Perceived Importance of Service Elements in Client Satisfaction Measures

ABSTRACT

Many evaluators or service providers develop their own client satisfaction measures using satisfaction rating items representing service elements specific to the service settings. Global satisfaction scores are then produced by summing these item scores while assuming an equal contribution of all items. One approach to overcome evidence against this assumption is importance weighting, which is achieved by considering both item satisfaction and item importance in measuring overall satisfaction. Unfortunately, the adequacy of importance weighting in client satisfaction measures is not well understood. This study assessed the adequacy of importance weighting. Analyzing data from a previous client satisfaction survey with 110 older adults, the current study found that the relationship between global client satisfaction and the sum of satisfaction scores across service elements was dependent upon the patterns of respondents’ perceived importance of service elements. These results provide support for importance weighting and suggest the need for incorporating perceived importance of service elements in measuring overall client satisfaction.     

A Client Satisfaction Measure of Homecare Services for Older Adults

Client satisfaction can be used as an indicator for service quality. Without concrete feedback from clients, however, the usefulness of client satisfaction data for service improvement can be limited. This study described the development of a client satisfaction measure that can be used to provide concrete feedback for service providers. Based on a conceptual framework proposed in the literature, the Client Satisfaction: Home Care (CSAT-HC) uses a client-centered perspective to measure client satisfaction for homecare services for older adults. A survey of 200 older adults receiving homecare services provided by a social service agency in a large U.S. Midwest city was conducted to assess the psychometric properties of CSAT-HC. Results based on the 156 completed surveys show that CSAT-HC has good validity (correlation r = .62 with a popular client satisfaction measure) and test-retest reliability (r = .75). These results indicate that CSAT-HC is a valid and reliable client satisfaction measure; and therefore, providers of homecare services for older adults can use CSAT-HC to obtain client feedback for quality assurance or program evaluation purpose. Future research may use CSAT-HC to explore the potential influences of quality of homecare services on the well-being of older adult clients.     

A Comparison of the Effectiveness of Various Approaches to Visiting Isolated Community Elderly

Two studies were conducted evaluating the effectiveness of friendly visitor programs in increasing clients' life satisfaction. Study 1 found no difference between face-to-face visiting, phone visiting, and a no treatment control on client life satisfaction. Study 2 found a marginally significant difference in favor of a personal history approach over a companionship approach to visiting in increasing client life satisfaction. Clients' living situation (alone or with others) had no effect on changes in life satisfaction in Study 1. However, in Study 2 clients who lived with someone increased their life satisfaction more than clients who lived alone.     

Toward Client-Centered Service: Asking Clients for Their Views of TANF,Food Stamps,Child Care,and Medicaid Services

ABSTRACT

This article presents the results of a randomized study that asked Division of Family and Children Services' (DFCS) clients throughout the state of Georgia to rate their satisfaction with Temporary Assistance to Needy Families (TANF), food stamps, child care services, and Medicaid services, as well as their perspectives of the customer service they received through their county DFCS offices. Telephone interviews were conducted with 2,408 clients. Overall client satisfaction percentages are: TANF, 80%; food stamps, 88%; child care, 92%; and Medicaid, 94%. Satisfaction indices were also created from the data collected. Client suggestions for improvement are presented as well as practice and educational implications.     

Client Experiences of Trauma-Informed Care in Social Service Agencies

This paper describes a qualitative study of individual client interviews (n?=?26) from four social service agencies to understand how clients experience trauma-informed care services and implementation challenges. We used the Fallot and Harris framework to explore client experiences of the five core concepts of trauma-informed care (safety, trustworthiness, choice, collaboration, and empowerment) using semi-structured interview questions with each client. The four agencies consisted of: refugees (n?=?4), substance abuse (n?=?8), older adults (n?=?12), and maternal/child health (n?=?2), and the agencies varied in size, service goals, and clientele. The results of the study suggest that clients’ experience of these concepts was shaped by the actions of other clients, and these experiences were either mitigated or hindered by actions of the agency employees. Agency policies either supported or enhanced their experiences as well. The results also suggest that it was challenging for agencies to provide for all of the trauma-informed care (TIC) concepts at the same time. We discuss the implications of these findings for social service delivery in a range of agency types. Future research should examine the effects of trauma-informed policies on client experiences of each TIC domain.     

A Comparative Study of the Management of Cases of Deliberate Self-Harm in a District General Hospital

Correspondence to Michael Bateson, Senior Psychiatric Social Worker, Lancaster Moor Hospital, Lancaster, Lanes. Summary A controlled study was undertaken of two services assessingand managing cases of deliberate self-harm admitted to a casualtydepartment. The first service featured psychiatrists only andthe second included psychiatric social workers as well as psychiatrists. A combination of standardized instruments, a structured questionnaire,a twelve month diary and medical and social work files wereused to collect information. Demographic factors, repetitionrates, types of help offered, client satisfaction, social circumstancesand general health were investigated. Few significant differences were found to have existed betweenthe client populations of the two services at initial assessment.Also, there were no apparent differences in factors interveningbetween initial assessment and follow-up. However, the analysisof outcome measures indicates that clients benefited substantiallyfrom the addition of a psychiatric social worker in the followingareas: help offered, client satisfaction, social circumstancesand general health. These results are discussed.     

