Evaluating consumer satisfaction in residential continuing care settings

The outcome of the project reported on here is a client-centered consumer satisfaction questionnaire designed to evaluate new models of residential continuing care in Alberta, Canada. Satisfaction is defined as a multi-dimensional construct that is grounded in the consumer's experience. Consultation with the clients of the services during development of the instrument ensured that characteristics important to the clients were assessed. The result is an instrument with which to measure satisfaction that is fully client-centered and that, with appropriate modifications, can be used to monitor any client-centered program for cognitively-able continuing care clients.     

Clients' views of live supervision and satisfaction with therapy

In this study we examined clients' perceptions of live supervision and their satisfaction with therapy in a university-based training clinic for marriage and family therapists. A total of 108 clients completed the Client Satisfaction Questionnaire-8 and a modified version of the Purdue Live Observation Satisfaction Scale. Clients' comments on the advantages and disadvantages of live supervision were also solicited through short-answer questions. Results indicated that clients were generally satisfied with therapy and found the live-supervision process satisfactory as long as the perceived helpfulness of live supervision outweighed its perceived intrusiveness. The challenge for training clinics is striking a balance between helpfulness and intrusiveness in an effort to both train competent therapists and provide quality treatment.     

Exploring the link between service quality and outcomes. Parents' assessments of family support programs

Relationships among consumer-generated quality factors, satisfaction, and outcome measures were examined for family support services provided by Michigan's public mental health system. Parents focused on structural and procedural aspects of program accessibility and attended less to program administration issues. Parents who gave the services the highest quality ratings also were the most satisfied with services, saw the services as more effective, had fewer family problems, and rated their time and child-related resources as more adequate. Implications for evaluation practice are discussed.     

What does client satisfaction tell us about effectiveness?

It is common in child protection research to undertake studies of client satisfaction with services. Although these studies have their own intrinsic value, it has been argued that they tell us little if anything about effectiveness—high levels of client satisfaction mean little if child abuse continues to occur. This study, undertaken in a statutory child protection service in Australia, considers the relationship between client satisfaction and other outcome measures, including worker estimates of client progress, further notifications of abuse and whether or not children have been removed. The results show strong correlations between different measures of client satisfaction and strong correlations between different measures of worker estimates of client progress. They show weaker but statistically significant correlations between client satisfaction and worker estimates of client progress, and between client satisfaction and further notifications. There is also a significant relationship between client satisfaction and children remaining at home. However, this applies only to parents, relatives and carers, not to the primary clients themselves. It is concluded that client satisfaction studies may have value beyond simply measuring client satisfaction. However, the study also supports an argument for using more than one outcome measure if the aim is to measure effectiveness. Copyright © 2008 John Wiley & Sons, Ltd.     

Relationship of service satisfaction to life satisfaction and perceived well-being

Two procedures for gaining patients' evaluations of health services were compared: (a) the Client Satisfaction Questionnaire (CSQ-18B), a direct approach assessing the setting and services actually encountered, and (b) the Patient Satisfaction Questionnaire (PSQ), an approach that indirectly assesses satisfaction with service by inquiring about general health care attitudes. Results from 148 public health patients indicated that the PSQ produced the most acceptability problems and was tapping aspects of life satisfaction other than service satisfaction. However, the PSQ produced significantly lower reports of satisfaction. Additional comparison and interpretation of typical responses generated from the two approaches suggested, on the whole, that the CSQ-18B data provided clearer, more efficient, and more useful information for program planning and evaluation. In this study, service satisfaction measured by the CSQ-18B did not have any significant relationship to global or multidimensional (LDQ-30) measures of life satisfaction and well-being. In contrast, over a third of the variance in PSQ scores was accounted for by measures of life satisfaction. It appears that the PSQ elicits attitudes toward the more generalized health care delivery system as well as aspects of life satisfaction rather than reactions to specific services actually received.     

