SERV is the subject of a recently published article in the prestigious "Psychological Services" journal of the American Psychological Association. SERV is one of the largest providers of outpatient mental health care in the nation, providing both residential and rehabilitation services to more than 1,200 individuals in five counties in N.J. (Hudson, Mercer, Middlesex, Passaic and Union).
The scientific paper is an empirical evaluation of SERV's 2006-2007 transformation from a traditional mental health services agency oriented to caring for mentally ill people to one guided by the Recovery Model philosophy, which assumes that people with mental illness can recover and that this is best accomplished when they alone decide their life's path. The staff's role is to help them reach their goals, rather than to define goals for them.
The three-year study, in which 627 consumers and 490 staff members participated, found that "recovery-oriented services had a positive impact on rates of overnight hospitalization, residents' ability to function in the community, some professional skills of employees, and the working alliance between direct care providers and residents." It also indicated that "comprehensive and well-structured recovery-oriented care may offer a cost-efficient and effective alternative to the deficit approach to mental health care."
The most important finding, and an unexpected one, according to Dr. Paul Lehrer, a professor of psychiatry at Rutgers-Robert Wood Johnson Medical School in Piscataway, was the decreased number of hospitalizations among SERV consumers, whether for mental health or other reasons. In the period after the Recovery Model was rolled out across the five counties, hospitalizations dropped 30% compared to the period before the rollout.
According to Lehrer, the study began when Gary van Nostrand, SERV's President and CEO, announced at a meeting of the SERV BHS board, of which Lehrer is a member, that SERV was about to adopt the Recovery Model for services. Literature in the mental health field was strongly suggesting that elements of this approach had a high potential for effectiveness. Van Nostrand had decided that existing data warranted a trial at SERV.
Nevertheless, there were as yet no controlled scientific data proving that the model actually worked when it was adopted system-wide by a large mental health agency. What effects would the Recovery Model have in a setting such as SERV's? Would the staff be willing to accept the change? Would the consumers respond well to it?
These questions prompted Lehrer to suggest evaluating it in an organized fashion by collecting data before and after the roll-out of the Recovery Model to "see whether it's as good as it's cracked up to be." However, evaluating a major program innovation is a daunting task, particularly without major external research funding. To accomplish the project, Lehrer involved a psychology graduate student at Rutgers, Igor Malinovsky, who could serve as the point person putting the research together. Van Nostrand was able to find sufficient funds to hire him to perform the task. In the process, Malinovsky thus proceeded to gather his doctoral dissertation data.
When the transformation began, the SERV leadership found that it would not be possible to roll out the Recovery Model in all five counties at once, so introduction began only in Mercer County, followed by a phased sequential introduction, county by county, over an eight-month period. This allowed the use of a "multiple baseline" design for evaluating the program. In this research design, the effects were measured before and after the rollout in each county. In this way the Recovery Model effects would not be confounded with various societal changes that may have occurred over time (e.g., changes in mental health funding, economic stress, etc.).
As adoption of the Recovery Model began across the SERV system, it immediately became evident that the quality of data was very good. "In my judgment, for an organization to do this without major funding is remarkable," Lehrer said. "It shows how committed the organization was to doing this task right. Only a very well-functioning organization can carry out such a laborious and meticulous task, and produce interpretable data. Gary and his whole staff, particularly Tracy Samuelson (Director of Quality and Compliance), saw that research forms were completed and organized as completely as if we had had a $2M grant to do it."
"We undertook this work because Gary wanted to know if this program works, and we wanted to make sure that Gary got his answer," Lehrer said. "The quality assessment was done so well, that it was worthy of scientific publication."
The publication of Malinovsky's manuscript in "Psychological Services" is a prestigious honor, Lehrer said. "This is a peer-reviewed journal, requiring the highest standards of scientific rigor. It took two years of writing, re-writing, analyzing data, and answering questions to meet their standards as well as our own. The journal editors believed that we found some evidence that is solid and worthy enough for the scientific and mental health communities to take note of it."
The paper, titled "An Empirical Evaluation of Recovery Transformation at a Large Community Psychiatric Rehabilitation Organization," was authored by Malinovsky; with Lehrer; Dr.Steven M. Silverstein, Director of Research and Director of the Division of Schizophrenia Research at Rutgers-University Behavioral Health Care (UBHC); Stewart A. Shankman, University of Illinois, Chicago; and van Nostrand, Samuelson and William O'Brien of SERV Behavioral Health System, Inc.
To read the study, click here.