Outcomes data from 2007 through 2012 demonstrate the continued and consistent dedication of leadership and professional staff to a holistic program of evidence-based psychiatric treatment and integrated medical care. These data confirm that our unique approach to recovery works. People who come to Skyland Trail return to their communities with improved skills to pursue more independent and productive lives.
At Skyland Trail, we want to know how we are doing and what trends we need to be prepared for in the future. We monitor key client demographic and clinical indicators to assess the impact of treatment and program effectiveness.
When clients begin treatment at Skyland Trail, we measure their symptom severity, attitude toward medication adherence, hope for the future, and level of functioning. We measure those indicators again when they complete their treatment. We supplement these measurements with annual satisfaction surveys. Results from these assessments continue to show statistically and clinically significant improvement for our clients on many levels.
2012 Outcomes and Demographics Report >
2012 Demographics
Total admissions in 2012: 261
In 2012, 50 percent of clients entering treatment at Skyland Trail
were young adults ages 18 to 25.
This follows the trend of the previous four years. Young adults often feel like they don’t “fit in” either traditional adolescent programs or adult mental health services. The Young Adult recovery community at Skyland Trail has tailored programming like vocational services and family therapy to individuals within this age group.
2012 Diagnoses
2012 Diagnoses at Admission
81 percent: primary mood disorder
10 percent: primary thought disorder
46 percent: dual diagnosis (primary mood disorder with secondary substance abuse)
46 percent: co-occurring Axis II diagnosis
In 2012, 70 percent of clients beginning treatment at Skyland Trail had multiple Axis I diagnoses.
Of those clients, 46 percent had a second primary Axis I substance abuse diagnosis, 32 percent had a second primary Axis I anxiety disorder diagnosis, and 11 percent had a second primary Axis I mood disorder diagnosis.
Clients’ diagnoses are confirmed at admission through the M.I.N.I. Mini International Neuropsychiatric Interview* to ensure placement in the appropriate level of care and recovery community. Diagnoses at discharge may differ from admission. Slight changes from admission to discharge included a decrease of clients diagnosed with bipolar disorder, an increase of clients with major depressive disorder, and an increase of clients with other diagnoses such as post-traumatic stress disorder (PTSD), social phobia, and substance abuse and dependence.
* Sheehan DV, Lecrubier Y, Harnett-Sheehan K, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar G: The M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview. J. Clin Psychiatry, 1998;59(suppl 20):22-33.
2012 Length of Stay& Discharges
Research shows a direct relationship between a patient’s length of stay in treatment and his or her recovery. Our ability to estimate length of stay by diagnosis also helps set expectations for our families.
The average length of stay in 2012 was almost 4 months.
Of the 190 discharges reported in 2012, approximately 24 percent were unplanned, while 76 percent were planned, positive discharges. Unplanned discharges decreased slightly in 2012 from 32 percent in 2011.
2012 Symptom Reduction
Beck Hopelessness Scale
Skyland Trail clients complete the Beck Hopelessness Scale to measure change in self-reported feelings of hopelessness.
Clients discharged in 2012 demonstrated a 61% improvement in their feelings of hopelessness.
* Results are statistically significant at the p<.05 significance level.
Beck AT, Weissman A, Lester D, Trexler L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865
Behavior & Symptom Identification Scale
Skyland Trail clients also complete the Behavior & Symptom Identification Scale-32 (BASIS-32), which measures change in self-reported symptom and problem difficulty in five domains: daily living skills, psychosis, depression/anxiety, relationship with self and others and impulsivity. A decline in self-reported score from admission to discharge indicates an improvement in life symptoms and life function. Results of the BASIS-32 show a statistically significant improvement in all domains for clients with a planned positive discharge or completed treatment in 2012.
Clients discharged in 2012 reported a 59% increase in their attitude toward activities of daily living and overall functioning.
* Results are statistically significant at the p<.05 significance level.
* Results are statistically significant at the p<.05 level.
The 32-Item Behavior and Symptom Identification Scale (BASIS-32). © Copyright McLean University, Affiliate of Harvard Medical School
2012 Functional Improvement
Medication Attitude Inventory
The Medication Attitude Inventory (MAI) helps us understand clients’ perceptions of using psychiatric medications as well as the extent of their personal experiences with medications. An increase in score from admission to discharge suggests improved likelihood of daily medication adherence.
Clients discharged in 2012 reported a 92% improvement in their attitude toward medication adherence.
* Results are statistically significant at the p<.05 significance level.
