Featured Tool: Client Contact Log

One of the goals of the CMHEI project is to collect information for evaluating cost and cost-effectiveness across study programs. This is a challenge because recording the required information can be time-consuming for the staff. In addition, collected information must be detailed so that it is clear how costs are calculated and how relevant the results are to other programs.

The multisite coordinating centre worked closely with the Kingston and Toronto projects to ensure that similar cost-related information was collected from all ACT teams. This was difficult because each team is operated by an organization with a different data system and orientation, and because we were concerned about minimizing the burden of data collection. However, we believe that the process helped staff develop more ownership of the research process.

In Kingston, the multisite team worked closely with program staff for several months to develop a tool that builds on their existing data collection process. The result was a common data collection instrument, the Client Contact Log, that gives the program staff the opportunity to record all that they actually do, puts forward a common set of definitions and terms for their activities, and is the least complex format possible under the circumstances.

The Client Contact Log records the amount of time spent in each separate activity provided by ACT team members. The Client Contact Log allows for documentation of 19 different provider activities. These activities range from social recreation, to substance abuse counseling, to legal issue involvement, to just plain "in search of the client." The Client Contact Log also records indirect time spent by staff in meetings, training, travelling, documentation, clinical work with non-clients and even student mentoring. The research team calculated that the ratio of direct staff time to indirect was actually 2:1, that is, for every 2 hours spent with the client, staff spent an hour on indirect activities. Including indirect time is important for more accurate cost calculations and for understanding how staff spend time.

The Client Contact Log is also exceptional as it records, on one compact form, the location of the staff/client contact, who else was present (e.g., family member), the work shift when the contact took place and whether the contact was based on crisis, outreach or advocacy. Departing significantly from typical data collection systems, client contacts are also recorded by clerical staff, whose time actually amounted to 2% of total direct service time.

At first, staff spent about 40 minutes per day completing the Log. With practice, however, this time was reduced to less than 20 minutes daily. Administrative departments of the ACT organizations also provided considerable time and support, some actually processing the log data.

Though bridging the worlds of research and service delivery requires a great deal of compromise and negotiation, the Client Contact Log has already shown that relationships can be mutually beneficial. Program staff found the resulting data helps them examine their practice patterns, identify demanding areas, and assess their overall functioning. The research team is able to produce common data from different ACT teams that is detailed enough to provide concrete evaluative results useful to the mental health system as a whole, and to other settings and providers wishing to adopt the ACT model.

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