Social Workers' Responses to Incontinence,Confusion and Mobility Impairments in Frail Elderly Clients

Social workers in home health care agencies are frequently involved in decisions concerning the independent living of their frail elderly clients. This study analyzes social workers' responses to elderly clients with three health problems that are relatively common among the elderly: urinary incontinence, confusion, and mobility impairments. Responses to clients with incontinence differ from responses to confused or mobility-impaired clients primarily in the specificity of attributions of cause of the problem and in evaluative responses toward the client. The findings are discussed in terms of the potential role of social work as an agent for change in both popular understandings of incontinence in later life and in the delivery of health care to the incontinent elderly.     

Social workers' perceptions of their power and service outcomes

While social workers are becoming increasingly interested in methods of client empowerment, little attention has yet focused on the links between workers' own power and the services they provide to clients. The authors examine the link between workers' perceptions of their power on the job and perceived service outcomes. Bivariate and multivariate analyses were conducted on survey responses from 591 direct practice social workers in Israel. Results indicate that power perceptions are significantly associated with an array of perceived service outcomes. These findings highlight the relevance of self-efficacy and control theory in understanding social workers' efforts toward effective service delivery. Further, they underscore a need to consider more carefully direct practitioners' own power concerns as they increasingly consider empowerment of their clients.     

Therapeutic management of violence in residential care for severely mentally ill clients: An application of intrapsychic humanism∗

The innovative psychology, intrapsychic humanism, is applied to formulate guidelines for effectively managing violent symptoms of severely mentally ill clients in residential settings, with the aims of: 1) helping staff reduce client violence; and 2) helping clients regulate their violent behavior. Using intrapsychic humanism, staff can understand, anticipate, and respond therapeutically to client violence. Triggers of violence, such as aversive reactions to pleasure and destructive reactions to real losses are described. Residential program structures that strengthen clients’ constructive motives and staff's caregiving motives are outlined.     

Client-oriented Quality Assessment within Municipal Social Services

The hypothesis of this article is that quality assessment, despite the fact that it has now become a part of social services, has largely occurred without taking clients into consideration. There are supposed to be at least three possible explanations for this: organizational structures and professionalism, the difficulty in defining client needs, and the opinion that a client is not an equal companion in social service organizations. The research method entailed a questionnaire which was sent to 60 managers working within municipal social administration during the periods of construction (1950–1965), supplementation (1966–1983) and reform and redistribution (1984 onwards) of the Finnish welfare state and a questionnaire for 146 public social welfare organizations in Finland. Fewer than 30% of the social managers of the construction (1950–1965) and supplementation (1966–1983) periods and fewer than 50% of the managers of the last period (1984 onwards) said that clients really had assessed quality. The needs of clients and client feedback were said to be important during all three periods but the managers did not include them in the most important tasks. The managers of the period of supplementation did this the least. The managers from the period of reform and redistribution (1984 onwards) were more likely to trust the ability of clients to assess quality of social services and they also gave more opportunities to do so. The most important reasons for neglecting client needs and feedback in quality assessment were organizational structures and difficulties in defining client needs. There also seem to have been some methodological difficulties in assessing social services. Statistics are still largely in use and concrete criteria related to quality are missing. More specific questionnaires, cross-experimental designs and interviews, more possibilities for clients to describe needs in their own words, and the specification of general concepts in more concrete terms of quality are needed in order to avoid abstract and general assessments.     

Vital Involvement Practice: strengths as more than tools for solving problems

This article describes Vital Involvement Practice, a strength-based approach to clinical practice with elders, including those who are extremely frail. Using this approach, practitioners have been able to help elders increase later-life vitality and associated positive quality of life through: (1) systematic identification of individual strengths and assets (found both in the person and in the surrounding environment), and (2) consideration of these strengths alongside the individual and environmental deficits that are the subject of most geriatric practice. The approach utilizes original data-gathering tools (Occupational Profile; Life Strengths Interview Guide) and a stepwise, worksheet- structured consideration of these data in order to formulate action strategies for achieving client goals (Domain Scan; Domain Goals; Life Plan/Strategy). All elements of VIP emerged in pilot work with gerontological practitioners and their elder clients in such settings as: primary health care; government social service; subsidized senior housing; private clinical practice; community recreation. Limitations, implications, and promise are noted, with respect to practice and research.     

