Skyland Trail is a trailblazer in the area of measurement-based care and outcomes research, which is an integral part of our evidence-based treatment model. Our robust outcomes and research program employs evaluative instruments considered to be the gold standards in the mental health field to measure the effectiveness of our treatment programs.
Outcome data from 2008 through 2021 confirm that our unique integrated, evidence-based approach helps our patients return to their communities with reduced symptoms and improved skills to pursue more independent and productive lives.
2021 OUTCOMES RESEARCH REPORT
2021 Patient Community
Age at Admission
Gender (Adult Patients)
Gender (Adolescent Patients)
Primary Diagnosis at Discharge
(Adult Patients)
Primary Diagnosis at Discharge
(Adolescent Patients)
Adult Patient Complexity
Skyland Trail has specialized in treating complex patients for many years. Many patients enroll in the residential treatment program after participating in other outpatient or inpatient therapeutic programs without results.
In 2021, Skyland Trail treated a large number of young adult patients ages 18 to 25 with a complex constellation of co-occurring disorders: a mood disorder, borderline personality disorder, and a substance misuse disorder. Patients in this category had outcomes similar to the broader patient population and experienced significant improvement in symptoms, functionality, and hopeful thinking.
66% of adult patients
had >3 co-occurring diagnoses confirmed at discharge
Co-occurring disorders include: anxiety disorders, substance use disorders, borderline personality disorder, PTSD, and others
44.1% of adult patients had a personality disorder in addition to their primary diagnosis
39.8% of adult patients had a substance use disorder in addition to their primary diagnosis
Adolescent Patient Complexity
More than half of adolescent patients have at least four co-occurring diagnoses. Many adolescent patients have a combination of major depression and an anxiety disorder. Other co-occurring diagnoses include substance use disorder, ADHD, autism spectrum disorders, OCD, PTSD, and Tick Disorder.
2021 Adult Programs Key Outcomes
Improved Functioning
92% of adult patients
experienced a statistically significant improvement in functionality, symptoms and social relationships 1
Improved Hope
84% of adult patients experienced a statistically significant improvement in hope 2
Improved Medication Attitudes
88% of adult patients leave treatment with a positive attitude about taking psychiatric medication 3
Reduced Psychosis
89% of adult patients with psychosis experienced clinically significant improvement in their symptoms of psychosis 4
Reduced Depression
94% of adult patients with very severe and severe symptoms of depression experienced clinically significant reduction in symptoms 5
Reduced Mania
85% of adult patients who had clinically meaningful episodes of mania showed no symptoms of clinically meaningful mania at discharge 6
2021 Adolescent Programs Key Outcomes
Reduced Depression
95% of adolescent patients
with severe and very severe symptoms of depression experienced clinically significant reduction in symptoms at discharge
Reduced Anxiety
91% of adolescent patients with very elevated or elevated symptoms of anxiety experience a clinically significant reduction in anxiety at discharge
(1) The 32-item Behavior and Symptom Identification Scale (BASIS-32): ©McLean University, Affiliate of Harvard Medical School. (2) 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) 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) Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962; 10:799-812. (5) Montgomery, S.A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389. (6) 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. (7) Hamilton M: The assessment of anxiety states by rating. British Journal of Medical Psychology, 32:50-55,1959.
Adult Symptom Reduction
Skyland Trail administers disease-specific outcome measurement tools every two weeks of treatment, based on the confirmed diagnosis at admission. Though the scales differ for each measurement, lower scores always indicate improved symptomatology.
WORKING TOWARD REMISSION
We are looking at how to bring about remission for diagnoses like depression and are moving the needle in that direction.
In 2021:
- 13% of adult patients with major depression were considered in remission - completely symptom free - at discharge
- 47% of adult patients with major depression improved by 50% or more
(Based on a comparison of scores on the Montgomery-Asberg Depression Rating Scale at admission and discharge.)
13% of adult patients with major depression
were considered in remission
at discharge
MAJOR DEPRESSION
94% of adult patients with very severe and severe symptoms of depression experienced clinically significant reduction
t(120) = 17.499, p < 0.001
Montgomery, S.A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
Montgomery-Asberg Depression Rating Scale 2021
(Adult Patients)
BIPOLAR ILLNESS
85% of adult patients who had clinically meaningful episodes of mania showed no symptoms of clinically meaningful mania at discharge
t(26) = 2.887, p < 0.05
Young, et. Al. (1978). A rating scale for mania: reliability, validity, and sensitivity. British Journal of Psychiatry, 133, 429-435.
Young Mania Rating Scale 2021
(Adult Patients)
ANXIETY DISORDERS
85% of adult patients with anxiety experience statistically significant improvement in control of anxiety
t(64) = 6.868, p < 0.001
Hamilton M: The assessment of anxiety states by rating. British Journal of Medical Psychology 32:50-55,1959.
Hamilton Scale of Anxiety 2021
(Adult Patients)
THOUGHT DISORDERS
89% of adult patients with psychosis experienced statistically significant improvement in their symptoms of psychosis
t(36) = 5.029, p < 0.001
Overall JE, Gorham DR. The Brief Psychiatric Rating Scale. Psychological Reports. 1962; 10:799-812.
Brief Psychotic Rating Scale 2021
(Adult Patients)
All Adult Patient Assessments
These assessments are administered to patients with all diagnoses at admission and at discharge.
IMPROVED FUNCTIONING
In 2021, adult patients consistently showed statistically significant functional improvement as measured by the BASIS-32. Comprised of 5 subscales, the BASIS-32 contains an overall average score ranging from 0 to 4, with lower scores indicating greater levels of functioning in daily life, interpersonal relationships, impulsivity, psychosis, depression, and anxiety.
