Jennifer R. Ellsworth and Dr. Gary M. Burlingame, Psychology
An interdisciplinary team of academicians from Brigham Young University’s Comprehensive Clinic initially developed a collaborative relationship with the Utah State Hospital for the purpose of improving the hospital’s group therapy program through staff group skills training and improving the hospital’s outcomes tracking system. They chose six instruments (three of which were currently in use at the hospital) to measure the impact of the staff skills enhancement program and to track patient outcome.
The three outcome instruments that were in use at the hospital included the Severe Outcome Questionnaire (S-OQ), the Youth Outcome Questionnaire (Y-OQ), and the Brief Psychiatric Rating Scale (BPRS). The S-OQ and Y-OQ are semi-parallel child/adolescent and adult instruments used to track the improvement of patients receiving mental health services. The BPRS is designed to assess the severity of psychiatric symptoms. It is given in a structured interview by a qualified rater and was developed to provide a rapid assessment of patient change.
Three more instruments were introduced in order to assess the quality of the groups and to learn about each patient’s experience in that group. These group process instruments were the Selfreport of Satisfaction Scale (SSS), the Hill Interaction Matrix G (HIM-G), and the Group Climate Questionnaire (GCQ). The SSS assesses participant’s satisfaction level, as well as their problems with the group. The HIM-G is a rating scale that is completed by a trained group observer. The quality of both patient and therapist interactions is captured by the HIM-G.
The GCQ is a twelve-item measure that allows those involved in group therapy to express their views regarding the group experience. Three areas of the group therapy experience are tapped by the GCQ; the positive working climate of the group, anger and rejection expressed in the group, and personal responsibility for making a meaningful contribution to the group (1). Currently, the GCQ is one of the most widely used rating formats in a variety of group settings. It has been related to both the developmental patterns of the group and to the prediction of improvement realized by group members.
Unfortunately, the GCQ has not been adequately studied in inpatient groups consisting of the severely mentally ill, including chronic schizophrenics. This research project set out to determine the relevance of the GCQ in its present form for this type of patient, specifically with respect to its ability to predict change in patient symptoms. GCQ data will be compared to data obtained from the other measures to determine whether a patient’s positive or negative process experience in group is related to their improvement or deterioration.
Although I initially planned to use data collected from the Southeast and Northeast adult units at the Utah State Hospital, data has been collected from the Southeast, Southwest, Northeast, and Northwest adult units and from the Boys Youth Dorm and Girls Youth Dorm adolescent units. Informed consent was obtained from these residents as part of the larger initial study. These patients are severely and chronically mentally ill and a high percentage of them suffer from schizophrenia.
Participants in existing therapy groups on all of the units were pre-tested using the outcome instruments and the group process instruments. After the initial assessment, groups were rated using the HIM-G and group members completed the GCQ and SSS every 30 days to plot their group experience. Some patients filled out these instruments for more than one of the groups that they attended. The hospital staff assessed patient improvement or deterioration every 90 days using the outcome instruments.
One concern that emerged during the collection of the group process data was whether or not the patients were filling out the questionnaire accurately. Some patients filled out the questionnaires with a pattern (e.g. circling all the same answer or alternating between two of the seven choices) and some patients were occasionally too disoriented to understand the questions and answer them accurately. In response to this problem, a rating system was established for data quality. Only accurate data will be included in the final data analysis.
The data for this project has been collected and entered into SPSS (a statistical software package). The current task is to examine the data and determine those patients who meet minimum criteria. The patients who are included in the final analysis need to have completed two or more S-OQs/Y-OQs, have two or more BPRS ratings, and have accurately filled out the GCQ and SSS for a group that occurred between taking the S-OQs/Y-OQs and receiving the BPRS ratings.
My faculty mentor, Gary M. Burlingame, has agreed to assist me with the final data analysis. Change in patient outcome will be related to the patient’s experience in the group using multiple regression analysis. The information collected during this research project will help determine whether group therapy is a viable form of treatment for the severely mentally ill. Based on the preliminary results of the initial project, I expect to find that group therapy is a valuable treatment experience. Further, should the GCQ prove a robust predictor of patient change, therapists will have an empirically validated, simple, and effective indicator of improvement or deterioration of individual group members.
Once the final results are obtained, a professional paper will be written and submitted to the American Psychological Association for presentation at the next national meeting in August, 2000. The initial project has already garnered positive national attention, including presentations and a national award nomination. It is expected that the information gained from this project will also be welcomed in the research community.
References
- MacKenzie, K.R. (1997). Time-Managed Group Psychotherapy: Effective Clinical Applications. Washington, DC: American Psychiatric Press, Inc.