Scolaris Content Display Scolaris Content Display

Graphical representation of comparisons 1 and 2
Figuras y tablas -
Figure 1

Graphical representation of comparisons 1 and 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Comparison 1 Consumer‐provider versus professional staff, Outcome 1 Quality of life: Life satisfaction subscale (subjective).
Figuras y tablas -
Analysis 1.1

Comparison 1 Consumer‐provider versus professional staff, Outcome 1 Quality of life: Life satisfaction subscale (subjective).

Comparison 1 Consumer‐provider versus professional staff, Outcome 2 Function: Daily activities subscale (subjective).
Figuras y tablas -
Analysis 1.2

Comparison 1 Consumer‐provider versus professional staff, Outcome 2 Function: Daily activities subscale (subjective).

Comparison 1 Consumer‐provider versus professional staff, Outcome 3 Social: Social relations subscale (subjective).
Figuras y tablas -
Analysis 1.3

Comparison 1 Consumer‐provider versus professional staff, Outcome 3 Social: Social relations subscale (subjective).

Comparison 1 Consumer‐provider versus professional staff, Outcome 4 Symptoms.
Figuras y tablas -
Analysis 1.4

Comparison 1 Consumer‐provider versus professional staff, Outcome 4 Symptoms.

Comparison 1 Consumer‐provider versus professional staff, Outcome 5 Depression.
Figuras y tablas -
Analysis 1.5

Comparison 1 Consumer‐provider versus professional staff, Outcome 5 Depression.

Comparison 1 Consumer‐provider versus professional staff, Outcome 6 Satisfaction.
Figuras y tablas -
Analysis 1.6

Comparison 1 Consumer‐provider versus professional staff, Outcome 6 Satisfaction.

Comparison 1 Consumer‐provider versus professional staff, Outcome 7 Client manager relationship.
Figuras y tablas -
Analysis 1.7

Comparison 1 Consumer‐provider versus professional staff, Outcome 7 Client manager relationship.

Comparison 1 Consumer‐provider versus professional staff, Outcome 8 Use of mental health services in 12 months.
Figuras y tablas -
Analysis 1.8

Comparison 1 Consumer‐provider versus professional staff, Outcome 8 Use of mental health services in 12 months.

Comparison 1 Consumer‐provider versus professional staff, Outcome 9 Attrition.
Figuras y tablas -
Analysis 1.9

Comparison 1 Consumer‐provider versus professional staff, Outcome 9 Attrition.

Study

Description

Consumer‐provider

Professional staff

Bright 1999

Caseload (Mutual support groups)

n = 22

n = 27

Bright 1999

Caseload (Cognitive behavioural therapy groups)

n = 21

n = 27

Clarke 2000

Average caseload

4.6 clients/case manager

5.4 clients/case manager

Rivera 2007

Personnel

4 x 0.5 EFT personnel (n = 70)

2 x 1.0 EFT personnel (n = 66)

Sells 2006

Average caseload

10 to 12 clients/case manager

20 to 24 clients/case manager

Solomon 1995

Personnel

4 personnel

(n = 48)

4 personnel

(n = 48)

Figuras y tablas -
Analysis 1.10

Comparison 1 Consumer‐provider versus professional staff, Outcome 10 Service provision: Caseload/personnel.

Study

Time spent with

Consumer‐provider

Professional staff

Effect measure

Clarke 2000

Team

40%

40%

not estimable

Clarke 2000

Clients

33%

33%

not estimable

Clarke 2000

Alone

25%

25%

not estimable

Clarke 2000

Family/staff and

other agencies/operators

6%

6%

not estimable

Clarke 2000

Solomon 1995

Face‐to‐face with client

mean 38.2 (SD 33.63), n=46

mean 9.95 (SD 10.54), n = 45

MD 28.25 hours [95% CI 18.06 to 38.45]

Solomon 1995

Telephone with client

mean 5.90 (SD 6.44), n = 46

mean 21.8 (SD 6.44), n = 45

MD ‐15.90 hours [95% CI ‐18.55 to ‐13.25]