Patients as a group showed significant impairment at admission, and low-moderate impairment (and in many cases, no impairment) at discharge.
The 32-Item Behavior and Symptom Identification Scale (BASIS-32). © Copyright McLean University, Affiliate of Harvard Medical School.
Significant Impairment
>1.5 Significant and systemic impairment in daily life and/or interpersonal relationships, with extreme impulsivity, psychosis, depression, and/or anxiety present.
Moderate Impairment
.5–1.5 Moderate impairment in daily life and/or interpersonal relationships, with some impulsivity, psychosis, depression, and/or anxiety present.
Full Functioning
<0.5 Indicates full functioning with no significant impairment in daily life and/or interpersonal relationships, with little or no impulsivity, psychosis, depression, and/or anxiety present.
BASIS-32 Overall Change Scores 2021
(Adult Patients)
t(253) = 14.748, p < 0.001
BASIS-32 Subscales Change Scores 2021
(Adult Patients)
Relation to Self/Others
t(253) = 13.211, p < 0.001
BASIS-32 Subscales Change Scores 2021
(Adult Patients)
Depression/Anxiety
t(253) = 12.707, p < 0.001
BASIS-32 Subscales Change Scores 2021
(Adult Patients)
Daily Living Skills
t(253) = 14.259 p < 0.001
BASIS-32 Subscales Change Scores 2021
(Adult Patients)
Impulsivity
t(253) = 10.227, p < 0.001
INCREASED HOPEFUL THINKING
In 2021, adult patients continued to experience a statistically significant decrease in feelings of hopelessness. This finding indicates that, on average, individuals improved from seeing very little hope in all domains of their lives at admission to feeling less hopeless at discharge. Hope for one’s future is one of the best predictors of continued adherence to a recovery plan and protective against suicide.
Human beings are much more than constellations of symptoms, thoughts and behaviors. Hopefulness, social interconnectivity, and a sense of self efficacy define recovery and what it means to be mentally well.
Beck AT, Weissman A, Lester D, Trexler L. (1974). The measurement of pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology, 42(6), 861-865
Nihilistic Preoccupations
>8 These individuals see very little hope in all domains of their lives.
Some Hopelessness
3–8 Individuals display some hopelessness in their thinking. Individuals closer to 8 can be said to be very hopeless while those scoring closer to 3 can be said to be somewhat hopeless.
Hopeful
<3 Individuals are said to be hopeful.
Beck Hopelessness Scale Scores 2021
(Adult Patients)
t(254) = 11.370, p < 0.001
IMPROVED MEDICATION ADHERENCE
Attitude toward taking psychiatric medications is a surrogate measure for medication adherence. Medication adherence is one of the best predictors of sustained recovery.
Scores on the Medication Attitude Inventory (MAI) range from -10 to +10, with higher scores indicating more positive attitudes towards medication use and medication adherence. On average, patients in 2021 experienced a statistically significant improvement with an average attitude score of 3.99 at admission to a 7.18 at discharge.
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.
>5 Indicates generally positive attitudes towards medication use and are correlated with greater levels of medication adherence in a clinical setting.
Medication Attitude Inventory 2021
(Adult Patients)
t(254) = -11.032, p < 0.001
IMPROVED ABILITY TO MAKE DECISIONS
A sample of 253 adult patients who completed the Making Decisions Scale at admission and discharge demonstrated statistically significant improvement in their ability to use self-esteem, optimism, and personal power in making decisions.
A four-point scale, where scores centered around 1 indicate negative beliefs about the ability to make decisions with psychological components like:
• self-esteem
• optimism
• activism
• personal power (beliefs in the efficacy to make decisions on one’s own)
Rogers et al. (1997). A consumer-constructed scale to measure empowerment among users of mental health services. Psychiatric Services, 48(8), 1042-1047.
Making Decisions Scale 2021
(Adult Patients)
SELF-ESTEEM
t(252) = -12.666, p < 0.001
OPTIMISM
t(252) = -9.392, p < 0.001
ACTIVISM
t(252) = -5.249, p < 0.001
PERSONAL POWER
t(252) = -8.497, p < 0.001
All Adolescent Patient Assessments
These assessments are administered to adolescent patients with all diagnoses at admission and at discharge.
IMPROVED DEPRESSION SYMPTOMS
Scores on this depression symptoms assessment range from 0 to 63, with higher scores indicating more severe symptoms of depression. On average, adolescent patients in 2021 experienced a clinically significant improvement with an average score of 32.84 at admission and an 8.7 at discharge.
> 40-31 Extreme to severe depression
30-17 Moderate clinical depression to borderline clinical depression
16-11 Mild mood disturbance
< 10 These ups and downs are considered normal
On average, adolescent patients enter treatment with severe depression and leave treatment with mood changes more consistent with a typical adolescent experience.
Depression Scores
(Adolescent Patients)
t(79) = 16.247, p < 0.001
IMPROVED ANXIETY SYMPTOMS
Responses on the Multidimensional Anxiety Scale for Children are combined to create T-scores, with higher T-scores indicating more severe and/or a greater number of symptoms. On average, adolescent patients in 2021 experienced a clinically significant improvement with an average T-score of 76.2 at admission to a 41.1 T-score at discharge.
March, J. S., Parker, J. D., Sullivan, K., Stallings, P., & Conners, C. K. (1997). The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American academy of child & adolescent psychiatry, 36(4), 554-565.
> 70-65 Very elevated to elevated anxiety
64-59 Slightly elevated to high average anxiety
58-40 Average anxiety
< 40 Low anxiety
On average, adolescent patients enter treatment with very elevated anxiety symptoms and leave treatment with little to no anxiety.
Multidimensional Anxiety Scale for Children
(Adolescent Patients)
t(79) = 10.724, p < 0.001