2020 Outcomes and Research Report Published

Atlanta, GA – Skyland Trail recently published the 2020 Outcomes Research Report. Outcomes research is an integral part of the evidence-based treatment model and measurement-based care provided to adult and adolescent clients in the psychiatric residential treatment and day treatment programs in Atlanta.

Patients complete standardized clinical assessments during the admissions process that measure their symptoms (including diagnosis-specific symptoms), attitude toward medication and treatment, hope for the future, level of functioning, sense of self-efficacy and relationships with others, and physical health. These indicators are also measured throughout treatment and when clients complete their treatment at Skyland Trail.

Key overall client outcome measures include:

• 89% of all patients experienced a clinically significant improvement in functionality, symptoms and social relationships₁
• 85% of patients with anxiety experienced clinically significant improvement in control of anxiety₆
• 86% of all patients experienced a clinically significant improvement in hope₂
• 88% of clients with very severe and severe symptoms of depression experienced clinically significant reduction in symptoms₄
• 100% of clients who had clinically meaningful episodes of mania showed no symptoms of clinically meaningful mania at discharge₅
• 90% of clients leave treatment with a positive attitude about taking their psychiatric medication₃
• 85% of patients with psychosis experienced statistically significant improvement in their symptoms of psychosis₆

Clients also complete diagnosis-specific assessments. These specialized evaluations measure improvement in function and reduction in symptoms for clients with specific diagnoses and provide a more detailed evaluation of treatment effectiveness in addition to the aggregate measures.

Patients admitting with bipolar mania were uniformly in remission from mania at discharge, meaning they no longer were experiencing symptoms of mania. Skyland Trail is looking at how to bring about remission for other diagnoses, specifically depression, and is moving the needle in that direction.

In 2020:

• 31% of patients with major depression were considered in remission—completely symptom free—at discharge₄
• 40% of patients with major depression improved by 50% or more₄
• 88% of all patients with major depression experienced a clinical improvement in symptoms₄

Key outcomes from 2020 demonstrate that patients who came to Skyland Trail for treatment during the pandemic were, in general, more complex and symptomatic than in previous years. Over 60 percent of all of the patients who were both admitted and discharged within the year 2020 had three or more validated psychiatric diagnoses. Further, a significant number of these complex patients experienced disabling anxiety that was associated with the pandemic. More patients with anxiety and depression also had co-morbid substance misuse of easily accessible substances such as alcohol and marijuana, likely due to delaying psychiatric care while isolating at home.

Outcomes research in 2020 explored the link between a history of trauma and response to treatment. Approximately 30 percent of adult patients in 2020 had histories of moderate or severe traumas, and individuals with sexual traumas showed statistically significant elevated levels of C-reactive Protein (CRP). CRP is an indicator of global body inflammation, and higher CRP levels suggest overall poorer physical health and treatment response compared to individuals with lower CRP levels. Based on this research, Skyland Trail is exploring opportunities to use CRP levels and trauma assessments to “predict” which patients will need specific trauma-informed therapies and connect patients with targeted interventions earlier in their treatment. 

References

1 t(259)=1302, p<.001 The 32-item Behavior and Symptom Identification Scale (BASIS-32): © Copyright McLean University, Affiliate of Harvard Medical School.

2 t(255)=9.04 p<.001 Beck Hopelessness Scale: Beck AT, Weissman A, Lester D, Trexler L. (1074). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865.

3 t(244)=-11.41, p=.001 Medication Attitude Inventory: Hogan TP, Awad AG, & Eastwood R. (1983). A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychological Medicine, 13, 177-183.

4 t(222) = 10.30, p =.000 Montgomery, S.A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.

5 t(25)= 4.42, p=0.001 Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry, 133:429-435, 1978.6 Hamilton M: The assessment of anxiety states by rating. British Journal of Medical Psychology, 32:50-55,1959.

6 t(46)= 11.8,  p=0.000 Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962; 10:799-812.