Solomon 1995

Contact with client family/friends

mean 0.46 (SD 1.22), n = 46

mean 13.62 (SD 18.38), n = 45

MD ‐13.16 hours [95% CI ‐18.54 to ‐7.78]

Solomon 1995

Contact with provider agency or staff

mean 1.98 (SD 7.03), n = 46

mean 25.56 (SD 23.87), n = 45

MD ‐23.58 hours [95% CI ‐30.84 to ‐16.32]

Solomon 1995

All case management services

mean 83.79 (SD 63.71), n = 46

mean 64.51 (SD 54.62), n = 45

MD 19.28 hours [95% CI ‐5.08 to 43.63]

Figuras y tablas -
Analysis 1.11

Comparison 1 Consumer‐provider versus professional staff, Outcome 11 Service provision: Time allocation.

Study

Location

Consumer‐provider

Professional staff

Effect measure

Clarke 2000

Out of office (eg client home or public place)

61%

73%

not estimable

Clarke 2000

Institution

15%

13%

not estimable

Clarke 2000

Clarke 2000

Clarke 2000

Solomon 1995

Office

mean 13.01 (SD 13.77), n = 46

mean 63.30 (SD 43.15), n = 45

MD ‐50.29 hours [95% CI ‐63.51 to ‐37.07]

Solomon 1995

Client's home

mean 9.23 (SD 9.71), n = 46

mean 5.21 (SD 8.34), n = 45

MD 4.02 hours [95% CI 0.30 to 7.74]

Solomon 1995

On the street

mean 4.89 (SD 8.32), n = 46

mean 1.50 (SD 3.52), n = 45

MD 3.39 hours [95% CI 0.77 to 6.01]

Solomon 1995

Provider agency

mean 28.44 (SD 37.29), n = 46

mean 1.95 (SD 3.01), n = 45

MD 26.49 hours [95% CI 15.68 to 37.30]

Solomon 1995

Hospital (no difference in days hospitalised between groups)

mean 1.08 (SD 2.55), n = 46

mean 5.05 (SD 8.30), n = 45

MD ‐3.97 hours [95% CI ‐6.50 to ‐1.44]

Figuras y tablas -
Analysis 1.12

Comparison 1 Consumer‐provider versus professional staff, Outcome 12 Service provision: Location of services.

Study

Category

Consumer‐provider

Professional staff

Service categories

Clarke 2000

Support/structure

14%

15%

Clarke 2000

Treatment Plan

3%

6%

Clarke 2000

Service Coordination

8%

8%

Clarke 2000

Crisis

1%

1%

Clarke 2000

Assess/monitor 

6%

7%

Clarke 2000

Training (skill/job)

1%

3%

Clarke 2000

Transporting

3%

5%

Clarke 2000

Counselling

3%

3%

Clarke 2000

Other

3%

2%

Administrative

Clarke 2000

Travel

11%

11%

Clarke 2000

Paperwork 

13%

14%

Clarke 2000

Administration/Supervision

15%

8%

Clarke 2000

Team meetings

19%

17%

Clarke 2000

Clarke 2000

Clarke 2000

Clarke 2000

Clarke 2000

Figuras y tablas -
Analysis 1.13

Comparison 1 Consumer‐provider versus professional staff, Outcome 13 Service provision: Case manager tasks.

Comparison 1 Consumer‐provider versus professional staff, Outcome 14 Crisis/emergency service.
Figuras y tablas -
Analysis 1.14

Comparison 1 Consumer‐provider versus professional staff, Outcome 14 Crisis/emergency service.

Comparison 1 Consumer‐provider versus professional staff, Outcome 15 Hospital admissions.
Figuras y tablas -
Analysis 1.15

Comparison 1 Consumer‐provider versus professional staff, Outcome 15 Hospital admissions.

Comparison 1 Consumer‐provider versus professional staff, Outcome 16 Length of stay.
Figuras y tablas -
Analysis 1.16

Comparison 1 Consumer‐provider versus professional staff, Outcome 16 Length of stay.

