EVALUATING CHANGES IN SYMPTOMS AND FUNCTIONING OF DUALLY DIAGNOSED CLIENTS IN SPECIALIZED TREATMENT

Objective: The authors outline a minimal set of outcome indicators to assess the effects of specialized treatment for people with severe men tal illness and substance use disorders and report on use of these ind icators in a longitudinal study of such treatments. Methods: A total o f 147 clients with dual disorders participated in a controlled clinica l trial of three interventions-behavioral skills training, case manage ment, and 12-step recovery-in a county mental health program. The clie nts were assessed every six months over a two-year period using multid imensional self-report and observer-rated outcome measures encompassin g psychosocial functioning, psychiatric and substance abuse symptoms, and service utilization. Results: Client self-reports showed changes i n psychosocial functioning, especially increased functioning in reside ntial stability and work, and reductions in alcohol and drug symptoms and usage. Data on service utilization showed decreased use of acute a nd subacute mental health services and increased use of outpatient and case management services over time. Ratings by trained observers of p sychiatric symptoms and psychosocial functioning improved dramatically . Conclusions: A minimal set of outcome indicators for clinical trials and demonstrations of interventions for clients with dual disorders s hould include client self-reports of social adjustment, life satisfact ion, psychiatric and substance abuse symptoms, and current substance u se; interviewers' ratings of psychosocial functioning and psychiatric symptoms; data on utilization of mental health treatment and support s ervices; and data on clients' personal income, use of medical services , and contact with the criminal justice system.