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.     

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.     

The effects of psychiatric symptoms on quality of life assessments among the chronic mentally ill

This study of chronically mentally disabled persons in community residences examined the discriminant validity of subjective quality of life indicators and self-report mental health indices to determine the potential confounding effects of psychopathology on the assessment of quality of life (QOL). Factor analyses and difference-score reliabilities identified a general QOL construct and a general mental health construct with 27% common variance. However, psychiatric symptoms did not significantly (p less than .05) alter the bivariate and multivariate relationships among the QOL ratings, except in the health domain in which the correlations of health-related QOL indicators with global QOL were significantly (p less than .05) attenuated after removing the effects of psychopathology. The results suggest that psychopathology does not introduce bias into the overall structure of QOL data, but they also indicate the importance of controlling for mental health effects in the assessment of patients' self-rated health and satisfaction with health care.     

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.     

Problem characteristics, decision processes and evaluation activity: a preliminary study of mental health center directors

This article reports on the results of a preliminary study on the characteristics of problems and problem solving in mental health centers. The major findings were that directors were generally quite satisfied both with the available level of information intended to help them make decisions, and with their ability to make good, even optimal, decisions. Much of this confidence resulted from the use of assumptions about the problems which reduced the need for empirical information. The problem solving process was highly dynamic and interactive, with changes over time in the characteristics of problems, constraints and alternative solutions. The directors played an active role in attempting to foster and influence the direction of many of these instabilities. Some implications for evaluation and research are discussed.     

Documentation in evaluation research: Managerial and scientific requirements

Documentation in evaluation research consists of written material, in human- or machine-readable form, pertaining to the plans, activities, and results of the project. It is argued here that good documentation is essential for effective management of evaluations, and for responsible reporting of the research procedures and findings. Documentation relating to electronic data processing activity is especially important. The purpose of this paper is to stimulate consideration and discussion of documentation, and to emphasize its importance in evaluation research. The role of documentation in the planning and control functions of project management is reviewed, and the importance of documentation in the assessment of research quality with respect to objectivity, validity, and replicability is discussed. Reasons for poor documentation are considered. An outline of documentation required in different phases of research projects is provided, and recommendations for improving the quality of documentation are presented.     

The optimal treatment approach to needs assessment

This paper describes a needs assessment technique which has not been considered in previous discussions. Basically the Optimal Treatment approach to needs assessment consists of comparing the most desirable set of services for a client with the services actually recommended or received. Discrepancies due to unavailable resources are noted and aggregated across clients. Systematic shortcomings may be taken to represent service needs.The advantages and disadvantages of this and other procedures are considered, especially with respect to political factors and the utility of data for planning and decision making in the local agency context.     

Environmental assessment and evaluation research: examples from mental health and substance abuse programs.

Evaluation researchers have been broadening the traditional client input--"black box" treatment--client outcome paradigm that has guided many evaluations of mental health, substance abuse treatment, and other intervention programs. The points of expansion are in the areas of treatment implementation and treatment processes, as well as "extratreatment" influences on treatment selection, duration, and, especially, outcome. This review illustrates the application of environmental assessment procedures--particularly social climate measures--in four aspects of evaluation research suggested by the more comprehensive model: (a) evaluating treatment implementation; (b) exploring treatment processes; (c) identifying extratreatment influences on client posttreatment functioning; and (d) operationalizing outcome variables. Conceptual and methodological issues raised by these applications are discussed, and the benefits to be derived from an expanded model of evaluation research--especially the greater potential for program improvement--are considered.     

Computer simulation of adult sentencing proposals

Several legislative proposals have been introduced in the State of Washington which would alter sentencing procedures for adults convicted of felonies. A major policy concern is the degree to which such new legislation would impact population levels in an already overcrowded prison system. The Sentencing Alternatives Impact Simulation Project developed a series of computer simulation programs to model the sentencing proposals. Results of the simulations were made available to the Legislature and to planners for Adult Corrections. This article describes the major model developed, the data required to run it, and the results obtained from it under a variety of hypothetical conditions. It includes a discussion of the level of utilization made of the results, and some comments on the requirements for maximizing utilization in future simulation projects.     

Repertoires of Contention and Tactical Diversity in the UK Psychiatric Survivors Movement: The question of appropriation

This paper seeks to advance our understanding of the processes whereby particular techniques of protest are selected from societal 'repertoires of contention'. Empirically, it focuses upon data which have been gathered on activists within mental health movements in the UK. Theoretically, it seeks to make a case for use of the work of Pierre Bourdieu, specifically his concepts of 'habitus', 'capital' and 'field'. The paper is exploratory, and acknowledged to be such. It is argued, however, that the evidence from the mental health movements is sufficiently persuasive to merit further investigation of the usefulness of Bourdieu's approach for analysing processes of repertoire selection.     

Use of drawings in evaluating children who may be incest victims

Five semi-structured drawing tasks are described which have been helpful in evaluating children who may be incest victims. Such children can be asked to do a kinetic family drawing, a drawing of the alleged perpetrator, a drawing of their house, a drawing of their own body, or a drawing of a dream. In a sample of 19 alleged victims, all children under 12 drew freely and expressed relief at being asked to draw. Children 12 and over tended to accept a drawing task only if it was structured as diagramming. These tasks were also found to be helpful in evaluating brothers of alleged victims to determine how aware the boys were of the incest situation and how critical it was for them to be included in therapy. Such drawings can be collected in pediatric and gynecologic settings as well as in the playroom. Use of drawings allows the physician to respect the child's developmental needs while obtaining the information about the incest complaint necessary for medical, protective, and forensic purposes.     

