Patients' characteristics and consumer satisfaction on an inpatient child psychiatric unit

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries

PURPOSE

There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes.

METHODS

This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models.

RESULTS

A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio.

CONCLUSION

Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

Consumer satisfaction with the Child and Adolescent Mental Health Service and its association with treatment outcome: a 3-4-year follow-up study

BACKGROUND

Consumer satisfaction studies with the Child and Adolescent Mental Health Service (CAMHS) have mainly assessed evaluations in a short-term follow-up perspective. Adolescent reports with CAMHS have not been included nationally.

AIMS

The purposes of this study were to explore adolescent and parental satisfaction with the CAMHS in a 3-4-year follow-up perspective, and to examine the relationships between reported consumer satisfaction and clinical parameters such as reason for adolescent referral, emotional/behavioral symptoms and treatment outcome.

METHODS

Of 190 adolescent-parent pairs in a sample of CAMHS outpatients, 120 completed a Consumer Satisfaction Questionnaire. Parents assessed adolescent emotional/behavior problems both at baseline and at follow-up by completing the Child Behavior Checklist (CBCL). Correlations were examined between adolescent and parental evaluations. The relationships between service satisfaction and symptom load at baseline and follow-up and treatment outcome at follow-up were explored.

RESULTS

Overall, adolescents and parents were satisfied with the services received from the CAMHS. The correlations between adolescent and parent consumer satisfaction ratings were low to moderate. Consumer satisfaction was significantly and negatively correlated with symptom load on the CBCL Total Problems scores at baseline, but not at follow-up. There was no difference in satisfaction levels between those who improved after treatment and those who did not.

CONCLUSIONS

Given the differences in informant ratings of consumer satisfaction, it is important to include both adolescent and parental perceptions in evaluations of CAMHS services and treatment outcomes. Consumer satisfaction should serve as a supplement to established standardized outcome measures.

'Living in an alternative reality': adolescents' experiences of psychiatric inpatient care

BACKGROUND

  To date minimal research has investigated adolescent psychiatric inpatient care from a service-user perspective.

METHOD

  Semi-structured interviews were conducted with 10 adolescents with experience of psychiatric inpatient care. Interviews were analysed using the grounded theory method (Glaser & Strauss, 1967).

RESULTS

  A core category, 'Living in an Alternative Reality', reflected the unusual nature of the hospitalisation experience. Adolescents reported feelings of restriction and disconnection and used various relational and practical strategies to cope with hospitalisation.

CONCLUSIONS

  Results suggest that psychiatric hospitalisation can cause strong affective reactions in adolescents, and may affect psychological constructs such as identity and self-esteem.

Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit.

Parent and adolescent satisfaction with mental health services: does it relate to youth diagnosis, age, gender, or treatment outcome?

Consumer satisfaction with treatment is important information for providers of mental health services. The goal of the current study was to examine the relationship between youth and parent satisfaction ratings and the following youth variables: gender, age, primary diagnosis, and changes in functioning and symptomatology after 6 months of services. Results demonstrated that in a large sample of youth receiving community mental health services satisfaction with services differed as a function of the adolescents' clinician-derived primary diagnosis, age, and reported changes in symptoms and functioning. Although significant, these variables accounted for only a small portion of the variance in satisfaction. Additionally, the relationship between parent and youth ratings of satisfaction was low, but significant. The implications of these findings are discussed as well as future directions for clinicians and researchers.

The association between GP and patient ratings of quality of care at outpatient clinics

BACKGROUND

GPs and patients are frequently asked to evaluate mental health care, but studies including evaluations from both groups are rare.

OBJECTIVE

To assess the association between GPs' and patients' assessment of mental health outpatient clinic in Norway and identify important health care predictors for patient and GP satisfaction with the clinics.

METHODS

Two cross-sectional national surveys were carried out: survey of GPs in 2006 and patients in 2007 evaluating outpatient clinics at 69 community mental health centres in Norway. A total of 2009 GPs and 9001 outpatients assessed the clinics by means of a postal questionnaire. Main outcome measures were correlations between GP and patient ratings of the outpatient clinics at the clinic level and health care predictors for patient satisfaction and GP satisfaction with the clinics.