Comparison 1 Consumer‐provider versus professional staff, Outcome 17 Professional's attitude: client manager relationship.
Figuras y tablas -
Analysis 1.17

Comparison 1 Consumer‐provider versus professional staff, Outcome 17 Professional's attitude: client manager relationship.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 1 Function.
Figuras y tablas -
Analysis 2.1

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 1 Function.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 2 Social.
Figuras y tablas -
Analysis 2.2

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 2 Social.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 3 Satisfaction.
Figuras y tablas -
Analysis 2.3

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 3 Satisfaction.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 4 Use of mental health services: attendance at clinic appointments.
Figuras y tablas -
Analysis 2.4

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 4 Use of mental health services: attendance at clinic appointments.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 5 Attrition.
Figuras y tablas -
Analysis 2.5

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 5 Attrition.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 6 Any hospital admissions.
Figuras y tablas -
Analysis 2.6

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 6 Any hospital admissions.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 7 Number of hospital admissions.
Figuras y tablas -
Analysis 2.7

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 7 Number of hospital admissions.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 8 Length of hospital stay.
Figuras y tablas -
Analysis 2.8

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 8 Length of hospital stay.

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 9 Professionals' attitude: client needs met.
Figuras y tablas -
Analysis 2.9

Comparison 2 Consumer‐provider as adjunct versus usual care alone, Outcome 9 Professionals' attitude: client needs met.

Table 1. Outcome measurement tools

Tool

Abbreviation

Reference/s

Description

Outcome

Assessor

Studies

Lehman Quality of Life (also in Brief Version)

QOLI (and QOLI‐Brief)

Lehman 1988

Lehman 1994

Subjective subscales: Life satisfaction, Daily activities, Family contact, Social relations, Finances, Health, Safety (score 1‐7).

Objective subscales: Family contacts, Social relations (score 1‐5), Daily activities, Finances (score 0‐1).

Higher scores better.

Quality of life

Client self‐report (interview)

Sells 2006, Rivera 2007, Solomon 1995

Quality of Life Index for Mental Health

QOLIMH

Becker 1993

A brief 25‐item questionnaire
modified from the Quality of Life Index for Mental Health.

Quality of life

Client self‐report

O'Donnell 1999

Making Decisions Empowerment

MDE

Rogers 1997

28 items (score 1‐4). Responses are summed. Higher scores better (individual scale values reversed).

Empowerment

Client self‐report

Rogers 2007

Personal Empowerment

PE

Segal 1995

20 items with two sub‐scales; 1) choice and 2) reduction in chance. Choice sub‐scale employs four point Likert scale . Reduction in Chance sub‐scale employs five‐point scale. Responses are summed. Higher scores better (individual scale values reversed).

Empowerment

Client self‐report

Rogers 2007

Life Skills Profile

LSP

Rosen 1989

A 39‐item measure of function
and disability. Higher scores better.

Function

Case managers and families

Craig 2004

Significant Others Scale

SOS

Power 1988

Interview assesses size of social network and ratings of qualitative aspects of support provided by individuals in the network.

Social

Client self‐report (interview)

Craig 2004

Hopkins Symptoms Checklist‐58

HSCL‐58

Derogatis 1974

58‐items on a four‐point scale. Higher scores worse. 

Symptoms

Client self‐report

Bright 1999

Brief Symptom Inventory

BSI

Derogatis 1983

Measures clinically relevant symptoms (score 1‐5). Higher scores better.

Symptoms

Client self‐report

Rivera 2007

Brief Psychiatric Rating Scale (also expanded version)

BPRS

Overall 1962

Velligan 2005

18 items (expanded version has 24 items) rated on seven point scale. Higher scores worse.  

Symptoms

Trained interviewer

Kaufmann 1995, Solomon 1995,

Symptom Check List‐90

SCL‐90

Derogardis 1977

Self‐administered check list of 90 items rated on a five point scale (0 = not at all; 4 = extremely), eight sub scale scores were computed and three global indices, global severity index, positive symptoms distress index, and positive symptom total.

