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2019 Outcomes Research Report

Skyland Trail is a trailblazer in the area of measurement-based care and outcomes research, which is an integral part of our evidence-based treatment model. Our robust outcomes and research program employs evaluative instruments considered to be the gold standards in the mental health field to measure the effectiveness of our treatment programs.

Outcome data from 2008 through 2019 confirm that our unique integrated, evidence-based approach helps our clients return to their communities with reduced symptoms and improved skills to pursue more independent and productive lives.

2019 AREA OF FOCUS

In 2019, we explored the impact of family therapy on treatment outcomes.

2019 OUTCOMES RESEARCH REPORT

Key Outcomes

Key measures about how Skyland Trail adult clients improved.

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Disease-Specific Assessments

Results of specialized assessments administered to clients with specific diagnoses.

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Client Population Assessments

Gold-standard assessments administered to all adult clients at admission and discharge.

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Client Demographics

Demographic description of our 2019 adult client population

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2019 Highlight: Impact of Family Engagement

The 2019 report examines the impact of family therapy on program completion and overall outcomes.

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Patient Complexity

Strong outcomes for patients with co-occurring diagnoses.

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2019 Client Community

Age at Admission

Gender

Primary Diagnosis at Discharge

Patient Complexity

Skyland Trail has specialized in treating complex patients for many years. Many patients enroll in the residential treatment program after participating in other outpatient or inpatient therapeutic programs without results.

In 2019, Skyland Trail treated a large number of young adult patients ages 18 to 25 with a complex constellation of co-occurring disorders: a mood disorder, borderline personality disorder, and a substance misuse disorder. Patients in this category had outcomes similar to the broader patient population and experienced significant improvement in symptoms, functionality, and hopeful thinking.

60% of clients
had >3 co-occurring diagnoses confirmed at discharge

Co-occurring disorders include: anxiety disorders, substance misuse, borderline personality disorder, others

2019 Key Outcomes

Annual Report BASIS 32 Graph

Improved Functioning

88% of all patients
experienced a statistically significant improvement in functionality, symptoms and social relationships 1

Annual Report BHS Graph

Improved Hope

89% of all patients experienced a statistically significant improvement in hope 2

Annual Report MAI Graph

Improved Medication Attitudes

92% of patients leave treatment with a positive attitude about taking psychiatric medication 3

Annual Report BPRS Graph

Reduced Psychosis

85% of patients with psychosis experienced statistically significant improvement in their symptoms of psychosis 4

Annual Report BHS Graph

Reduced Depression

89% of patients with very severe and severe symptoms of depression experienced clinically significant reduction 5

Annual Report YMRS

Reduced Mania

96% of patients who had clinically meaningful episodes of mania showed no symptoms of clinically meaningful mania at discharge 6

(1) The 32-item Behavior and Symptom Identification Scale (BASIS-32): ©McLean University, Affiliate of Harvard Medical School. (2) Beck Hopelessness Scale: Beck AT, Weissman A, Lester D, Trexler L. (1074). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865. (3) Medication Attitude Inventory: 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. (4) Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962; 10:799-812. (5) Montgomery, S.A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. (6) Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133:429-435, 1978. (7) Hamilton M: The assessment of anxiety states by rating. British Journal of Medical Psychology, 32:50-55,1959.

Symptom Reduction

Skyland Trail administers disease-specific outcome measurement tools every two weeks of treatment, based on the confirmed diagnosis at admission. Though the scales differ for each measurement, lower scores always indicate improved symptomatology.

MAJOR DEPRESSION

89% of patients with very severe and severe symptoms of depression experienced clinically significant reduction

t(222)= 10.30, p=0.000

Montgomery, S.A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

Montgomery-Asberg Depression Rating Scale 2019

BIPOLAR ILLNESS

96% of patients who had clinically meaningful episodes of mania showed no symptoms of clinically meaningful mania at discharge

t(25)= 4.42, p=0.001

Young, et. Al. (1978). A rating scale for mania: reliability, validity, and sensitivity. British Journal of Psychiatry, 133, 429-435.

Young Mania Rating Scale 2019

ANXIETY DISORDERS

89% of patients with anxiety experience statistically significant improvement in control of anxiety

t(202)= 6.44  p=0.000

Hamilton M: The assessment of anxiety states by rating. British Journal of Medical Psychology 32:50-55,1959.

Hamilton Scale of Anxiety 2019

THOUGHT DISORDERS

85% of patients with psychosis experienced statistically significant improvement in their symptoms of psychosis

t(46)= 11.8,  p=0.000

Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962; 10:799-812.

Brief Psychotic Rating Scale 2019

All Client Assessments

These assessments are administered to clients with all diagnoses at admission and at discharge.

IMPROVED FUNCTIONING

In 2019, patients consistently showed statistically significant functional improvement as measured by the BASIS-32. Comprised of 5 subscales, the BASIS-32 contains an overall average score ranging from 0 to 4, with lower scores indicating greater levels of functioning in daily life, interpersonal relationships, impulsivity, psychosis, depression, and anxiety.

Clients as a group showed significant impairment at admission, and low-moderate impairment (and in many cases, no impairment) at discharge.

The 32-Item Behavior and Symptom Identification Scale (BASIS-32). © Copyright McLean University, Affiliate of Harvard Medical School.

Significant Impairment
>1.5 Significant and systemic impairment in daily life and/or interpersonal relationships, with extreme impulsivity, psychosis, depression, and/or anxiety present.

Moderate Impairment
.5–1.5 Moderate impairment in daily life and/or interpersonal relationships, with some impulsivity, psychosis, depression, and/or anxiety present.

