Assessment of client/patient satisfaction: development of a general scale

The development and shaping of a general scale to assess client/patient satisfaction is reported. The scale, the CSQ, was constructed empirically by the authors. The CSQ is a response to several problems and issues that currently cloud the measurement of consumer satisfaction in health and human service systems. These problems and issues in assessing satisfaction are described. Finally, we present practical expriences to date in using the CSQ along with general psychometric qualities of the scale and correlations of CSQ results with client characteristics, service utilization, and service outcomes.     

Professionalization of evaluative research: Conflict as a sign of health

Morell and Flaherty (1978) present arguments about the current status of evaluative research as a profession. This paper contains a critique, using a process model of professional development, of the perspectives employed by Morell and Flaherty. Issues discussed are the nature and substance of conflicts in evaluative research, including conflicts over methodological perspectives, the role of the evaluator in program planning, and the appropriate uses and users of evaluative information. The paper concludes with a discussion of the needs within the profession of evaluative research if it is to remain viable and responsive to change.     

A Cross-Cultural Study of the Psychosocial and Spiritual Impact of Natural Disaster

We report a cross-cultural comparison of coping with natural disaster involving two populations—survivors from the 1999 earthquake in Turkey and from the 1994 Northridge earthquake in California. The research project was explorative in design and included 222 people—123 individuals from Turkey and 99 from California. A main focus of the study was how age, gender, marital status, and cultural differences impact on levels of Posttraumatic Stress Disorder (PTSD). Concomitantly, the association of many other variables was explored including cultural education, presence and degree of loss, extent of damage to one's home, whether individuals did or did not receive assistance, etc., and how these impacted their coping. Statistical analysis revealed strong associations between PTSD and age for both studies. It was found that the highest level of PTSD in the California sample occurred among individuals at least 60 years old. In the Turkey sample, those in their fifties showed the highest level of PTSD. The article highlights similarities and differences between the post-earthquake coping responses in California and Turkey and concludes by discussing forms of assistance to earthquake victims.     

Persona‐based information shapes linguistic perception: Valley Girls and California vowels

This paper investigates the effect of persona‐based information on implicit linguistic perceptions of a sociolinguistic feature – the backed trap vowel. trap ‐backing is associated both with macro‐social region (California) and with a particular persona that inhabits this region (the Valley Girl). An eye‐tracking paradigm is used to examine these associations in early, automatic stages of perception. One group of listeners was told the speaker was from California, while another group was told that the speaker had been described as a Valley Girl. Findings demonstrate that both the California information and the Valley Girl information caused listeners to expect the speaker to exhibit trap ‐backing. While previous studies have highlighted the influence of macro‐sociological categories on linguistic perception, the present study suggests that persona‐based social meanings can also serve to influence perception, supporting theories that foreground personae as social constructs crucial to interaction.     

The Difficult History of Ancillary Units: The Obstacles and Potential Opportunities to Increase the Heterogeneity of Neighborhoods and the Flexibility of Households in the United States

ABSTRACT

Most aging Americans express the desire to stay in their current home for the rest of their lives. However, as literature and practice indicate, aging in place cannot be successfully achieved in all places, especially in those places where zoning regulations and building codes act as barriers to the flexible adaptation of environments. One possible solution could come from the legalization of what is commonly known as granny flats, or more technically as Ancillary Dwelling Units. This article is divided into three parts. The first part is a brief history of Ancillary Dwelling Units. The second part focuses on the critical role played by local and state urban planning policies in the future of Ancillary Dwelling Units. California is used as a noteworthy example. The third part discusses how positive outcomes for senior residents who have Ancillary Dwelling Units legally present in their neighborhoods are linked to the appropriateness of their design.     

When the Spirit Blooms: Acquiring Higher Education in the Context of Welfare Reform

ABSTRACT

Established within a political context greatly influenced by stereotypical assumptions of impoverished women of color, welfare reform codified a work-first philosophy meant to attack perceived “dependency” and spur “self-sufficiency.” This article describes the shortcomings of the work-first approach and highlights the importance of higher education for helping women, and especially women of color, achieve economic well-being. It then reports key findings from a study that examines the impact of higher education on the lives of welfare participants in California. Utilizing a mix of surveys, focus groups, and personal interviews, this study finds that despite the challenges associated with balancing parenthood, college-level coursework, and the bureaucratic demands of welfare reform, the stereotypical notions of the “welfare queen” do not apply. Instead, study participants exhibited a high level of ambition, persistence, determination, and hard work in pursuit of their educational ambitions; and in the process, improved their lives and the lives of their children.     

