Spring 1996, Vol. 5, No. 1

Treatment outcomes consultation

By Len Sperry, M.D., Ph.D.

As the practice of psychiatry continues to evolve under managed care, we can expect that organizational and occupational psychiatry will attract more clinicians to its ranks. We can also anticipate that these clinicians will find that competition for traditional organizational consultation services and disability evaluation clientele will become more intense. Accordingly, it is my belief that clinicians entering this area of practice will, of necessity, have to develop a consulting specialty area or "niche" which sets them apart from others.

One such niche is treatment outcomes consultation. Treatment outcomes consultation involves a broad range of clinically-related services. Since this type of consultation is closely related to clinical practice, the novice consultant should be relatively comfortable with both the scope and setting of the consultation.

Since combined treatment has been shown to be both cost-effective and treatment efficacious, combining two or more treatment modalities such as individual therapy and medication or group or family therapy is becoming commonplace (Sperry, 1995). Providers will need to become competent with specific strategies for tailoring and combining treatment. They will also be expected to measure, monitor and manage the outcomes of such treatment.

Because provider practice styles and clinic patterns are undergoing major changes, many providers and clinic groups will need both expert and process organizational consultation to accommodate and adjust to these changes. In short, it appears that at least three types of consultation are needed: instructional, clinical research, and organizational.

Regarding instructional consultation, it would seem that enterprising consultants will establish training programs and seminars for providers on a wide variety of topics. This training, or more accurately "retraining", will range from current topics such as time-limited therapy, solution-focused treatments, cognitive-behavioral therapy strategies, and the like to strategies for tailoring and combining various treatment modalities. Training in the use of computer-assisted assessment and diagnosis, interactive video treatment methods, as well as in the effective utilization of time-limited couple and group treatments will be additional topics that clinicians, clinics, and other health care organizations will perceive as necessary competencies.

While some entrepreneurs will develop individual study materials or large workshops which may or may not involve continuing education credits, consultants will establish contractual relations with health care systems to evaluate the training needs of those agencies, clinics or practices and tailor various educational programs and experiences to meet those needs. Of course, an understanding of organizational behavior and dynamics will be invaluable in this process.

With regard to the clinical research dimension of treatment outcomes, some consultants will be able to establish a reputation for expertise in this particular niche. To many providers and managed care organizations, measures of treatment outcomes have progressed no further than patient satisfaction surveys. Because of response bias and questionable relationship to other outcome measures, patient satisfaction surveys appear to have limited utility and value.

Of more value and utility are measures of treatment effectiveness which involve ratings of client-patient symptom severity, global functioning, and the like (Sederer & Dickey, 1995). Some managed care organizations have begun monitoring outcomes before, during and after the course of treatment to predict patterns involving relapse and recurrence.

A few managed care organizations are attempting to manage outcomes. That is, they are profiling client-patient presentations and comparing the efficacy and efficiency of specific treatment protocols, and then profiling providers to predict the best match among client-patient, provider, and treatment protocol. (Sperry, Brill, Howard & Grissom, 1996).

Both of these areas of treatment outcomes can generate the need for organizational consultation. Consultants may provide such consultation in assisting providers and provider organizations to change their professional practice styles and patterns. Because of the extensiveness of such changes, many providers will need to grieve the loss of the way they practiced and functioned previously. Furthermore, the organizational culture and dynamics of clinics, practice groups, and provider organizations will also be changing. And, like other organization-wide planned change efforts, organizational restructuring and transformation usually requires the assistance of consultants.

References

Sederer, L. & Dickey, B. (eds.) (1996). Outcomes assessment in clinical practice. Baltimore: Williams & Wilkins.

Len Sperry (1995), Psychopharmacology and psychotherapy: Maximizing treatment outcomes. New York: Brunner/Mazel.

Len Sperry, Peter Brill, Kenneth Howard and Grant Grissom. (1996), Treatment outcomes in psychotherapy and psychiatric interventions. New York: Brunner/Mazel.

 
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