VALERO Study aims to provide new outcomes assessments for Skyland Trail Clients
The lack of rigorous research data has been a challenge in the world of psychiatry and mental health treatment for many years. This is an issue Skyland Trail hopes to help rectify by taking a supporting role in researching and testing the most effective treatment options for people with mental illness.
In May, Skyland Trail’s clinical team began working on the VALERO Study, an innovative research initiative aimed at developing assessments to quantify and VALidate the Everyday, Real-life Outcomes of people with serious mental illness.
The program, which is sponsored by the National Institute for Mental Health (NIMH) in conjunction with Emory University’s Department of Psychiatry and Behavioral Sciences, began in May with a series of tests on 30 clients who volunteered for the study at the Skyland Trail testing site. The same tests are being conducted at the University of California, San Diego with the same number of clients who were recruited from that site. Both Skyland Trail and UC San Diego will repeat the tests with 30 new volunteers next year at each testing site.
The VALERO Study assessments began with a series of interviews and questionnaires for the patient volunteers including: a structured assessment of their current and previous symptoms of illness, an assessment of the volunteers’ concentration, attention, memory, problem-solving abilities, and tests of everyday living and social skills. Finally, the volunteers are asked to provide some self-ratings of their ability to perform everyday living skills, like cooking, cleaning, transportation and work. Principal Investigator for VALERO and Emory psychiatry professor Philip D. Harvey, PhD, explained the importance of having the volunteers provide the self-assessments.
“The study stems from when I was in New York and we asked a large sampling of patients with schizophrenia to perform a self-assessment of everyday living skills,” he said. “What we kept finding was that the patients’ assessments were not consistent with those of their case managers. They were not seeing those abilities to perform basic skills in the same way. And it wasn’t that the perceptions of the patients were over or under those of the case managers, but the two just did not correlate.
“The idea is that people with schizophrenia have a hard time establishing how ill they are,” continued Harvey. “So, this study is about finding out how to most effectively evaluate real-world functionality, and we use performance in these assessments as a reference point for how to measure that.”
In the past, Skyland Trail has used the ‘Basis 32,’ an outcomes measure consisting of a 32-item, self-administered (or structured interview) questionnaire developed to assess outcomes of mental health treatment for patients undergoing psychiatric care for a wide range of disorders. The five domains measured by the Basis 32 are psychosis, daily living/role functioning skills, relation to self/others, impulsive addictive behavior, and depression.
“With the Basis 32, you are asking people to tell you how they are doing,” said Harvey. “It’s important to keep in mind that how a person is feeling and how they might actually be doing in reality are two different things in some cases. Our argument is that both are important, but the two should not be confused with one another.”
The tests themselves measure cognitive capacity for people with schizophrenia, giving clinicians a better sense of what people with schizophrenia might be able to accomplish once they are back in the community.
“It goes right back to our overall philosophy of reintegrating clients back into the community to lead productive lives,” said Skyland Trail Medical Director Ray Kotwicki, M.D. “We want to take a close look at what people diagnosed with serious mental illnesses such as schizophrenia can accomplish and what their capabilities are.”
In the future, Harvey said he is hopeful that the VALERO Study can transcend measuring not only outcomes for schizophrenia, but for other mental illnesses as well.
“Our goal is to move this beyond just looking at schizophrenia,” he said. “It would be beneficial to patients in the sense that clinicians have this whole new skill-set for the future. We are hopeful to see it open up new doors in the psychiatric world.”
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