The outcome of clinical goal setting in a mental health rehabilitation service. A model for evaluating clinical effectiveness

Abstract

In a standard care planning cycle, all 139 patients on the Gloucester Rehabilitation Register were involved in multi-disciplinary care programme approach assessment, generating 366 formal treatment goals (mean 2.6 goals per patient). At review 1 year later, 68% of goals were fully and 11% partially achieved. Goals were no more likely to be achieved in any care setting (i.e. with professional supervision/living independently), or any particular diagnosis. However, goals targeting the drug treatment of psychiatric syndromes were most likely to be fully successful (84%) while approaches to self-care skills, side effects, physical/medical problems, family relationships, were moderately successful. Least successful were the attempts to promote structured day care/activities, and to treat substance abuse, fully successful in 39% and 17%, respectively. Possible reasons for treatment success in different areas, including the positive impact of the introduction of 'atypical' antipsychotic drugs, were discussed. The present model of evaluating clinical outcome may have wider application in a health service which increasingly values evidence-based clinical practice.