How do you measure progress? This can be a challenge in a setting like the Kusnacht Practice. Our clients are admitted with a wide range of diagnoses and arrive in various states of mind. They have their own sets of goals and targets. Sometimes families will also bring their own expectations, and, on occassion these are different to those of the client.
Modern medicine uses objective data to determine the improvement in health of clients such as lab values, blood pressure and temperature. Improvements in clients with substance use disorders also uses objective values, for example drug and alcohol testing, attendance at sessions, planned completion of treatment. Objective data is sometimes referred to as hard outcomes.
At the Kusnacht Practice we use such objective measures to evaluate and follow our client’s improvement, and in the last year we have added subjective data to support our success. This is looking more at soft outcomes. In order to measure these soft outcomes, we have developed a self-assessment process. The definition of a self- assessment is a process or an act of looking at one’s achievements or progress in aspects important to one’s identity. We understand that there is an important psychological component in the recovery process, and so we have introduced our self-assessment form to help identify the client’s own perception of their improvement.
We established four criteria that were relevant to all our clients’ wellbeing; self-esteem, reaching their treatment/life goals, relationships, and overall quality of life. This evaluation is performed on admission, on discharge and every week in between. The ultimate goal is to see the journey from the client’s perspective. The four criteria are added together and the total for each week is plotted on a graph. We are able to see on a weekly basis how the client is progressing in their treatment, and indeed if there are times when they need more focussed support. No matter the peaks and valleys in between, our experience is that there is always a substantial net gain from admission to discharge.
The last few days of the client’s stay the final graph is presented to the client and it has become a powerful tool to drive home the significant improvements that they have accomplished during their stay. This helps to build and maintain motivation and a sense of achievement. The process also helps the treatment team and the client identify the reasons for some peaks and valleys during the course of their treatment. Common stressors such as family programmes or important changes can often cause anxiety and therefore are reflected in some of the criteria. This supports effective planning of potential stress hotspots for clients’ post-treatment, and additional aftercare support can be utilised during these times.
In the last months, we have also included the self- assessment in our returning aftercare clients. It is a great indicator of how they are coping since their return home. Again, this information will help us to tailor the support we deliver to our clients as part of their continuing care.
Author: Geraldine Matthews, Clinical Operations Manager - The Kusnacht Practice