Residential mental health care for Oregon adults: an in-depth look
A report by Acumentra Health for the Oregon Addictions and Mental Health Division (AMH) provides the first comprehensive look at the state’s adult residential mental health care system—the types of treatment provided to residents, appropriateness of care in various settings, and barriers to independent living. The report is available on the AMH website.
The purpose of Oregon’s residential system is to provide community-based alternatives to long-term institutional care, in line with the widely adopted Recovery Model. The study for AMH sought to determine whether Oregonians served by residential facilities are moving through the system into less intensive levels of care.
From March through July 2010, Acumentra Health staff visited 99 facilities across Oregon, which housed a total of 506 residents. The facilities ranged from adult foster homes, which serve the least severe cases, to secure residential treatment facilities, which serve the most severe. The study team interviewed residents, reviewed their clinical records, and surveyed mental health service providers. Among the major conclusions:
- Community-based treatment through the adult residential mental health system is keeping people out of state hospitals. Residents have benefitted from, and are more functional as a result of, residential treatment services. Most residents are stabilized and report being satisfied with services. Overall, however, residents are notprogressing through the system to less intensive settings, toward independent living.
- About one-quarter of residents are at the appropriate level of care expected in a given facility type. These residents will require ongoing residential placement as an alternative to long-term institutionalization. They are best served in their current settings and will not benefit from being forced to move into a lower level of care.
- About 60% of residents appear capable of moving into lower levels of care or to independent living, but many have not been prepared for the transition because of a scarcity of discharge/transition planning services. Providers commonly cite resident reluctance and the lack of available options as the primary barriers to transition.
- No overarching treatment model or theory guides residential services in Oregon. Some facilities adhere to the Recovery Model, aimed at transitioning residents to less intensive levels of care. Others focus mainly on traditional symptom management and stability, while still others provide a basic “caretaking” service. The most common services provided are skills training and group activities, rather than intensive mental health treatment. Treatment plans typically are not specific enough to provide truly individualized services and are not updated often enough to support recovery.
Overall, the review suggests that adult residential services focus mainly on daily supports, rather than on rehabilitation. In addition, state regulations do not clearly define and distinguish among levels of care, and do not specify that the system is responsible for transitioning of residents. A statewide focus on training facility operators in the theory and method of recovery-oriented care would improve the quality and quantity of services. Acumentra Health recommended that the state establish regulations to guide the implementation of these approaches and hold facilities accountable for the quality of their treatment.
The study supports these conclusions with a comprehensive set of baseline data on the number, frequency, and types of services provided by facility type; evidence of individualized treatment plans and discharge/transition planning; and self-reports of services provided and expected levels of functioning from the provider survey.
For more information, contact Jody Carson, firstname.lastname@example.org.