Assessing the content of mental health services: a review of measures

Measurement of service content is necessary to understand what services actually provide and explain variation in service outcomes. There is no consensus about how to measure content of care in mental health services.

Content of care measures for use in mental health services were identified through a search of electronic databases, hand searching of references from selected studies and consultation with experts in the field. Measures are presented in an organising methodological framework. Studies which introduced or cited the measures were read and investigations of empirical associations between content of care and outcomes were identified.

Twenty five measures of content of care were identified, which used three different data collection methods and five information sources. Seven of these measures have been used to identify links between content of care and outcomes, most commonly in Assertive Community Treatment settings.

Measures have been developed which can provide information about service content. However, there is a need for measures to demonstrate more clearly a theoretical or empirical basis, robust psychometric properties and feasibility in a range of service settings. Further comparison of the feasibility and reliability of different measurement methods is needed. Contradictory findings of associations between service content and outcomes may reflect measures' uncertain reliability, or that crucial process variables are not being measured.

Measures providing a greater depth of information about the nature of interventions are needed. In the absence of a gold standard content of care measure, a multi-methods approach should be adopted.