Variations in outcomes of consumer-operated service programs offered as adjuncts to traditional services

Consumer-operated services have matured and increased their numbers across the United States, but lack of formal evidence of effectiveness has limited inclusion within the service system. In 1999, SAMHSA/CMHS funded a large study to investigate the outcomes of consumer-operated services when offered as an adjunct to traditional mental health services for persons with serious mental illnesses. The Consumer-Operated Service Programs Multisite Research Initiative (COSP-MRI) used an experimental design and a common assessment protocol with 1,827 participants in eight sites representing a range of service programs. Multiple outcomes were assessed over a 12-month follow-up period. A composite measure was developed to test the primary hypothesis that participants offered both traditional and consumer-operated services would show greater improvement in wellbeing over time than participants offered only traditional mental health services. Conservative intent-to-treat analysis supported the primary hypothesis. Because there was only partial engagement in these voluntary programs, as-treated analyses typically showed greater effects in wellbeing and other outcomes, both subjective (e.g., empowerment) and objective (e.g., symptoms), and there were important variations across sites and selected demographic characteristics. Program elements of both consumer-operated and traditional services were assessed using a fidelity measure informed by consumer-defined concepts of recovery-oriented service characteristics; analysis suggested that recovery-oriented characteristics of the service environment may account for substantial variation in outcome, independent of setting. The presentation will include a recap of the COSP-MRI design, methodology, and overall findings, as well as discussion of results and implications of variations in outcome across participant and site characteristics.