Symptoms

Client self‐report

Kaufmann 1995

Beck Depression Inventory

BDI

Beck 1979

21‐item scale. Each item consists of four statements of depressive symptoms (score 0‐3) and assesses respondents mood in the past week. Maximum score 63 (≥19 indicates significant depressive symptoms). Higher scores worse.

Depression

Client self‐report

Bright 1999

Hamilton Rating Scale for Depression (revised)

HRSD

Rehm 1985

Observer‐rated scale for depressive symptomatology following clinical interview taking into account patient behaviour in the immediate preceding week (score 0‐52; 30 = severe illness). Higher scores worse.

Depression

Clinician

Bright 1999

Behavioral Health Care Rating of Satisfaction

BHCRS

Dow 1995

Client satisfaction with clinical staff and services (score 1‐6). Higher scores better.

Satisfaction

Client

Rivera 2007

Verona Service Satisfaction Scale

VSSS

Cozza 1997

54 questions that cover seven dimensions:
overall satisfaction, professionals’ skills and behaviour, information access, efficacy,
types of intervention and relative’s involvement. Higher scores better.

Satisfaction

Client

Craig 2004

Client Service Satisfaction Questionnaire

CSQ

Larsen 1979

Greenfield 1989

Modified nine‐item scale. Higher scores better.

Satisfaction

Client

O'Donnell 1999

Satisfaction with treatment

Hoult 1983, modifying Stein 1980

Interview based 16 item scale to measure client satisfaction with all MH treatment (not case management services alone) on a 4‐point scale. Higher scores associated with greater satisfaction, authors note that they used a modified version of the instrument for assessing community treatment team approach

Satisfaction

Trained interviewer

Solomon 1995

Camberwell Assessment of Needs 

CAN

Phelan 1995

Sum score (possible score 0‐22). Higher scores worse.

Satisfaction

Can be rated independently by staff and clients

Craig 2004

Barrett‐Lennard Relationship Inventory

BLRI

Barrett‐Lennard 1962

64 items, six point scale (1=definitely false, 6=definitely true). Higher score better.

client‐counselor relationship

client self‐report

Sells 2006

Working Alliance Inventory

WAI

Ralph 1992

Hovarth 1989

36 items (score 1‐7) equally divided across 3 subscales: Goals, Tasks, and Bonds. Higher scores better.

Client‐manager relationship

Client and case managers

Solomon 1995

Figuras y tablas -
Table 1. Outcome measurement tools
Table 2. Missing data and outcome reporting bias

Outcome

Studies assessed outcome

n studies with outcome data

(total N included in analysis)

n studies with incomplete data

(total N randomised)

COMPARISON 1 (n = 5)

Primary outcomes

QOL

3

1 (130)

2 (233)

Function

3

1 (130)

2 (233)

Social

3

1 (130)

2 (233)

Symptoms

3

2 (197)

1(96)

Depression

2

1(67)

1(96)

Satisfaction

2

2 (213)

0

Client manager relationship

2

2 (160)

0

Use of mental health services

3

2 (227)

1 (137)

Client attrition

5

3 (333)

2 (250)

Hospital admissions

2

1 (114)

1 (96)

Crisis/Emergency services

3

2 (250)

1 (96)

Length of stay

2

1 (136)

1 (96)

Secondary outcomes

Providers' attitudes

1

1 (96)

0

COMPARISON 2 (n = 6)

Primary outcomes

QOL

1

0

1 (84)

Function

3

1 (45)

2 (208)

Social

2

1 (45)

1 (89)

Symptoms

1

0

1 (90)

Sense of community

1

0

1 (89)

Motivation for change

1

0

1 (89)

Self‐determination

1

0

1 (89)

Hope

1

0

1 (89)

Satisfaction

2

2 (125)

0

Client manager relationship

1

0

1 (89)

Use of mental health services

1

1 (45)

0

Client attrition

3 (218)

3 (199)

Hospital admissions

3 (199)

1 (84)

Crisis/emergency services

1

0

1 (84)

Length of stay

4

3(199)

1 (84)

Secondary outcomes

Providers' attitudes

3

1 (45)