Prevention validation and accounting platform: a framework for establishing accountability and performance measures of substance abuse prevention programs

The field of substance abuse prevention has neither an overarching conceptual framework nor a set of shared terminologies for establishing the accountability and performance outcome measures of substance abuse prevention services rendered. Hence, there is a wide gap between what we currently have as data on one hand and information that are required to meet the performance goals and accountability measures set by the Government Performance and Results Act of 1993 on the other. The task before us is: How can we establish the accountability and performance measures of substance abuse prevention programs and transform the field of prevention into prevention science? The intent of this volume is to serve that purpose and accelerate the processes of this transformation by identifying the requisite components of the transformation (i.e., theory, methodology, convention on terms, and data) and by introducing an open forum called, Prevention Validation and Accounting (PREVA) Platform. The entire PREVA Platform (for short, the Platform) is designed as an analytic framework, which is formulated by a collectivity of common concepts, terminologies, accounting units, protocols for counting the units, data elements, and operationalizations of various constructs, and other summary measures intended to bring about an efficient and effective measurement of process input, program capacity, process output, performance outcome, and societal impact of substance abuse prevention programs. The measurement units and summary data elements are designed to be measured across time and across jurisdictions, i.e., from local to regional to state to national levels. In the Platform, the process input is captured by two dimensions of time and capital. Time is conceptualized in terms of service delivery time and time spent for research and development. Capital is measured by the monies expended for the delivery of program activities during a fiscal or reporting period. Program capacity is captured by fourteen measurement units, tapping into the dimensions of staff resources and community assets. Staff resources are, in turn, operationalized in terms of staff size, staff certification status, staff turnover rate, and the accreditation status of a provider agency. Community assets are operationalized by the number of community centers accessible to the funded agency, number of formalized teams or antidrug coalitions active in the catchment area, and other social/human services providers with whom the prevention agency has formalized networks. The totality of process output from all sources of program activities is reduced to eighteen classes of measures. These are operationalized by thirty-three summary measures. Some of these include: total count of events facilitated; total number of clients served; average number of clients served per event; clients served by single and multiple program sessions; classification of target population in terms of the severity of risk as defined by the Institute of Medicine; age groups and race/ethnicity of clients served; number of program participants retained by recurring programs; number of clients who have completed the program; penetration rates to the target population; client attrition rates; average referral rates per provider per time interval; referral success rates; and so on. All process output measures specified in the Platform are derived from two broad classes of events classified as either products or services. The collectivity of these measures is expected to present a cost-effective, parsimonious, yet comprehensive picture of the entire spectrum of the process output, i.e., "what came out of the program as program activities". For the measurement of performance outcomes, two types of data are incorporated into the Platform: outcome data from individuals and the behavior (or performance) of social indicators from aggregated data bases. Individual data are used to evaluate the outcome of substance abuse programs     

Child welfare clients and school satisfaction

Despite long-standing knowledge about child welfare clients' poor educational outcomes, we know less about these vulnerable young people's situation in school. This article addresses school satisfaction among upper secondary students who have been in contact with the child welfare services. These child welfare clients' school satisfaction is compared with their peers' satisfaction. The results from a survey indicated that the majority of child welfare clients were satisfied with school but that they were less satisfied with school than were their peers. The results showed that the association between school satisfaction and positive school experiences explains a large part of this difference. Among students who reported they were doing well in school, had supportive teachers and friends at school, the difference in school satisfaction between child welfare clients and others was small. Among students who did not report similar positive experiences in school, difference in school satisfaction between child welfare clients and their peers was more substantial. These results show that school can be a good place for child welfare clients, but that facilitating support from teachers, increasing opportunities for making friends at school, and working to develop the child welfare clients' academic performances are important as efforts to improve school satisfaction.     

Approaches to worker rehabilitation by occupational and physical therapists in the United States: factors impacting practice

Work-related rehabilitation services have changed in nature and scope since their inception in the late 1970s. A review of the literature reveals a large body of published data concerning the various approaches used by therapists in this practice area, but a limited number of comparison studies documenting the value of one approach over the other. This national survey of physical and occupational therapists in the US was conducted in 2002, and examined the prevailing trends in service provision, and factors that determine the nature of services provided to clients. Results indicate that services continue the move to onsite service provision and an emphasis on prevention, but that select services, such as onsite job analysis and comprehensive, inter-disciplinary programs are being used to a limited degree. Research that examines the relative contributions of selected work-related services to successful and efficient return to work outcomes is necessary to identify best practice approaches. Therapists and insurance providers should work more closely in exchange of data that will ensure optimal program design and funding.     

