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Classifying clients with serious and persistent mental illness (SPMI) into groups with differential demographic and clinical characteristics that relate directly to the need and receipt of services and changes in functioning provides a strong foundation on which to build program- or system-level planning, development, and evaluation efforts. In this study, clinician-generated problem data and cluster-analytic techniques were used to develop a four-group typology for a sample of 293 clients with SPMI. Each of the types--extremely disabled, young adult, personally distressed, and adapted--was profiled demographically and clinically in terms of human service needs, prognosis, and treatment outcomes. Each of the four types evidenced a unique pattern of needs and outcomes that was consistent with its clinical profiles. The typology, associated service needs, and outcomes provide valuable information for use in service planning and program development for clients with SPMI.

The outcomes of a reform of the Denver mental health system, cosponsored by the state and the RWJF, are contrasted with changes in a comparison area of the state. The study examines the structural characteristics of the mental health system, staff attitudes and satisfaction, and client-reported services and outcome. Results indicate that, in Denver, structural changes, the introduction of new services, and an intervening financial crisis increased worker dissatisfaction. Client reports documented parallel changes in the following variables: continuity of care, unmet need for case management services, frequency of symptoms, and satisfaction with services. The reform had no impact, however, on most quality-of-life indicators. The possibly adverse consequences of centralizing the system and the indirect influences of system integration on quality of life are discussed.

Colorado has been measuring mental health treatment outcome statewide for the past four years. The data system for it is built around the Colorado Client Assessment Record ( CCAR ), a multi-dimensional checklist and Level-of-Functioning ( LOF ) measure. The CCAR is used by the Colorado Division of Mental Health for needs assessment, defining target groups, estimating bed need and doing cost-effectiveness studies. An underlying structure consisting of seven independent scales has recently been established using factor-analytic methods. A rater effect was also discovered and mathematically removed, revealing reliable and valid LOF information heretofore unknown. The improved CCAR will hasten implementation of Colorado's long-range plan for treatment outcome assessment.

Thinking regarding the needs of the chronically mentally ill has changed substantially in the post-deinstitutionalization period. Increasingly, the heterogeneity existing within this population has been recognized along with the need for an integrated continuum of residences and services. At a state level, this realization has stimulated the development of planning models which are used to predict the number and types of residential/service slots needed by the chronically mentally ill. In Colorado, a model was developed which uses data-based client profiles to predict needs along a continuum of services ranging from inpatient treatment to independent living with mental health support. In this paper, we discuss the development of the model and present the results of implementing it for a sample of 5,017 chronically mentally ill clients. The practical and heuristic value of the model is featured as well as its implications for further research.