“It is not just about the alcohol”: service users’ views about individualised and standardised clinical assessment in a therapeutic community for alcohol dependence

Paula Cristina Gomes Alves,Mark Ashworth,Célia Maria Dias Sales

doi:10.1186/s13011-016-0070-5

Abstract

BackgroundThe involvement of service users in health care provision in general, and specifically in substance use disorder treatment, is of growing importance. This paper explores the views of patients in a therapeutic community for alcohol dependence about clinical assessment, including general aspects about the evaluation process, and the specific characteristics of four measures: two individualised and two standardised.MethodsA focus group was conducted and data were analysed using a framework synthesis approach.ResultsService users welcomed the experience of clinical assessment, particularly when conducted by therapists. The duration of the evaluation process was seen as satisfactory and most of its contents were regarded as relevant for their population. Regarding the evaluation measures, patients diverged in their preferences for delivery formats (self-report vs. interview). Service users enjoyed the freedom given by individualised measures to discuss topics of their own choosing. However, they felt that part of the standardised questions were difficult to answer, inadequate (e.g. quantification of health status in 0–20 points) and sensitive (e.g. suicide-related issues), particularly for pre-treatment assessments.ConclusionsPatients perceived clinical assessment as helpful for their therapeutic journey, including the opportunity to reflect about their problems, either related or unrelated to alcohol use. Our study suggests that patients prefer to have evaluation protocols administered by therapists, and that measures should ideally be flexible in their formats to accommodate for patient preferences and needs during the evaluation.

Highlights

The involvement of service users in health care provision in general, and in substance use disorder treatment, is of growing importance
A single focus group with 10 service users was conducted in a therapeutic inpatient community for females with alcohol dependence, based in a rural area of northern Portugal
General views about the evaluation process The evaluation process was reported by most service users as a positive experience, because it helped them to reflect about their clinical situation

Summary

Introduction

The involvement of service users in health care provision in general, and in substance use disorder treatment, is of growing importance. One area where service user involvement is paramount is the selection of measures to evaluate the patient’s clinical condition [6,7,8]. Evaluation measures are helpful for clinical work at different points in time during treatment. At treatment intake, they allow the assessment of patients’ distress, and if administered at pre-post treatment, they provide data for outcome assessment purposes. Several authors have suggested that, to maximize their clinical utility, these measures should be relevant, acceptable and valuable for both professionals and service users [6, 9]. The reality, though, is that many popularly used measures do not reflect the service users’ perspective [10,11,12]

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