Introduction
The Client Service Receipt Inventory started life as the Client Service Receipt Interview (CSRI). Developed at the PSSRU in the mid-1980s, it was initially aimed at collecting information about the way residents of long-stay hospitals used services and support during their first year of living in community-based homes. Two economic evaluations drove the schedule development: the evaluation of the North East Thames Regional Health Authority re-provision policy (NETRHA, 1986-1998; Beecham et al., 1997) and the evaluation of the DH-sponsored Care in the Community initiative (CinC, 1982-1990; Knapp et al., 1992). Further information about the NETRHA project can also be found in Knapp et al., 1987.
The CSRI for these evaluations was designed in such a way that it could be used:
- in interview with participants or their carers
- to record all the different services and supports that participants were likely to use to replace their long-stay hospital care, such as accommodation, day activities, community-based services, unpaid care, monies received
- to record use of resources delivered through the full range of public and independent sector agencies and organisations that may be involved in implementing re-provision policies, and
- to be applicable in the many local areas of England involved in these studies, all with very different arrays of services available to these people.
The aim, which remains today, was to build an aggregate picture of the services and support each person used over a specified period. This would allow calculation of costs from the most disaggregate level (that is, the individual users) into the greatest number of formats: such as a total cost for each service type, a total cost for each person, a total cost to each agency.
The first draft of the CSRI was discussed at research team meetings in mid-1986; this included a discussion around the content of other schedules used in the same project to ensure there was no overlap. During August and September of 1986, the questionnaire was piloted in three locations of the CinC evaluation. Together these covered a range of clients living in different types of settings and using different types of services. Following these discussions and pilots, we added two more questions: one on participant satisfaction with services, and one asking about services that the participant was not receiving which the interviewee through might be helpful. The CSRI was first used as part of the NETRHA evaluation on September 29th 1986.
Description of the CSRI
The CSRI was printed on one-sided A4 paper allowing plenty of space for the interviewer to make notes to describe particularly complex situations. This version also incorporated coding boxes and ‘prompt sheets’ listing service options. One CSRI was completed per person. Following a section in which the interviewer and interviewee(s) could be identified, the CSRI was divided into several sections, in each of which could be recorded information relating to a particular facet of living:
- accommodation and on-site care
- employment and finances
- tables on which to record which services had been used over the last month and over the last year for infrequently used but commonly more expensive ones
- use of any aids or adaptations for community living
- tasks performed by unpaid carers and the time involved
- managerial involvement, satisfaction with services, unmet service needs, and
- any information that is required from other research instruments, such as prescribed medication types and doses.
The information on accommodation is particularly important as it describes the establishment along a number of set criteria that, in the absence of cost-related information coming from the managing agency, allowed categorisation into six accommodation ‘types’ (Table 1), facilitating a broad cost estimate from other sources. Some examples of tables derived from this categorisation can be found here.
Table 1 Definition of accommodation types
| Type | Staff cover | No. residents |
|---|---|---|
| Residential/nursing home | Continuous staff cover by day, Waking night staff cover | Six or more resident places |
| Hostel | Continuous or regular staff cover by day , Sleeping-in or on-call night staff | Six or more resident places |
| Staffed group home | Continuous or regular staff cover by day, Waking or sleeping in or on-call night staff | More than one but fewer than six resident places |
| Unstaffed group homes | Ad hoc or no day staff, On-call or no night support | More than one but fewer than six resident places |
| Sheltered housing | Continuous or regular staff cover by day, Some form of night staff cover | Provides individual living units within a larger complex |
| Adult placements, incl. formal foster care | Includes formal foster care within an established household and less formal supported lodging arrangements | |
| Independent living | Single or group tenancies in domestic housing, including living with relatives or spouse, where there is ad hoc or no day staff cover and no staff cover at night. | |
| Hospital ward | Where clients have been readmitted from community placements, as a permanent placement | |
Very few participants were in either open or sheltered employment so in both evaluations there was high reliance on social security benefits. This information was essential both to help estimate the costs of accommodation and on-site care (at that time, 24-hour staffed facilities could be funded through social security benefits) as well as personal living expenses.
At this time, the very beginnings of mental health economic evaluation in England, very little was known about the likely range of services people leaving long-stay hospitals would use. Although later CSRI variants usually have an integrated list of services, in these first iterations blank tables were designed so that the service and provider could be identified, the frequency and duration of contact recorded, as well as whether contacts were at the professional’s office or at the person’s home. ‘Prompt sheets’ with lists of service options accompanied this part of the CSRI. And, of course, the design of this section of the CSRI was informed by economic theory, intending to collect information on all ‘resources’ that would be employed to support a person.
Unless costs are defined and measured comprehensively, one treatment mode may appear to be less costly than another when in reality that mode merely shifts costs into forms that have not been measured (Weisbrod et al., p.403).
Unpaid care, in fact found to be rarely available as many who were leaving long-stay hospitals had lost contact with family members during their long hospital residence, was again recorded on an open matrix. The final question of administrative/managerial involvement was particularly important to the re-provision studies, where some hospital staff had dedicated roles to support transfers, or where community-based projects provided a range of services for a specific group of participants. These questions are rarely needed in other research or service contexts.
A copy of the original CSRI, as used in the NETRHA re-provision study, can be found here.
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