Full Functioning
<0.5 Indicates full functioning with no significant impairment in daily life and/or interpersonal relationships, with little or no impulsivity, psychosis, depression, and/or anxiety present.

BASIS-32 Overall Change Scores 2019

T(203) = 15.965, p = 0.000

Beck Hopelessness Scale 2019 - Admission 1.64 Discharge 0.79

BASIS-32 Subscales Change Scores 2019

Relation to Self/Others

t(203) = 15.783, p = 0.000

BASIS-32 Subscales Change Scores 2019

Depression/Anxiety

t(203) = 15.243, p = 0.000

BASIS-32 Subscales Change Scores 2019

Daily Living Skills

t(203) = 8.050, p = 0.000

BASIS-32 Subscales Change Scores 2019

Impulsivity

t(203) = 8.050, p = 0.000

BASIS-32 Subscale for Impulsivity - Admission 0.61 Discharge 0.21

INCREASED HOPEFUL THINKING

In 2019, clients continued to experience a statistically significant decrease in feelings of hopelessness, t(198) = 12.399, p=0.000. This finding indicates that, on average, individuals improved from feeling very hopeless at admission to having hopeful future expectations at discharge. Hope for one’s future is one of the best predictors of continued adherence to a recovery plan and protective against suicide.

Human beings are much more than constellations of symptoms, thoughts and behaviors. Hopefulness, social interconnectivity, and a sense of self efficacy define recovery and what it means to be mentally well.

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

Nihilistic Preoccupations
>8 These individuals see very little hope in all domains of their lives.

Some Hopelessness
3–8 Individuals display some hopelessness in their thinking. Individuals closer to 8 can be said to be very hopeless while those scoring closer to 3 can be said to be somewhat hopeless.

Hopeful
<3 Individuals are said to be hopeful.

Beck Hopelessness Scale Scores 2019

t (198) = 12.399, p=0.000

IMPROVED MEDICATION ADHERENCE

Attitude toward taking psychiatric medications is a surrogate measure for medication adherence. Medication adherence is one of the best predictors of sustained recovery.

Scores on the Medication Attitude Inventory (MAI) range from -10 to +10, with higher scores indicating more positive attitudes towards medication use and medication adherence. On average, clients in 2019 experienced very highly statistically significant improvement with an average attitude score of 4.47 at admission to a 7.10 at discharge.

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.

>5 Indicates generally positive attitudes towards medication use and are correlated with greater levels of medication adherence in a clinical setting.

Medication Attitude Inventory 2019

t (205) = -9.009, p=0.000

IMPROVED ABILITY TO MAKE DECISIONS

A sample of 204 clients who completed the Making Decisions Scale at admission and discharge demonstrated statistically significant improvement in their ability to use self-esteem, optimism, and personal power in making decisions.

A four-point scale, where scores centered around 1 indicate negative beliefs about the ability to make decisions with psychological components like:
• self-esteem
• optimism
• activism
• personal power (beliefs in the efficacy to make decisions on one’s own)

Rogers et al. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48(8), 1042-1047.

Making Decisions Scale 2019

SELF-ESTEEM

t(203) = 8.050, p = 0.000

OPTIMISM

t(203) = -7.948, p = 0.000

ACTIVISM

t(203) = -2.887, p = 0.004

PERSONAL POWER

t(203) = -8.521, p = 0.000

2019 Highlight: Impact of Family Engagement

In 2019 Skyland Trail examined factors that influence adult patients' engagement in treatment and their likelihood to complete treatment with statistically and clinically significant reduction in symptoms and improvement in functioning.

This analysis pointed to the importance of family and support system engagement as a key variable, especially for adult patients with complex diagnoses. Skyland Trail engages families in treatment through several programs.

professional participating in panel discussion

Family Orientation

On average, about 48% of families attend family orientation. Family orientation is a full-day education and information session presented by several members of the clinical team. In addition to an overview of how clients move through the treatment program, families learn how programs like family therapy, vocational services, and expressive therapies contribute to their loved one's recovery. 

Skyland Trail families

Family STEP

The Family STEP program is a weekly education and peer support group for families. Families can participate in person or through zoom online conferencing. Skyland Trail clinical team members as well as experts from the community present on a variety of topics from mindfulness to pharmacology. The number of STEP services delivered increased 35% from 2017 to 2019.

two men talking in an apartment

Family Therapy

Family therapy with our family psychologist is offered to adult residential and day treatment clients. Family therapy with our adolescent family therapist is an integrated part of our adolescent residential and day treatment programs. 

Last year, participation in family therapy in our adult programs grew from 40% (N=302) in 2018 to 50% in 2019 (N=276).

Adult Clients Who Graduated (Completed Program)

Adult Clients Who Did Not Graduate

Family Therapy Impact on Symptoms

  • On average, adult clients in 2019 who participated in family therapy experienced a 7% greater improvement in feelings of hope than clients who did not participate in family therapy.
  • Adult patients with depression and thought disorders who graduated (completed treatment) but did NOT attend family therapy did not, on average, reach the same level of symptom reduction as the patients who attended family therapy.

Family Therapy Impact on Program Completion

  • Adult patients who do NOT participate in family therapy have 4.2X greater odds of leaving treatment before graduation (treatment completion).

Adult Programs Family Therapy

Family therapy, led by family psychologist Carlyle Bruce, PhD, is available to adult clients in residential treatment and day treatment. Family therapy is available via zoom online conferencing.

Adolescent Programs Family Therapy

Family therapy, led by family Ashley Lanier-Pszczola, LMFT, is an integrated part of treatment for adolescents in residential treatment and day treatment. Family therapy is available via zoom online conferencing. Families participate in two family therapy sessions each week and two family enrichment Saturdays each month.

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