Program Description
The current Regional Behavioral Health Authority (RBHA) is Magellan and its contracted service providers: Southwest Network, CHOICES of AZ, People of Color Network and Partners in Recovery. As a member of one of the contracted providers the institution has the option of applying for supported housing through Arizona Behavioral Health Corporation (ABC). ABC has a Tenant Based Rental Assistance Program which is a program that if you meet the HUD definition of homelessness, provides quality, affordable supportive housing for persons with behavioral health needs in Maricopa County. ABC contracts with three housing providers for the homeless housing programs, they are:
Housing Providers operate Tenant-Based Rental Assistance (TBRA) Programs on behalf of Arizona Behavioral Health Corporation (ABC) for homeless persons with serious mental illness. The participants in the program are provided with supportive services by designated managers to assist them to live independently in the community. The case managers ensure that a participant is well placed in the community with the provision of any help the participant may require.
However, there appears to be a trend that indicates that once the participant receives the housing subsidy they are unable to maintain the housing for an extended period. The participants have portrayed an inability to effectively integrate into society smoothly. This evaluation will try to find what would enable the provision of better support to the participants enabling them to live independently in the community without being evicted from their homes and being ejected from the housing program.
Program description
The purpose of the evaluation is to identify the effectiveness of the Tenant-based Rental Assistance Program and the incorporation of house visits into the program. This evaluation is meant to serve several purposes; to judge the effectiveness of the Arizona Behavioral Health Corporation in the integration of mentally ill patients into the community. The other function is to determine measures to be taken for better results and finally to determine the degree to which the goals of the organization are being met.
The target audience includes the patients themselves, staff of ABC, and the local public with whom the participants are to integrate. The secondary audience includes Maricopa County as most of the housing projects takes place here.
The Arizona Behavioral Health Corporation (ABC) has also instituted a mobile crisis team that responds to 911 calls concerning psychiatric cases. The mobile crisis team comprises professional doctors in collaboration with police offers to intend to provide help to mentally ill patients. The team works to reduce the number of mentally ill patients going to jail or the hospitals. The mobile crisis team is also another program that may help the transition of participants into the general public. The general public is not ready to help mental health patients due to ignorance and fear. Through the provision of programs that support these participants during the initial integration process, the public and the participants may both benefit.
Design
The main problem with the rehabilitation of mental patients into the public is the lack of a smooth transition into this new life. This might arise due to their inability to effectively cope with being alone or through being misunderstood by their neighbors. The Mobile crisis team should not only deal with 911 calls but also help the integration of the participants into society (Best 2001). Members of the team should work closely with the participants showing them how to navigate through this new life and also introduce them to their neighbors. Through constant checking in, the mobile team through time shall aim at making the participants feel comfortable being on their own and eventually help in fitting in with the society. The mobile crisis team also responds to calls by participants involving any problems. They act as mediators between the participants and the community they reside in. For this to be successful one has to assume that the participants can interact in the outside world and they pose no danger for themselves or to others. One has to assume that after the initial snag and through assistance the participants will be able to effectively enter the main public stream. The amount of manpower and skill of manpower will be determined by the number of participants and their ability to effectively participate in the program.
A logic model will be used to show how the objectives are expected to be met. A logic model separates the input, the output, and outcomes of the program. We shall look at these separately
The evaluation of the mobile crisis team has previously been carried out by Roger Scott. In his evaluation, Scott mainly focused on effectiveness, efficiency, and customer satisfaction. According to Scott, fifty-five percent of emergencies handled by the mobile crisis unit were managed without the hospitalization of the individual involved. The consumers and normal police officers were also impressed by the team and gave good reviews on the capabilities of the team. The mobile crisis program evaluated was however belonging to DeKalb County in Georgia.
Purpose and scope of the evaluation
The main focus of this evaluation is to examine the viability of the Mobile crisis team as indicated by the ability to help in ensuring participants keep their housing arrangements and effective integration into the community. The evaluation looks at the current functions of the mobile crisis team and its effectiveness, possible changes to the mobile team to aid in the settlement of participants, and the expected effectiveness of the program.
The scope of the evaluation is the Arizona Behavioral Health Corporation Mobile Crisis Team. The evaluation will mainly highlight the desired outcomes that relate to the program goals i.e. assessment of change in socializing skills of participants, Assessment in the change of communication skills, and finally the assessment of the change in the confidence level of the participants concerning living alone and the subsequent reduction in several participants unable to maintain their housing arrangements.
The program evaluation shall seek to compare outcomes for those receiving help from the mobile team and the previous outcome recorded. The number of those who were unable to maintain housing for a chosen period will be compared to the number who will not be able to maintain housing once the program is implemented. The reason to choose this method of evaluation is to have an account of changes that need to be implemented in the future during similar projects. Since human actions cannot be quantified and decisions made by people are usually random it is better to examine the cause and effect involved in this case.
