Assessing the Impact of an Arizona Consumer-Operated Service Program (COSP)

Assessing the Impact of Consumer-Operated Service Programs (COSP)

Abstract

Background:

Consumer-operated service programs (COSPs) are peer-run organizations, administratively controlled and operated by consumers of behavioral health services. COSPs actively engage clients by employing reciprocity and mutual aid to support clients in recovery, bridging traditional behavioral health services and community integration. Research supports COSP impact on client outcomes, such as decreases in symptomology, hospitalization, and justice involvement and have been demonstrated as effective in promoting client outcomes when compared with more traditional behavioral health programs but often less costly.  Previous research, however, overlook other critical effects from COSP membership that may serve to increase client empowerment and community impact. In this paper, we report the results of a four-year evaluation of a COSP operating in a large southwest metropolitan community that utilized both client outcome measures and service outcome measures to assess the impact of member participation.

Methods:

We employed a mixed methods, pre-post design with comparison data from member surveys, electronic health records (i.e., service encounters), and interview protocol. Data were collected on 391 members from 2010 to 2014.  Self-reported survey data were validated against service encounters. Specific hypotheses were tested using statistical tests of difference to determine the effects of member participation on both consumers and organization as compared with statewide averages. 

Results:

Client outcomes were found to significantly improve with COSP membership.  Significant decreases with moderate effect sizes were observed in psychiatric hospitalizations (Z=2.24, p<.05), problematic psychological symptoms (Z=-2.71, p<.01) and excessive substance use (Z=-2.12, p<.05). Encountered hospitalizations are significantly lower than statewide averages. Unfortunately, no comparison data were available to assess these results specifically against traditional non-consumer operated programs.

High levels of member satisfaction were observed, including services promoting symptom management (78%), social skills (76%), health and wellness activity (72%), and living skills (70%). Text analysis of open-ended survey results and interviews also illustrate strong effects from organizational responsiveness to member needs in addition to identifying new areas of need/expansion such as advocacy activities and ongoing opportunities for staff education.

Implications:

Considerable research has already established that COSPs have positive, cost effective effects on client outcomes.  However, current research suggests that in addition to promoting wellness and cost effectiveness, the unique organizational structure of the COSP may promote stronger, more effective community organizations for delivering behavioral health by empowering consumers.  Considerably more research is required to better understand how mutual aid and reciprocity work in COSPs to promote individual recovery, resiliency and wellness as well as stronger, more responsive and more client-centered organizational delivery systems. Research on COSPs should continue to integrate service outcomes measures to better understand the full array of effects achieved though COSPs.  Future plans include expanding this research to other COSPs as well as comparing organizational effects to traditional non-consumer operated behavioral health programs.