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Steering Committee Notes: April 9, 1999
Participants
Jean Campbell, moderator
Louetta Hix
Jo-Anne O’Connor
Susan Essock
Ruth Ralph
Pat Corrigan
Carol Silverman
Sharon Togut
Bonnie Schell
Brian Yates
Stephen Fischer
Mark Salzer
Greg Teague
Jaime Delgado
Tom Summerfelt
Betsy McDonel
Sarah Lickey
Daphne Walker-Thoth
Goal of Meeting
To review the cost proposal that was drafted April 8.
Announcements/Requests
The Cultural Competency teleconference scheduled for April 12 is canceled. Jaime
Delgado will attend the face-to-face Steering Committee meeting.
A request was made that these minutes be sent to Diane in Washington.
A draft of the common protocol was posted on the website through e-mail just a few
hours ago.
Discussion of Cost Proposal
Jean stated that there may be errors in some minutes recently posted. Barbara Dickey
had a correction. Her concern discussed in the last paragraph is related to data
interpretation of traditional services and medical care and not to the cost.
Brian Yates provided an overview of what was agreed to:
There should be two tracks for the cost study. Track 1 will be followed by 2 study
sites that have a lower capacity for data collection. Track 2 would be used by 6 sites
that have greater collection capacity and resources.
Questions about income and money are already in the common protocol so they need not be
asked as part of the cost study. Much of the information in the enhanced portion of the
questionnaire was not as relevant to cost as it is to the research question.
Service utilization is important to cost and to the study of outcomes. The service
utilization service list is available on the website. It might also help the fidelity
questions. One part of service utilization that was good but that changes something else
is the distinction between getting service from traditional, consumer operated, or other
sources. If people deem this important, it can be reincluded.
At sites that have Medicaid access, the consumers' report of services with Medicaid
data will help defend the research. Brian would be doing this work with the understanding
that the sites will help him obtain access to their Medicaid systems. It was pointed out
that the same questions about service utilization would be asked by all consumers in
traditional and consumer-operated services.
To collect program costs for tracks 1 and 2 will require a five-step procedure--there
would be more in track 2. We will arrive at a best estimate (average cost service) by
using state specific costs and national averages.
Points that need further discussion:
The extent of overlap on what programs can collect versus what will be collected from
individuals. Services can be looked at a variety of levels--can these be cross-referenced
or cross-walked?
In order to look at the intensity of services, we need to get good service utilization
data. The Cost, Research, and Logistical subcommittees might work on this in Arlington.
Some study sites consider "drop in" a service, whereas others view it as a
program that encompasses a variety of services such as provision of meals, access to
washers/dryers, socialization and recreational activities. Some sites do not record which
activities or services people take part in at the drop in centers. Jean pointed out that
there are three models of consumer-operated services in the multi-site study that include:
drop in, educational, and peer support. She considers "drop in" a descriptor
that would cover a list of services. It was decided that "drop in" needs to be
unbundled. Ruth suggested that the following questions be used: (1) what did you do at
(name of agency) last week? (2) How many days did you go and which activities did you take
part in? (3) What was most helpful?
Susan suggested that the categories and columns need to be mutually exclusive and
terms need to be used that are familiar to consumers. The challenge is to word it so that
consumers have the same sorting rules that we have in mind. Jean pointed out as an example
that peer mutual support could be something that goes on all the time at the centers, but
this would be different from a formal peer group.
Brian said ROW has developed a list of definitions that could be helpful with examples.
Carol stated that she was nervous about giving people examples of services because they
become interested in services they didn't know about and may start going to them--this
means the research would change their activities. She suggested that people who use the
services may not know the distinctions and that the name of the agency where the service
was received be collected and then the services coded at the office. It was also pointed
out that visits may not always be the appropriate unit since telephone outreach is used to
a great degree by some sites.
Greg suggested a conceptual structure that would include a small number of mutually
exclusive categories so people can say how long they were at a place. The secondary
inquiry would allow for the checking off of categories of services that occurred in that
setting.
It was suggested that we be specific about the source from which consumers received
assistance. The data would be inadequate if it showed only that services were received
from other sources in general. We have to be careful about what is treated as a source and
what is treated as personal assistance. For example, there is a distinction when a person
receives housing assistance from a housing program or service and when a person receives
help from a friend in finding housing.
It was decided that the confounded categories need more work.
Sally asked that Betsy provide clarification at the face-to-face meeting on what
constitutes a consumer-run service. This has serious implications for the recruitment of
consumers for the multi-site study. We need to know from the federal government which
consumer-run programs exclude people from the study. Betsy indicated that the Steering
Committee should decide and discuss this with CMHS. Jean pointed out that this issue
probably will not be resolved in Arlington during the upcoming face-to-face meeting.
Changes or corrections:
"Case management" is listed on the service utilization document twice (#12
and 23).
Next Steps on Cost Study
The Steering Committee needs to have a small group with representation from the
Cost, Research, and Consumer Advisory Panel meet in Arlington and develop a service
utilization data collection product. Jean, Sally, and Ruth will work on how accomplish
this.
Other Issues
Authority of Subcommittees
It was suggested that there be a discussion and vote on the level of authority
subcommittees have. When recommendations are presented to the larger group from
subcommittees, will these recommendations stand or will the entire group rehash the issues
again?
When there are contentious issues on which a group cannot agree, a subgroup will be
assigned the task of presenting a recommendation to the larger group.
Vote on Common Protocol
It was decided that instead of taking one all-encompassing vote on the common protocol
at the Arlington meeting that big issues would be isolated and voted on separately.
Fidelity
Sally suggested that some time at the face-to-face meeting be devoted to fidelity. Jean
indicated that as much time as possible should be reserved for the common protocol, but
that there is 1.5 hours at the end of the meeting to discuss other items.
Sexual Orientation
It was pointed out that sexual orientation is one of the major process issues. We need
a sensitive way to ask this if we ask it at all. Jaime stated that it is important to
determine the purpose of this question and then determine how to go about asking the
information, if it is needed. There likely will be different ways of getting the
information at different sites keeping in mind that the common protocol must be
consistent.
Steve asked that the issue be discussed in Washington.
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