RESULTS

Clinic scores for GPs' and patients' assessment of waiting time were moderate to highly correlated (0.65), while clinic scores for GP and patient satisfaction had a lower but significant positive association (0.37). Significant positive correlations between clinic scores for GP and patients ratings were found for 38 of the 48 associations tested. The most important predictors for patient satisfaction with the clinics were interaction with the clinician (beta: 0.23) and being met with politeness and respect at the clinic (beta: 0.19), while the most important predictors for GP satisfaction with the clinics were perceived competence (beta: 0.25), rejection of referrals (beta: -0.17) and waiting time for patients (beta: -0.16).

CONCLUSIONS

A consistent positive association between GP and patient ratings at the clinic level was identified. Mental health services aiming at improving GP and patient satisfaction should be sensitive to the fact that the two groups prioritize different health care factors.

Relationship between caregiver hopefulness and satisfaction with their children's mental health services

Relationships among the Youth Services Survey for Families (YSSF) Indicators, selected demographic and clinical variables, and caregiver-rated hopefulness and children's problem severity were examined in a random sample of 1,500 caregivers of Medicaid-enrolled youth in a satisfaction study with Kentucky's 14 community mental health centers. Multiple linear regressions revealed that caregiver services and caregiver hopefulness were excellent predictors of two and three YSSF Indicators, respectively. Providers need to respond to caregiver concerns when developing support services and understand the mechanisms associated with these services' effectiveness. Tracking changes in caregiver and youth hopefulness during treatment may improve services and retention and bridge the gap between research and the important construct of hope.

The development of the child and adolescent versions of the Verona Service Satisfaction Scale (CAMHSSS)

BACKGROUND

There is a shortage of comprehensive and validated instruments to measure satisfaction with Child and Adolescent Mental Health Services (CAMHS). This study chose the Verona Service Satisfaction Scale (VSSS as a template for the development of a new CAMHS Satisfaction Scale (CAMHSSS).

METHOD

The new questionnaires were developed by involving service users and members of the multidisciplinary team in several stages. The psychometric qualities of the 39-item draft were tested on a random sample.

RESULTS

A total of 56 adolescents and 104 parents participated in the study. The acceptability of the questionnaires was excellent, and internal consistency was high. Test-retest reliability was between substantial to moderate for individual items, and high for the seven dimension and the final versions of the scale. The questionnaires differentiated well between satisfied and dissatisfied service users.

CONCLUSIONS

Two versions were generated to measure service satisfaction among outpatients (CAMHSSS-39 and 20) and one for inpatients and day-patients (CAMHSSS-Unit). All have good psychometric properties and can be recommended for future studies.

Longitudinal assessment of parental satisfaction with children's psychiatric hospitalization

OBJECTIVE

To examine trends over time in parents' satisfaction with their children's prior psychiatric hospitalization and whether such trends are related to postdischarge outcomes.

STUDY DESIGN/DATA COLLECTION

Parents of 107 child inpatients completed a satisfaction survey at discharge. Satisfaction with the same inpatient stay was re-assessed 3, 6, and 12 months after discharge. Parents also provided ratings of behavioral symptoms at admission, discharge, and at postdischarge follow-ups.

PRINCIPAL FINDINGS

Random regression analyses indicated significant decline in satisfaction from discharge to follow-up. The proportion of parents reporting that they were not satisfied doubled between discharge and 3-month follow-up. Parents whose satisfaction appraisals shifted from satisfied at discharge to not satisfied at follow-up also provided mean ratings of their child's disruptive behavioral problems at follow-up that were higher than those of parents who reported satisfaction with inpatient care at both times.

CONCLUSIONS

Findings suggest that appraisals of inpatient care are subject to change, and may become more negative when clinical improvement associated with hospitalization dissipates in the months following discharge.

Determinates of youth and parent satisfaction in usual care psychotherapy

OBJECTIVE

Client satisfaction with mental health services is used commonly as an indicator of the quality of care, but there is minimal research on the construct of client satisfaction in youth services, and the extent to which satisfaction is related to improvements in clinical functioning versus other determinants. We examined the relationship between parent and youth satisfaction with youth services, and tested for significant determinants of satisfaction across three major domains: (1) change in youth clinical functioning; (2) youth/family service entry characteristics; (3) treatment/therapist characteristics.