The evaluation and selection of adequate causal models: a compensatory education example

Procedures for ascertaining relative model adequacy in latent variable structural relations models are discussed. Under diverse methods of estimation, this determination may be assessed using the chi square goodness of fit statistic, incremental fit indices for covariance structure models, and latent variable coefficients of determination. An example from evaluation research is taken (cf. Magidson, 1977; Bentler & Woodward, 1978). Numerical sensitivity of parameter estimates under alternative model specifications is demonstrated. Interpretive implications based on these procedures are discussed in terms of parameter sensitivity to alternative model specifications.     

Managing urban wetlands for multiple use: research,restoration, and recreation

Conservation of urban wetland habitat is challenging, because multiple uses must coexist. We use examples from California and Wisconsin to describe potential synergies among recreation, restoration and research activities (the 3 R's). Allowing passive recreation is often essential to garner public support for habitat protection, restoration, and research. In turn, restoration activities can improve the appearance of degraded sites, and designing the work as a research experiment can serve the scientific community. Two projects at Tijuana Estuary support the 3 R's. (1) Oneonta Tidal Linkage is a 0.7-ha tidal channel and salt marsh that was excavated from disturbed upland to bring wetland habitat closer to the Visitor Center (thereby reducing visitor intrusion into natural marsh habitat, where endangered species would be disturbed). It supports an ambitious field experiment that is testing the importance of species diversity in restoration; it also includes a bridge that serves the interpretive program, and it adds 0.7 ha of wetland habitat that helps restore regional biodiversity. (2) A larger excavation (8 ha) of former tidal wetland will soon add wetland habitat, while testing the importance of tidal creek networks in ecosystem functioning and offering views and interpretive opportunities. A third situation, at the 485-ha University of Wisconsin–Madison Arboretum, concerns restored wet prairies, which provide habitat for native species and serve many hikers. Urban stormwater flows into and degrades the Henry Greene Prairie, allowing aggressive plants to invade. Research and restoration efforts are planned to sustain the habitat and recreation functions. These three models suggest that recreation, restoration, and research are compatible uses of urban wetland habitats.     

Artifact in client satisfaction assessment: experience in community mental health settings

Artifact in client satisfaction assessment is discussed and the results of a study of three factors thought to mediate client satisfaction ratings; (a) general life satisfaction, (b) mode of administration, and (c) psychological symptomatology, are reported. A standard client satisfaction questionnaire (CSQ) was modified to yield parallel forms and was administered orally and in writing to 92 clients in two mental health day treatment programs. Satisfaction ratings obtained from these clients were quite similar to out-patient ratings obtained in previous studies conducted in this setting and using the same measures. Oral administration of the CSQ produced 10% higher satisfaction ratings than written administration (p less than .05) and less missing data (p less than .01). Satisfaction ratings were also obtained using a simple graphic instrument. Graphic ratings were comparable to CSQ ratings. Satisfaction with life in general and level of psychiatric symptoms together accounted for 25% of CSQ variance. The implication of these findings for future client satisfaction research is discussed.     

Lesbian landscape

ABSTRACT

In this article about first love, the author discusses her coming of age as a lesbian who is also tribally affiliated.     

Antiblackness as a Logic for Anti-Immigrant Resentment: Evidence From California

Drawing on data from a novel survey of Californians, this article examines the relationship between anti-immigrant resentment and antiblackness. Over the last decade, there has been a significant increase in research on anti-immigrant resentment, as well as a steady growth in public opinion literature on antiblack bias. Nonetheless, there are almost no studies that examine the relationship between these types of attitudes. Using two different measures of anti-immigrant resentment and three different measures of antiblack bias, we find that antiblackness among those Californians surveyed was significantly and robustly correlated with anti-immigrant resentment. Our findings suggest that even in a state where there is a relatively small black population and where there is little overlap between the categories of “black” and “immigrant,” attitudes toward blacks may be shaping attitudes toward immigrants. The findings suggest a need to move beyond dyadic theories of othering and in doing so, to think more critically about how the racialization of one group can shape the racialization of other groups.     