2 (173)

Figuras y tablas -
Table 2. Missing data and outcome reporting bias
Table 3. Included studies reported in multiple publications

Study

Other papers reporting study

Clarke 2000

Herinckx 1997; Paulson 1996; Paulson 1999

Craig 2004

Doherty 2004

Gordon 1979

Edmunson 1982; Edmunson 1984; Gordon 1979b

O'Donnell 1999

O'Donnell 1998

Rogers 2007

Johnsen 2005

Sells 2006

Jewell 2006; Sells 2008

Solomon 1995

Solomon 1994a; Solomon 1994b; Solomon 1995b; Solomon 1995c; Solomon 1995d; Solomon 1996a; Solomon 1996b

Figuras y tablas -
Table 3. Included studies reported in multiple publications
Comparison 1. Consumer‐provider versus professional staff

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Quality of life: Life satisfaction subscale (subjective) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2 Function: Daily activities subscale (subjective) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Social: Social relations subscale (subjective) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Symptoms Show forest plot

2

197

Std. Mean Difference (IV, Random, 95% CI)

‐0.24 [‐0.52, 0.05]

5 Depression Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Self‐report (BDI) at 10 weeks

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5.2 Observer‐rated (HRSD) at 10 weeks

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 Satisfaction Show forest plot

2

213

Std. Mean Difference (IV, Random, 95% CI)

‐0.22 [‐0.69, 0.25]

7 Client manager relationship Show forest plot

2

160

Std. Mean Difference (IV, Random, 95% CI)

0.22 [‐0.10, 0.53]

8 Use of mental health services in 12 months Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

8.1 Rehabilitation services

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Outpatient contacts

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

9 Attrition Show forest plot

3

331

Risk Ratio (M‐H, Random, 95% CI)

0.80 [0.58, 1.09]

10 Service provision: Caseload/personnel Show forest plot

Other data

No numeric data

11 Service provision: Time allocation Show forest plot

Other data

No numeric data

12 Service provision: Location of services Show forest plot

Other data

No numeric data

13 Service provision: Case manager tasks Show forest plot

Other data

No numeric data

13.1 Service categories

Other data

No numeric data

13.2 Administrative

Other data

No numeric data

14 Crisis/emergency service Show forest plot

2

Std. Mean Difference (Random, 95% CI)

‐0.34 [‐0.60, ‐0.07]

15 Hospital admissions Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

16 Length of stay Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

17 Professional's attitude: client manager relationship Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 1. Consumer‐provider versus professional staff
Comparison 2. Consumer‐provider as adjunct versus usual care alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Function Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2 Social Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3 Satisfaction Show forest plot

2

Std. Mean Difference (Random, 95% CI)

Subtotals only

3.1 Service

2

Std. Mean Difference (Random, 95% CI)

0.76 [‐0.59, 2.10]

3.2 Staff

1

Std. Mean Difference (Random, 95% CI)

0.18 [‐0.43, 0.79]

3.3 Needs met

1

Std. Mean Difference (Random, 95% CI)

0.68 [0.05, 1.31]

4 Use of mental health services: attendance at clinic appointments Show forest plot

1

Std. Mean Difference (Random, 95% CI)

0.52 [‐0.07, 1.11]

5 Attrition Show forest plot

3

218

Risk Ratio (M‐H, Random, 95% CI)

1.29 [0.72, 2.31]

6 Any hospital admissions Show forest plot

1

45

Risk Ratio (M‐H, Random, 95% CI)

1.07 [0.55, 2.07]

7 Number of hospital admissions Show forest plot

1

74

Mean Difference (IV, Fixed, 95% CI)

‐0.64 [‐1.30, 0.02]

8 Length of hospital stay Show forest plot

2

119

Mean Difference (IV, Random, 95% CI)

‐13.41 [‐32.09, 5.27]

9 Professionals' attitude: client needs met Show forest plot

1

45

Mean Difference (IV, Random, 95% CI)

1.56 [0.50, 2.62]

Figuras y tablas -
Comparison 2. Consumer‐provider as adjunct versus usual care alone