ROMS: Managing Outcomes for SPMI Consumers

Introduction

ROMS (Recovery Outcomes Management System) is a computer-supported, multi-informant system that identifies consumer strengths, assesses the nature and severity of problems, and encourages collaboration in the therapeutic process. The system supports consumers who have been diagnosed as severely and persistently mentally ill (SPMI) in building and sustaining functional behaviors and relationships.

Polaris-ROMS is designed to improve and document the effectiveness of care delivered to SPMI adults. The system also provides clinical decision support, facilitates case management and utilization review, and documents outcomes for purposes of accreditation and third party reporting.

Foundations for Polaris-ROMS Development: Basis-24, Strength-Based Domains, and Clinical Progress in Relation to Expected Progress

The Polaris-ROMS development team recognizes the unique challenges of managing the treatment process within the SPMI population. The design of Polaris-ROMS is the result of a collaborative process among leading experts in outcomes management, consumers, caregivers, administrators and clinicians. By including the perspective of the various stakeholders in the treatment process of SPMI consumers, Polaris-ROMS increases consumer and caregiver acceptance of the product and provides accurate, actionable data for clinicians and administrators.

Basis-24

One of the main components of the Polaris-ROMS system is an enhanced version of the Basis-24. Input was solicited from 52 researchers, administrators, clinical providers, and consumers regarding the existing Basis-24, including length of the instrument, items that seem confusing or difficult, appropriateness of the response options, time frame, domains covered, and sensitivity to different racial and cultural groups. Finally, the revision team assessed readability (all words above a 6th grade reading level were eliminated) and addressed such issues as generalizability, multicultural sensitivity, item redundancy, and the potential inapplicability of some items. Overall, the enhancements of the Basis-24 improved its reliability and validity as well as its utility among heterogeneous groups of mental health and substance abuse service providers and recipients.

Strength-Based Domains

The underlying premise of Polaris-ROMS is that recovery can be defined, not as a cure, but as a process of acquiring relational, vocational, and emotional skills that lead to more meaningful and satisfying lives, with sustained improvement along certain dimensions. In support of this premise, Polaris-ROMS incorporates, in addition to traditional measures of symptoms and deficiencies, several strength-based domains: Goal directiveness, Resiliency, Emotional/Relational skills, Meaning/Purpose, and Supports.

These domains correspond to trainable behaviors and attitudes such as…

• Goal setting
• Persistence in the face of obstacles
• Identifying gifts and talents
• Identifying/disengaging from hurtful relationships
• Expressing emotions appropriately
• Reaching out for support
• Respecting others

…that clinicians indicate may be related to:

• Purposeful employment
• Volunteer or school achievement
• Long-term gains in functioning and symptom reduction
• Development of key emotional/behavioral skills that remove sense of victimization
• Instilling a sense of empowerment to build and sustain relationships
• Reducing danger to self and others
• Independent living/Community involvement
• Safety in community
• Participation/Access in service planning

The strength-based domains of Polaris-ROMS were developed from a review of relevant literature, the experience of the Polaris Health Directions team in their work as consultants, and clinician interviews.

Reliance on Single Informants

To gain an accurate assessment of a consumer’s behavior, instrumentation should include the perceptions of the consumer, the caregiver, and the clinician. Each of these individuals has a valid and unique perspective as they see the consumer in different settings and situations. Polaris-ROMS includes multiple informant data to build a multi-dimensional picture of the functioning of the consumer. This provides a more fully elaborated clinical description for treatment planning and case management. Inconsistencies in viewpoints are made evident to the clinician who can then explore them with the consumer. Research suggests that caregiver information concerning expressed emotion in the family system will be both clinically important and useful for severity adjustment.