An evaluation of a program of continuing education in community mental health.

Abstract Functioning as a research team we organized an evaluative program to determine the effectiveness of an educational program in inculcating changes in attitudes about community mental health causes and management approaches plus changes in working behavior among four consecutive groups of about 20 mental health professionals employed at facilities supported by the Ohio Department of Mental Hygiene and Corrections. The research team members were independent and not under the aegis of the educational program's policy makers or educators. The program lasted four weeks for each group of trainees. It involved 40 hours per week of lectures, demonstrations, workshops, and active, supervised participation in consultative and other community mental health activities within an urban mental health center complex at Cincinnati, Ohio. Nearly all the participants belonged to three professional disciplines: social work, psychology, and psychiatry. A set of evaluative instruments was designed specifically for this study to determine the effectiveness of this training program. An enumeration of these in the order they were administered follows: A goals questionnaire designed to elicit each trainee's own particular objectives in attending such a program and the contextual characteristics of the organization in which he was working. A time-expenditure questionnaire indicating the manner in which each participant spent his professional time before and after the program. A five-minute verbal sample, a brief, free-associative sample of speech elicited from each participant and content analyzed using the Gottschalk-Gleser method, to provide scores on anxiety, hostility, capacity for human relations, hopefully predictive of the type of trainee who showed optimal changes upon completion of the course. A rating scale of causes of various mental disorders or social conditions filled out by the trainee in terms of his attitudes about the relative importance of these causes. A rating scale on management approaches to changing mental or social problems filled out by the trainee in terms of his opinions about their relative effectiveness. A structured interview designed to elicit detailed information in more depth about the institution and community in which the participant works. Four psychiatrists, three psychologists, and three social workers—either on the policy-making committee or lecturers on the program—were asked to fill out the two rating scales of the causes of and the optimal management approaches to mental or social disorder in order to provide criteria for determining favorable and unfavorable attitude changes in these dimensions among the trainees as a result of the program. These professional groups showed divergent views regarding these issues. Psychiatrists assigned more importance to heredity as a causal factor, whereas, psychologists and social workers laid more emphasis on cultural factors. Psychiatrists favored individual therapies and the need for further research as preferred approaches to these problems. Psychologists preferred group therapies and social workers preferred agency consultations. Both these latter two groups emphasized community mental health centers as superior to research. Immediately after the four-week training period all professional groups tended to view heredity as a less important causal condition and economic and geographic conditions as more important. All four training groups attributed more relevance to consultation and community centers and less importance to individual therapies and research. With regard to the correspondence in attitudes of each professional group with their respective criterion group, social workers and psychiatrists began the course with a very high consensus (r = .98) and both these professional groups showed a slight decrease at the end of the course (r = .94–.96). In contrast, the psychologist trainee showed attitudes which were more highly correlated with their criterion group after the training program (r = .88) than before (r = .85). A different pattern of correspondence occurred between the pre- or post-ratings of management approaches by the trainee-professionals and their respective criterion groups. A control group of mental health professionals, who worked at the same facilities as the trainee but did not attend this educational program, did not show attitude changes of the kind occurring among the trainees after a one-month testing interval. In contrast to the attitude changes noted among the trainees immediately after the four-week course, there was no compelling evidence from the time-expenditure questionnaire administered five to six months after their didactic experience that distribution of effort and work of the four groups of trainees was consistently increased in the prescribed directions of coordination, comprehensiveness, and continuity of services. Some groups of trainees did, however, show changes in professional approach along the lines fostered by the program. However, some groups showed behavior changes in the opposite direction. Since no significant positive changes were consistently demonstrated across all four groups, it was not possible to adopt any change as a criterion to be predicted on the basis of content analysis scores derived from the five-minute verbal samples. We examined whether the mean and range of certain psychological measures (affect scores and human relation scores) differed appreciably for those who indicated new educational programs after their training as contrasted to those who did not do so. No significant differences were noted. At a further followup of ten trainees from the first class who attended a reunion-workshop over a year after the course, however, one-half reported they had changed their approach to patients after the course. The factors reported which prevented changing ranged from personal inertia to difficulties with the administration of their mental health facility. Nonetheless, all of these trainees were very enthusiastic about the course they had taken. We think it is interesting that the most frequently proposed change they recommended to augment the effectiveness of the program was to place greater emphasis on group interaction and discussion in small groups. The findings are discussed emphasizing some of the advantages of the research design and evaluative measures used toward minimizing experimenter bias or systematic measurement error.