prediction methods nor the use of outcomes in systems level planning.
The book is divided into eight chapters. The first chapter gives a rationale for why outcomes evaluation is important and the second chapter stresses the goal of keeping such work practical. Chapter three tackles the complicated problem of defining and determining effectiveness. Table 1 in this chapter presents a nice summary of the relationship of sampling strategies to the limits on the interpretation of findings. Chapter four discusses measurement considerations with a primary focus on traditional and widely used outcome measures. Chapters six and seven discuss challenges and implementation issues. These chapters remain conceptual but cover many of the conundrums experienced when working in this area. Finally, chapter eight wraps up the book with a succinct summary and recommendations.
This book is a useful guide to individuals who wish to become involved in the evaluation of service effectiveness. It provides the basics in a readable, concise fashion. It provides a useful and informed discussion about issues with regard to sampling and design. The best chapter is probably the third. This provides a very good discussion of sampling and design from a Cook & Campbell tradition.1 Chapter six on potential problems is also particularly well conceived.
The book’s brevity is both its strength and weakness. While it is an easy read, the focus is fairly narrow. As mentioned previously, the design discussions are limited to those intended to estimate change from beginning to end of treatment. For example, there is no discussion of decision support and dispositional (level of care) outcomes. Nor is there any discussion of using growth curves to model the trajectory of change. The chapter on measurement strategies focuses very generally on three core constructs--distress, symptoms, and functioning. There is no discussion of measures of case-mix, risk behaviors, or strengths. I would recommend this book for clinicians and administrators who are becoming involved in the process of assessing service effectiveness.
John S. Lyons, Ph.D.
Associate Professor and Director, Mental Health Services and Policy Program
Northwestern University Medical School
References
1. Cook, TD, Campbell, DT: Quasi-Experimentation: Design & Analysis Issues for Field
Settings. Chicago: Rand McNally College Publishing, 1976.
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