In choosing a quasi-experimental evaluation method, comparisons can be made on the changes involved during the implementation of the program. The data on the number of people leaving the housing program after the program is instituted will be obtained and compared with the previous value of those who left. To identify the participants, the type of mental illness has to be the same. This is done with the assumption that their reasoning will be almost the same and reaction to different events is not highly variable. Another criterion for selection is that the sickness has not progressed to a point where coherence and reasoning skills are hampered.
Development of indicators
The evaluation aims to determine the ability of the mobile team to help participants integrate into society. The main indicators that will be checked to judge on the success will be the change in several participants who lose their housing and the time it takes for participants to integrate into the situation of living alone. In checking on the success of participants retaining their homes it is possible to account for the progress the program is making. Since the object of the program is helping in smooth integration into the society, reduction in participants losing housing is a success but if the rates increase or hold constant then the program is deemed a failure. Another indicator is an increase in socializing skills. If participants are comfortable on their own and with time can socialize with the neighbors then the program is successful.
The success of the program will also be indicated by a reduction of 911 calls regarding psychiatric patients integrated into society through the organization. The number of calls can be quantified and compared before implementation and after implementation. Disturbances arising from the participants will generally describe the level of success of the program.
To carry out this evaluation the analysis methods have to be statistical. This will allow for comparison between obtained data and that in the institution database (Fisher 1951). Data collection strategies to be used for this evaluation ranges from the survey, testing, and document reviews i.e. studying of past information collected on the matter.
One has to take into account the highly variable nature of human actions and the many unpredictable factors surrounding this evaluation. It is hard to quantitatively analyze this situation using formulas since the decision made by the participants is not known. The success of the program can only be determined by the reduction in the rate of people unable to maintain the houses with which the institution has helped them acquire
Evaluation Design
The collection of data will entail both qualitative and quantitative methods. Interviews will be carried out on the participants, medical staff, and the policemen, a survey will be carried out on the participant’s neighbors, and also several tests will be given on the participants. The test done on the participants will try to judge how well the subject deals with his neighbors and situations that require social interaction
The interviews on the staff of the mobile team will be done every month with the main aspect in question being progressed on the participants and the number of crises they have had to solve. The survey to be carried out on the neighbors will try to determine how well the participant is coping and what changes have been noticed since the implementation of the program. According to Joel Best, the collection of statistics dealing with social values should deal with the exact processes that are involved. As such in the survey details on how the participants interact, a problem encountered in socializing with the participants, and the impression the neighbors have on the participants have to be collected. The questionnaires will contain Yes or no questions with four possible responses; certainly yes, positively no, usually yes, and usually no. The answers will then be tallied and the percentages of the total determined
The Arizona Behavioral Health Corporation will then tally the number of participants who entered the program and those who have been able to retain their housing conditions for a long period. Comparison graphs can be drawn to compare variations between those in the program and those who did not attend the program. This comparison will be done for a specific time over a constant period e.g. number that left for 6 months before the implementation of the program and the percentage of those who stayed over a similar period after implementation.
The test given to the participants will aim at providing a detailed account of the progress made through help from the mobile team. The participants will be asked short questions and told to choose one of the answers provided to them. If the comprehension capability of a participant is good, then the participant might be given a written test to answer. The answers are then compiled and statistical analysis the carried out. The standard deviation on the answers is very important as it will show what progress is made and the difference in reaction by the participants to the program
During the evaluation process, it will be difficult to judge the experiences of one participant to those of another. Since human behavior is random one participate may have harsh neighbors making it harder for him/her to effectively socialize. The evaluator thus has to determine the reaction by the community to effectively account for answers collected from the participant.
The survey to be carried on the community will be primarily to judge how the participant integrates with everyone else. The answer provided will highlight what advances have been made and how well the participant is coping with the new living condition. In this survey, the problem of assumption might arise. The neighbors might not have interacted enough with the participant hence answers given might be highly presumptuous.
Another possible problem is the lack of willingness of the community to be involved in the evaluation. Since this is likely a touchy issue many people might shy away fearing to be misinterpreted or to be seen as a discriminative person.
Summative Evaluation
The summary of the evaluation of the project outcomes is outlined below concerning both initial, intermediate, and long-term outcomes. The first initial outcome expected is the improvement in social interaction capabilities. For a participant to maintain housing arrangements for a long period interaction with the community is necessary. At the end of the evaluation, the participant should display the ability to effectively converse with the community and also partake in some of the community activities. The participant should also be well thought of by the neighbors and should not be engaging in antisocial behaviors. The intermediate outcome expected should be integrated into the community with the neighbors considering the participant as one of their own and the participant themselves being well adjusted into living in that particular neighborhood.
To carry out this evaluation, a non-experimental design will be used. The purpose of the program is to find out why a problem exists and determine if the Mobile Crisis Team can effectively handle the situation. The posttest-only design is the best method since a control group does not exist in this situation and observation is only made after the intervention has been instituted (Fisher & Foreit 2002). The measurement describes the problem at hand and offers insight into the problem.