Hogan TP, Awad AG, & Eastwood R. (1983). A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychological Medicine, 13, 177–183.
Making Decisions Scale
In 2012, statistically significant results were found in three of the five domains of the Making Decisions Scale including self-esteem/efficacy, power/powerlessness, and optimism/control. An increase in scores from admission to discharge signifies improvement in those areas.
| |
Admission |
Discharge |
p value
|
| self-esteem/efficacy* |
2.66 |
3.03 |
.000 |
| power/powerlessness* |
2.56 |
2.72 |
.021 |
| community activism/autonomy |
3.28 |
3.32
|
.570 |
| optimism/control* |
2.68 |
2.86 |
.018 |
| righteous anger |
2.41 |
2.49
|
.293 |
* Results are statistically significant at the p<.05 level.
Rogers, E.S., Chamberlin, J., Ellison, M. L., & Crean, T. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48(8), 1042-1047
WHO Quality of Life Scale-26
The WHO Quality of Life Scale-26 (WHOQoL-26) is an abbreviated version of the WHOQoL-100, which assesses quality of life for four domains including: physical health, psychological health, social relationships, and environment. In 2012, patients reported a statistically significant increase from admission to discharge in quality of life for all domains.
| |
Admission |
Discharge |
p value
|
| physical health* |
19.49 |
22.4 |
.000 |
| psychological health* |
17.01 |
19.71 |
.001 |
| social relationships* |
8.68 |
10.15 |
.001 |
| environment* |
27.92 |
31.08 |
.001 |
* Results are statistically significant at the p<.05 level.
World Health Organization (1993). WHOQoL Study Protocol. WHO (MNH7PSF/93.9).
2012 Disease-Specific Assessments
In July 2012, Skyland Trail began implementing disease-specific measurements through a program called “Feedback Fridays.” The goals of the program are:
- to provide clinical staff and clients with real-time feedback on current symptomatology as they progress through the program from an objective perspective, and
- to provide clinical staff with additional information to guide clients’ treatment planning.
In this first reporting year, the majority of clients (59 percent) who discharged during 2012 were assessed with the Montgomery-Asberg Depression Rating Scale (MADRS)* for major depressive disorder, followed by clients assessed using the Brief Psychiatric Rating Scale (BPRS-24) for schizophrenia or schizoaffective disorder.
A total of 28 clients diagnosed with major depressive disorder were assessed with the MADRS, a 10-item checklist designed to measure the degree of severity of depressive symptoms. Scores from the first assessment were compared to the last assessment prior to discharge. Results show a statistically significant decrease in reported severity of symptoms from moderate to mild depression. Specifically, a statistically significant difference and strong correlation between first and last assessment was found.
* Montgomery, S.A. & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
2012 Client Health Outcomes
Physical health outcomes of Skyland Trail clients are another important measure of our impact, specifically as it relates to cardiometabolic syndrome and mental health outcomes. Vital statistics including blood pressure and pulse, height, weight and body mass index (BMI) are collected by the staff nutritionist and Thrive Wellness Clinic staff.
The findings of 2012 are similar to those of 2011 with a slight change in the average decrease in BMI (-1.59 vs. -1.43, respectively). The average increase in BMI in 2012 also showed a slight change from the findings of 2011 (+1.89 vs. +1.90, respectively).
2012 Client and Family Satisfaction
Finally, patient and family satisfaction remains an integral portion of understanding how both clients and their families rate the services received from Skyland Trail. Currently, the satisfaction survey is collected from clients annually as well as at the time of discharge. Clients are asked various questions, including but not limited to, overall satisfaction with services, satisfaction with the amount of help received, and if the program has meet their needs.
Patient Questions
|
(N) |
Responses |
| Overall, how satisfied are you with the service you are receiving? |
56 |
93% - Very satisfied/satisfied |
| How satisfied are you with the amount of help you are receiving? |
55 |
94% - Very satisfied/satisfied |
| Has the program met your needs? |
56 |
97% - Very satisfied/satisfied |
Family satisfaction surveys are collected from family members at the time of discharge. Family members are asked questions, including but not limited to the quality of services their family member has received, the overall satisfaction with the service provided, and recommendation to others who need mental health treatment.
Family Questions
|
(N) |
Responses |
| How would you rate the quality of services your family member has received? |
16 |
69% - Excellent/good |
| Overall, how satisfied are you with the service that your family member has received? |
16 |
75% - Very satisfied/satisfied |
| Would you recommend this program to someone else who needed mental health treatment? |
16 |
81% - Definitely/generally |