An evaluator of the future

For the evaluator who is part of the management of a human service organization, future expectations will be more demanding than at present. Operating staff, managers, and funders will already be familiar with the methods and the usefulness of capable program evaluation. Improved information tools will help the evaluator meet this challenge, by keeping the organization visible and manageable. A more fundamental change will be an improved “language of accountability”. Program standards, accreditation, and review now focus on structure and process characteristics. What is emerging is a growing consensus on definitions of client problems and program objectives in relation to these problems. This consensus spurs psychometric research on measures of problems and of the attainment of program objectives. Dependable, standard measures and meaningful comparative data will make the evaluation of program effectiveness possible.     

Treatment participation and outcome in a program for problem drinker-drivers

Relationships were examined between 13 predictor variables and two criteria of improvement in a program for problem drinker-drivers. Four measures of social background (income, educations, age, marital status), four measures of psychopathology based on the Minnesota Multiphasic Personality Inventory (MMPI), one measure of general alcoholism, and four indicators of treatment involvement served as predictor variables. Two factorially derived criteria served as outcome indicators, one reflecting general improvement, the other reflecting improved social adjustment, but a failure to reduce drinking. This second factor was interpreted as indicating resistance. Analysis included partial correlation and multiple regression, from which explained variance was completely partitioned into sources unique to each predictor, and sources shared by combinations of predictors. Results suggested that with other factors controlled, treatment involvement was linked both to improvement and to resistance. Similar conclusions were suggested for social background, but slightly different ones for psychopathology and alcoholism. Psychopathology was uniquely related to improvement; alcoholism, to resistance.     

The client satisfaction questionnaire. Psychometric properties and correlations with service utilization and psychotherapy outcome

An 18-item version of the Client Satisfaction Questionnaire (CSQ-18) was included in an experimental study of the effects of pretherapy orientation on psychotherapy outcome. The psychometric properties of the CSQ-18 in this study were compared with earlier findings. In addition, the correlations of the CSQ-18 with service utilization and psychotherapy outcome measures were examined. Results indicated that the CSQ-18 had high internal consistency (coefficient alpha = .91) and was substantially correlated with remainer-terminator status (rs = .61) and with number of therapy sessions attended in one month (r = .54). The CSQ-18 was also correlated with change in client-reported symptoms (r = -.35), indicating that greater satisfaction was associated with greater symptom reduction. Results also demonstrated that a subset of items from the scale (the CSQ-8) performed as well as the CSQ-18 and often better. The excellent performance of the CSQ-8, coupled with its brevity, suggests that it may be especially useful as a brief global measure of client satisfaction.     

Harnessing the reliability of outcome measures

A method is presented for engineering the necessary levels of measurement reliability for evaluating ongoing programs. Two studies of levels of client functioning at a community mental health center (CMHC), in which an outcome measure, the Global Assessment Scale (GAS), did not perform as expected, drew attention to the need for better control of outcome measure reliabilities. Drawing from generalizability theory, a study was conducted of three sources of GAS score variance — clients, raters, and training in the use of the scale. Several estimates of reliability (ERs) were developed, depending on the manner in which the GAS ratings were, or would be, obtained in the CMHC. The differences among these ERs clarified why the GAS had lower reliability when used in our setting. Finally, two hypothetical examples are described to illustrate the utility of applying generalizability theory to achieve higher reliabilities for outcome measures.     

A majority sound change in a minority community: /u/-fronting in Chicano English

Many sociolinguistic studies have found that minority groups are not participating in the sound changes characteristic of the majority community. This study, however, presents evidence that /u/-fronting, a sound change observable in California Anglo speakers, is found in the minority Mexican-American community as well, among speakers of Chicano English. Furthermore, while a high percentage of variation research has focused on correlating sociolinguistic variables with traditional social factors (age, gender, and social class being the most common), the results of this research underscore the need to analyze variation within the context of those social categories that are of particular significance to the specific community being studied, as well as the importance of incorporating interactions among social factors into a sociolinguistic analysis.     

Who are the social media influencers? A study of public perceptions of personality

Social media influencers (SMIs) represent a new type of independent third party endorser who shape audience attitudes through blogs, tweets, and the use of other social media. A mature public relations literature has identified the characteristics of effective spokespersons, but relatively little is known about audience perceptions of the SMI. A q-sort technique identified core perceived attributes of four sample SMIs. A better understanding of the perceived personality of SMIs provides tools for optimizing an organization's SMI capital.