The Transformed Political World of Older Boomers

Abstract

This article describes Vital Involvement Practice, a strength-based approach to clinical practice with elders, including those who are extremely frail. Using this approach, practitioners have been able to help elders increase later-life vitality and associated positive quality of life through: (1) systematic identification of individual strengths and assets (found both in the person and in the surrounding environment), and (2) consideration of these strengths alongside the individual and environmental deficits that are the subject of most geriatric practice. The approach utilizes original data-gathering tools (Occupational Profile; Life Strengths Interview Guide) and a stepwise, work-sheet-structured consideration of these data in order to formulate action strategies for achieving client goals (Domain Scan; Domain Goals; Life Plan/Strategy). All elements of VIP emerged in pilot work with gerontological practitioners and their elder clients in such settings as: primary health care; government social service; subsidized senior housing; private clinical practice; community recreation. Limitations, implications, and promise are noted, with respect to practice and research.     

Gerontological Social Workers' Perceived Efficacy for Influencing Client Outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure–process–outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R ² = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Gerontological social workers' perceived efficacy for influencing client outcomes

Using a sample of practitioners (n = 269) from the 2004 National Study of Licensed Social Workers, this article employs a quality assurance structure-process-outcome model to examine factors at the practitioner, workplace, and service delivery levels that influence the perceived efficacy of licensed gerontological social workers to affect client outcomes in the context of a highly challenging health care environment. A regression model accounted for 33.9% of the variance (adjusted R (2) = .291) in perceived efficacy with 3 aspects of service delivery satisfaction having significant effects: ability to address complex/chronic care, to influence the design of services, and to help clients navigate the system.     

Foster Family Care for Frail Elderly

For the last 10 years, the development of cost-effective, community alternatives for chronically ill has been a serious concern of many service providers and policy-makers. The expanding of the elderly population has been well documented. In this state, projections show a need for an additional 1602 long-term care beds by the year 2000, almost double the current capacity. The state Medicaid Program is searching for ways to reduce the 50 million spent in 1982 for institutional long-term care. Already experiencing the shortage of long-term beds, hospitals have a chronic loss of revenue potential through the holding of non-acute patients in the hospital while waiting for a nursing home bed vacancy. At the 500 bed acute care hospital, 25-30 beds daily are occupied by nursing home wait-listed clients. The average wait-listed days per patient is 20.4. In September 1979, the hospital's department of social work began foster family care for elderly persons eligible for nursing home care. Foster families are extensively screened and trained for the severely dependent clients. The social worker and registered nurse team are closely involved in placements, developing and implementing an individualized written treatment plan to assure the clients quality of care. Data collected over the past three years clearly indicates that this setting provides cost-effective, quality care. Overall scoring on bathing, dressing, toileting, transfer, and continence, utilizing the KATZ Activity of Daily Living, shows that 71% of the clients improve after 3 months on placement. Although 45% of the clients are incontinent of bowel or urine at the time of placement, 33% make significant improvement to only occasional accidents. With 41% of the clients at placement requiring adaptive device and assistance for walking, 48% of the clients show functional improvements in walking. Most significant for continued survival of this type of care, the total program cost is half the cost of institutional care for these elderly clients. The paper will examine the multiple needs served through the program: the ill elderly person's need of a therapistic, caring environment; the hospital's need to curb loss of potential revenue; and the need of the Medicaid Program to contain costs. The paper also reviews client characteristics, foster family characteristics, quality assurance, and overall cost-effectiveness of the foster family model.     

Worker Participation and the Social Service Agency

Summary Is there real sharing of decision-making responsibility withinsocial service agencies? What hope is there for participationby the consumer of services if the agency worker nearest andmost relevant to him has little voice or leverage within theorganization? This paper examines the notion of worker participationwithin the context of the social services department and theprobation service, noting the imperfections of the ‘publicmandate’ behind the authority structure of these organizations.Above all it looks for continuity between the values socialservice agencies publicly represent and the values in theirday-to-day dealings with their own staff and clients. Currenttrade union proposals for worker representation at committeelevel are considered, and Dutch experience in extending theworkers' council from the industrial to the social welfare sphereis presented as one alternative model.     

Spiritual Assessment and Latter-Day Saints: Establishing the Preliminary Validity of Spiritual Eco-Maps

ABSTRACT

Few spiritual assessment approaches have been validated with Latter-Day Saints (LDS), in spite of the importance of religion to this culturally distinct population and its burgeoning growth. Drawing on the concept of social validity, this mixed-method study validates a qualitative spiritual assessment approach—spiritual eco-maps—using a geographically diverse sample of social workers (N = 100), all of whom had at least 5 years of direct practice experience with LDS clients. These individuals were asked to identify: a) the degree of cultural consistency, strengths, and limitations of the spiritual eco-map at a conceptual level; and 2) how the questions designed to operationalize the approach might be improved to be more valid, relevant, and consistent with LDS culture. The results suggest that spiritual eco-maps are consistent with LDS culture as long as they are operationalized appropriately. Toward this end, a culturally valid question protocol is provided along with suggestions for administering the instrument in a culturally competent manner. Spiritual eco-maps may be particularly useful in settings where a quick, visually oriented assessment that focuses on clients’ present relationships is indicated. Future research might build upon the present study by assessing the validity of spiritual eco-maps with both community and client samples.