CMHEI Crisis Outcome Study

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CMHEI Crisis Outcome Study

• RCT Intervention Team Crisis Evaluation Team
• Donald Wasylenki (PI) Sean B. Rourke (PI)
• Margaret Gehrs Paul Links (PI)
• Lorne Tugg Nancy Read
• John Langley Ian Dawe
• Nancy Read Lorraine Ferris
• Nicole Kirwan Rahel Eynan
• Michael Higgins Donald Wasylenki
• Suzanne Cohen
• Ron Heslegrave

Funded by Ontario Mental Health Foundation
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Cases with a Crisis Episode
Group ns Time p lt 0.05
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Cases with Medical-PsychiatricCrisis Episodes
Group p lt 0.05 (1ST 9 months) Time p lt 0.01
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Cases with ER Visits(past 90 days)
p 0.01
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Cases Admitted to Hospital
p 0.02
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Multnomah Community Ability Scale
Four dimension scores average score adjusted
for items
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Changes in Multnomah and BPRS Total Scores
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Frequency and Type of Crisis Episode across 18
months
58
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Prediction of Outcome (Crisis) in 1st 9 months
Logistic Regression Model (p lt 0.002)
Overall 74 Sensitivity 87
Specificity 48 Positive PV 76
Negative PV 67
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Prediction of Outcome (Medical-Psychiatric
Crisis) in 1st 9 months
Logistic Regression Model (p lt 0.0001)
Overall 76 Sensitivity 90
Specificity 58 Positive PV 74
Negative PV 82
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Prediction of Outcome (ER visit) in 1st 9 months
Logistic Regression Model (p lt 0.001)
Overall 74 Sensitivity 73
Specificity 74 Positive PV 61
Negative PV 83
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Prediction of Outcome (admission) in 1st 9 months
Logistic Regression Model (p lt 0.03)
Overall 63 Sensitivity 35
Specificity 80 Positive PV 50
Negative PV 67
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Significant Multnomah Item Predictors of outcomes
in 1st 9 months

• Crisis
• Any Psych ER Admit
• Mood abnormal ns yes yes ns
• Independence ns yes ns ns
• Coop Tx provider ns ns yes ns
• Impulse control yes yes yes ns

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Main Messages

• ACT and Intensive Case Management Programs can be
  effectively implemented for clients with severe
  and persistent mental illness in the inner city
• Client functioning (Multnomah Scale) increases
  about 20 in both programs at 9 months
• Psychiatric symptoms (BPRS) are reduced about 10
  in both programs at 9 months
• 33 reduction in ER visits in ACT Program and 62
  in Intensive Case Management Program at 9 months

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Main Messages

• Hospital admissions reduced by 43 in ACT Program
  and 86 in Intensive Case Management Program at 9
  months
• Crisis events reduced by 34 from 1st 9 months to
  2nd 9 months
• Baseline functioning scores (Multonomah Scale)
  significantly predictive of crisis events and ER
  visits in 1st 9 months but not in 2nd 9 months
• Psychiatric symptoms (BPRS) at baseline are not
  predictive of crisis events and ER visits across
  both programs