The main threat to the validity of this evaluation is that people’s characters widely differ and no control is provided to the participant as to where he might reside. Some participants might be welcomed in the neighborhood while some are treated badly and shunned. This might complicate the efforts of the mobile crisis team in that external influences play a very big role in the outcome. This design method does not control bias associated with the interviewing process and also one cannot differentiate between the effects caused by the mobile crisis team and those caused by the environment in which the participant is residing.
The main intermediate plan that needs to be observed is the reduction in the number of participants leaving the housing program. The study design chosen is comparative and entails the implementation of the intervention followed by the measurement of change and finally, a comparison of the data acquired. Since this evaluation is about comparing the success of the mobile crisis team as a means of curbing the eviction of participant’s problems, the design method chosen adequately provides a way of measurement.
Discussion
The evaluation process is however prone to many obstacles. First and foremost is the mental status of the participants. To correctly judge progress the participants must have a precise way of thinking. Most mental patients make rash decisions that do not follow any logic. The evaluators must thus be able to interpreted answers provided by the participants
Another problem is attitudes from the community. Most people do not know how to handle disabled people especially those with mental illnesses. This might cause bias in the presentation of opinions during the survey session and also some individuals might hamper the integration process by threatening the participants.
The outcomes may also be affected by the type of mental condition the participant has. The institution does not discriminate against the type of illnesses hence decisions made may be a factor of the mental illness that inflicts a participant. If a participant’s decision is a function of an illness then the values gotten as the outcome may not be reliable.
The evaluation design in itself is feasible since it tries to identify the reason why many of those in the program do not retain their houses and also tries to determine if the mobile crisis unit may be of assistance to the participants. If the medical staff is adequately integrated into the evaluation process, a reliable analysis might be carried out, and results retrieved might be used to ensure that the home provision project does not collapse.
The evaluation process does not pose any ethical issues or pose any threat to the rights of an individual. The people taking part are needy and thus in carrying out the evaluation it is possible to help them by ensuring they do not lose their housing. Many people are not ready to provide housing solutions to mental health patients despite a large number of them being homeless.
Reporting plan
Each audience member will receive the results except the participants. Each group is interested in different items on the evaluation plan. The staff is mainly interested in participant social skills development, communication skills, and consistency in housing arrangements. The community is concerned about the integration of the individuals into the neighborhood and the investors are mainly concerned with the number of participants who can maintain the housing arrangements.
The stakeholders all need to be involved in different stages of the evaluation process. The policemen and medical staff will be involved extensively throughout the project as they are responsible for checking up on the participants, training the participants on the various issues stated, and recording notable changes
The housing providers will be involved in the provision of housing facilities and also in ensuring that the neighborhoods in which the participants are placed are receptive. Although it is hard to control these groups of participants, the participants play a big role in the evaluation. Through the various interactions between them and the mobile crisis team and between them and their neighbor’s adequate data can be collected to offer insight into the problem.
Summary and conclusion
A program evaluation should provide a detailed account of the benefits of a program. It should highlight its viability and effectiveness (Patten 2007). This evaluation of the Mobile Crisis Team program employed an objective-oriented approach to effectively determine the outcomes of the program. The effectiveness of the program was questioned and answer for the betterment of the program sort.
For the evaluation to be used the shareholders i.e. the housing providers should be involved in every aspect of the process and the main institution, Arizona Behavioral Health Corporation (ABC), be actively involved. The participants should be selected such that they can live independently and care should be taken to ensure that the participants move into friendly neighborhoods.
The initial function of the Mobile Crisis Team was to help out mental health patients in a crisis involving 911 calls (Geller 1995). The addition of a new task requires additional manpower which has to be handled.
The shareholders should at the end of this evaluation be able to make informed decisions on the application of provided ideas to solve the housing problems that the participants face and also calculate the amount of additional investment required for the program to work.
The limitations provided have to be checked in detail to ensure that the correct decision is made. Dealing with mentally ill individuals requires an alteration to conventional decision-making as most actions taken by these individuals do not take on a logical path. It is imperative to remember the type of individuals the program is meant to benefit and the final analysis of the evaluation has to take account of that.
References
Best, J. (2001). Damned Lies and Statistics: Untangling Numbers from the Media, Politicians and Activists. California: University of California Press.
Fisher A. A. & Foreit J. R. (2002) Designing HIV/AIDS Intervention Studies. New York: Population Council.
Fisher, R. A. (1951). The design of experiments (6th ed.) New York: Hafner.
Geller J.L, Fisher W.H & McDermeit M. (1995): A national survey of mobile crisis services and their evaluation. Psychiatric Services 46:893–897, 1995.
Patten, M. (2007). Understanding research methods (6th ed.). Glendale, CA: Pyrczak Publishing.