Therapy with Transsexual Youth and Their Families: A Clinical Tool for Assessing Youth’s Readiness for Gender Transition

The World Professional Association for Transgender Health’s Standards of Care suggests a letter of recommendation be provided from a mental health professional if a transsexual desires hormone therapy or surgery. Therefore, transsexual clients have a unique dependence on therapists to obtain medical treatments needed to live life in their affirmed gender. Despite this need for therapeutic services, most therapists lack the training that is necessary to sensitively serve transsexual clients, particularly transsexual youth. While a published clinical assessment tool exists for therapists to determine readiness of adult transsexual clients for medical gender transition, no similar tool is available for therapists working with transsexual youth. This article discusses therapeutic issues specific to transsexual youth and families and presents a clinical assessment tool for determining transsexual youth’s readiness for medical treatments.     

Comparisons of marriage and family therapists, psychologists, psychiatrists, and social workers on job-related measures and reactions to managed care in Iowa

This study compares marriage and family therapists (MFTs) to psychologists, psychiatrists, and social workers on job-related measures, such as job autonomy, job satisfaction, burnout, and intention to stay in their present position, as well as on reactions to a managed care initiative in the state of Iowa. Findings indicate that MFTs scored significantly lower than other practitioners on job autonomy and intention to stay in their present position, but there were no differences in job satisfaction or burnout. Marital and family therapists also reported less dissatisfaction with the managed care initiative than psychiatrists, although virtually all practitioners were dissatisfied with the managed-care program. These findings indicate some dissatisfaction within the MFT profession and may be relevant to practitioners seeking to change or expand their practice, as well as to the needs of MFTs in their training programs.     

Negative attitudes,nonverbal behavior and self-fulfilling prophecy in simulated therapy interviews

This research investigated if interpersonal expectancies in a psychotherapeutic context were mediated through nonverbal behavior. Beginning (male) therapists served as interviewers and interacted with (male) subjects who were introduced as clients (who were treated for psychological problems) or normal students. It was hypothesized that the therapists would have a more negative attitude toward the supposed clients than toward the nonclients and show more arm position symmetry and less forward lean toward the supposed clients. The interviewees were predicted to show more ah-filled pauses, speech disturbances, and less looking at the interviewers in the client condition than in the nonclient condition. The results demonstrated that therapists had more negative expectancies toward supposed clients than toward nonclients. Support was shown for the hypothesis that more arm position symmetry would be shown in the client condition than in the nonclient condition. The results also indicated that supposed clients used more ah-filled pauses and speech disturbances than nonclients. The therapists used this information when they attributed more discomfort to the supposed clients. It is suggested that the findings of this study have implications for understanding the process of self-fulfilling prophecy in a therapeutic context.     

Treatment services received in the CASAWORKS for Families program

This article presents information on treatment services received by women participating in an initial multistate evaluation of CASAWORKS families. Results indicated most women received services to address medical, employment, basic needs, alcohol and drug, family, and psychiatric problems during the first six months of the program. The clients also had frequent contact with their case managers and were retained in the program for an average of 222 days. Considerable variation was observed across sites in the percentage of clients who received various services and the number of sessions they received. In Cox regressions, shorter retention in the program was predicted by referral to program from Child Protective Services or parole/probation, social conflicts, employment, and marijuana use at baseline, whereas a history of suicide attempts was associated with longer retention. Longer retention was associated with better alcohol use outcomes but was unrelated to employment or drug use outcomes.     

Marriage and family therapists and psychotropic medications: practice patterns from a national study

A national sample of marriage and family therapists (MFTs) was used to describe practice patterns of MFTs whose clients use psychotropics and to compare medicated and nonmedicated clients. Marriage and Family Therapists (n=283) reported on 195 medicated and 483 nonmedicated adult clients. Clients (n=375) rated their improvement and satisfaction with treatment. Results showed that 91% of MFTs treat medicated clients, and these clients accounted for 25% of MFT cases. Medicated clients were most often seen in individual therapy, had more serious medical problems, and showed greater cumulative improvement in relational functioning. Therapists from MFT educational backgrounds had fewer medicated clients than MFTs from other educational backgrounds.     