Quality of life in the evaluation of community support systems

As a result of the authors' experience in conducting an evaluation of the community support system (CSS) program in New York State, they have identified five reasons for focusing on quality of life (QOL) as a desired outcome for programs for the chronically ill. These reasons are presented and problems in QOL evaluative research are discussed. Psychological indicators are distinguished from social indicators of QOL, and two methods of operationalizing perceived QOL, the psychological well-being and life domains methods, are examined. A conceptual model is presented and the results of an exploratory study of the QOL of 118 chronic psychiatric patients receiving CSS services are presented.     

Videoconferencing in Telepsychiatry

SUMMARY

Interactive videoconferencing is an easy, fast, and relatively inexpensive method of providing psychiatric services over long distances. The experiences of telepsychiatry practitioners have been promising in Finland, Norway, the United Kingdom, the USA, Canada, and Australia.

The first practical telepsychiatry experiments in Finland were carried out at the Department of Psychiatry of the University of Oulu, where videoconferencing has been used for family therapy, psychiatric supervision, consultation, patient negotiations, and teaching. During 1998, out of a total of 400 hours, 35% of the online time was used for teaching, 24% for occupational counseling, 21% for consultations and patient negotiations, and 20% for methodological development and other activities (mainly testing the connections). The costs of inpatient negotiations via teleconferencing is half those of conventional negotiations. In general, cost analyses have also shown that telepsychiatric services are economically cost-effective in most European countries and in Australia, where a relatively small number of connections exists, while in the USA and Canada, high telecommunications costs make telemedicine more prohibitive compared to conventional care.     

Child global rating scales: Selecting a measure of client functioning in a large mental health system

The Global Assessment Scale for Children (GAS-Children) and the Children's Impairment Scale (CIS) were examined for inter-rater reliability, discrimination of outpatients from inpatients, and clinician acceptance. Forty-four clinicians used the two scales to rate 146 recently admitted children and adolescents in eight mental health programs. An additional study assessed the inter-rater reliability of the two scales compared with the Connors Parent-Teacher Questionnaire and the correlation of the GAS-Children with both the Connors Parents Questionnaire and Achenbach's Child Behavior Checklist. The GAS-Children showed better interrater agreement than any of the four subscales of the CIS, although the sum of the CIS subscales also showed adequate inter-rater reliability. Among adolescents, the GAS-Children correlated highly with the adult GAS, but the scales showed different mean values. Clinicians slightly preferred the GAS-Children over the CIS. To assess comparability of scale usage across sites, clinicians rated six case vignettes. Inpatient clinicians rated the vignettes as more dysfunctional than did their outpatient counterparts. Bias-adjusted scores still discriminated outpatient from inpatient children. Nevertheless, these rater biases should make evaluators cautious about comparing functioning scores across programs, even when the rating scale is ostensibly the same.     

Defining the severely mentally disabled

A definition of the "known target population of severely mentally disabled" in community mental health centers is examined. Criteria include intensive treatment contact and persistent, severe disability, but not diagnosis. Feasible and reliable screening procedures are demonstrated. In the identified population, most subjects at some time had received a diagnosis of schizophrenia and had been on public assistance. These criteria apply to catchmented treatment systems and should be useful in services research.     

Tracing developmental trends in Ira Gordon's programs for children and families

Ira Gordon's work in the area of child and family services is traced for six of his programs according to two main trends: (1) perceptions of families through the years and the changing roles of parents in the education of their children; and (2) curriculum changes in activities brought into homes. Gordon's programs, some being initiated as early as 1966, focused upon parents, infants, toddlers, and school-age children and utilized home visitations as a major intervention strategy. Evidence of successes reported for these programs has shown the impact of early intervention upon children as well as their families, school, and community.     

The roles of inflation and consumer sentiment in explaining Australian consumption and savings patterns

Qualitative and quantitative measures of inflation, unemployment and consumer sentiment are incorporated into traditional models of the allocation of consumers' income. Quarterly survey data collected by the Melbourne Institute of Applied Economic and Social Research are used. Both current and expected levels of variables are considered.Equations are estimated for expenditure on motor vehicles, household durabls and non-durable goods as well as for household saving. The non-traditional variables are found to be significant, although the traditional price and income variables still dominate. In several cases qualitative variables prove to be superior to their quantitative counterparts.     

How changes in price and salary affect economic satisfaction: Information integration models and inference processes

Preliminary studies demonstrated the interactive effects of changes in salary and inflation rate on feelings of personal satisfaction, and showed that the effects of price increases in different cost categories could he described by a weighted average model. Participants in the main study were presented with varying hypothetical economic situations which included salary changes (raises) as well as specific price changes. A ratio model was found to describe how raise levels and price increases were combined. The rationality of this model was discussed in terms of how variations in price and income would affect the amount of a given commodity that could he purchased. On some trials only partial information was presented. Low ratings of personal satisfaction were produced when information about raises was missing, and high ratings were produced when information about price increases was missing. These results were discussed in terms of inferences people make when a key source of information is missing.