METHOD

The participants were 143 youths receiving community-based outpatient care. Youths and parents were interviewed at service entry and six months later using well-established measures of clinical functioning and service satisfaction.

RESULTS

Youths and parents reported generally high satisfaction, but the correlation between them was low. Despite testing for many potential predictors of satisfaction, very few significant effects were found. In regression analyses of significant predictors of satisfaction, higher youth satisfaction was significantly associated with Caucasian ethnicity and more positive youth expectations about treatment. Higher parent satisfaction was associated with lower caregiver strain at service entry, increased number of sessions, and improvement in youth-reported functional impairment.

CONCLUSIONS

Client satisfaction remains a rather elusive construct, but it is not necessarily a strong indicator of service effectiveness.

Model testing: examining parent satisfaction

The purpose of this study was to test a model predicting social-psychological determinants of parent satisfaction with children's mental health services. Model concepts were parents' characteristics, definition of situation, desired services, expectations, met desires, met expectations, and satisfaction. The sample included 120 parents of children, ages 3-18 years, admitted to one of five treatment programs. With minor changes, results of structural equation modeling indicated a good fit between the data and the proposed relationships. The strongest predictor of parent satisfaction was met expectations; however, inclusion of the desire concepts was essential in obtaining a strong, acceptable model fit.

Consumer satisfaction and child behaviour problems in child and adolescent mental health services

Consumer satisfaction with health care is one of the goals of health care delivery. Information on what affects satisfaction helps health care providers to deliver patient-centred care. The aim of this study was to explore the relationship between young persons' symptoms and satisfaction with Child and Adolescent Mental Health Services (CAMHS). It also examined differences in satisfaction of the parent/carer and their child. Self-report questionnaires were used to gather information from respondents. High levels of satisfaction were reported, although children and adolescents were less satisfied than parents/carers. Young people with self-reported conduct problems were least satisfied with CAMHS, as were those who rated their problems as having a significant impact on their lives. There was no relationship between carer-reported 'caseness' and carer satisfaction with services. Further exploration of the needs and expectations of young people who have behavioural difficulties is necessary so that their needs are better understood and expectations met.

Development and testing of a scale measuring parent satisfaction with staff interactions

This study tested the psychometric properties of the Parent Satisfaction Scale (PSS), a new scale measuring parents' satisfaction with their child's mental health services, primarily focusing on staff's interpersonal interactions. Data were collected by postal surveys 5 to 10 months after a child's admission to 1 of 5 mental health treatment programs. Completed surveys were received from parents of 120 of a potential 232 children (52% response rate). Internal consistency reliability of the PSS was strong (alpha = .96). Construct validity was supported by significant relationships between the PSS and constructs considered to be antecedent variables influencing parent satisfaction, including met expectations (r = 0.62, P < .001), met desires (r = 0.32, P < .001), and met needs (r = 0.55, P < .001). Convergent validity was supported, with the PSS having Pearson correlations of .86 (P < .001) with the Client Satisfaction Questionnaire-8 and .76 (P < .001) with parents' ratings of satisfaction with specific services received.

Consumer satisfaction with an adolescent inpatient psychiatric unit

OBJECTIVE

To explore factors influencing the satisfaction of patients, parents, and referring clinicians who used the services of an adolescent inpatient psychiatric unit, and to explore how levels of satisfaction related to the patient's symptomatic and functional improvement during the admission.

METHOD

All 105 adolescents, their families, and the referring community clinicians who used an inpatient service over a 1-year period were asked to rate the patient's symptoms and functioning on admission, at discharge, and 4 months after the patient's return to the community. We obtained satisfaction ratings at discharge, and consumers were asked to rate helpfulness of the ward experience at 4 months postdischarge. Ward psychiatrists provided Children's Global Assessment Scale (CGAS) ratings and diagnoses over the course of the inpatient stay.

RESULTS

Most of the patients (83%) improved during their admission. Consumer satisfaction ratings correlated with improvement of self-identified problems and with the perceived usefulness of discharge recommendations. Satisfaction did not, however, correlate with the patient's symptomatic and functional progress. Interaction with ward staff was an important source of both positive and negative experiences.

CONCLUSION

Our study indicates that inpatient psychiatric staff should attend closely to the consumer's perception of difficulties and the need for practical discharge recommendations.