Money Over Marriage: Marriage Importance as a Mediator Between Materialism and Marital Satisfaction

While the negative relationship between materialism and marital satisfaction is well documented, mediators that possibly explain this association have not been widely explored. Based on the Incompatibility of Materialism and Children Model and Marital Paradigms Theory, this article explores the perception of marriage importance as a potential mediator between materialism and marital satisfaction. Using a sample of 1310 married individuals, we found evidence of partial mediation in that materialism was negatively associated with perception of marriage importance, and this association partially explained why being materialistic was associated with lower marital satisfaction. Thus, as counselors, therapists, and financial planners work with married clients, it is important that they consider how their clients’ materialistic tendencies may influence the family both financially and relationally. Suggestions for future research are discussed.     

Clients' Perceptions of Single Session Consultations as an Option to Waiting for Family Therapy

A single-session program was mailed at Bouverie Family Therapy Centre (BFTC), Melbourne, and results indicated a high level of client satisfaction with the service. Within the review period 53% of clients chose to attend for a one off consultation only, with the option of an ‘open door’ to return far therapy if they felt the need. The BFTC outcome supported findings of Moshe Talmon (an international advocate of the effectiveness of single session therapy), and also of two other Australian agencies whose research was reviewed and compared with the BFTC results.     

The Relationship between Change and Satisfaction: Parents' Experiences in a Child and Adolescent Mental Health Service

In the consumer satisfaction literature, there is little exploration of the relationship between change and satisfaction and the two are often conflated. This qualitative study interviewed parents a year after using child and adolescent mental health services. Eliciting an account of their experiences enabled the development of ‘grounded theories’ about what constitutes satisfaction for parents. The outcomes suggest that in addition to the expectable stories of ‘high change and satisfaction’ or ‘no change and low satisfaction’, considerable numbers of people are satisfied with a service despite experiencing little or no change, while others who experience positive change are not satisfied. Understanding these alternative stories helps address critical issues that affect the way therapists respond to people's needs and provide services — these matters are often within the capacity of therapists and services to address, even when working with limited resources.     

Systemic alliance in individual therapy: factor analysis of the ITAS-SF and the relationship with therapy outcomes and termination status

Clients providing systematic feedback to therapists via self-report measures of psychological distress and working alliance have been shown to increase therapy outcomes. However, there are few systemic-based measures that are feasible for therapists to use. Recently, Pinsof et al. (Family Process, 2008, 47, 281) developed a brief systemic alliance measure (ITAS-SF) for individual therapy. The current study tested the factor structure of this measure and examined whether the subscales related to clients' therapy outcomes and termination status (N = 570). The results demonstrated supported a 3-factor model for the ITAS-SF (as compared to the seven factors proposed by Pinsof et al.). In the first factor, content combined the goals for therapy, the tasks or methods to reach those goals and bond between the client and therapist. The second factor reflected how clients perceive the relationship with the therapist (i.e., interpersonal dimension-self/therapist), and the third factor reflected how clients perceive the alliance between their social network and the therapist (i.e., interpersonal dimension others/therapist). The two interpersonal factors were related to therapy outcome and termination status.     

Family Therapy Practitioners Researching the Reactions of Practitioners to an Outcome Measure

Family therapy is under increasing pressure to use ‘objective’ measures of effectiveness, but there are strong voices in the field objecting to such research. The primary objective of this project was to investigate the acceptability and perceived potential usefulness of a short self‐report questionnaire. A secondary objective was to explore the viability of conducting such research by a group of practitioners who would collaborate primarily through emails. Nine experienced family therapists were interviewed as they worked through the 16 items of a pilot version of the SCORE questionnaire. The recorded interviews were analysed using Template Analysis. The SCORE was found to be generally acceptable for use with clients but the exercise generated information on a variety of concerns about the content of the measure. Beyond its potential as an outcome measure there was considerable interest in how it could be used therapeutically. The operation of the Practitioner Research Network proved functional but indicated some of the difficulties that such networks might encounter.