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.     

Health Care Professionals' Experience,Knowledge, and Attitudes Concerning Homosexuality

The purpose of this study was to examine the experience with attitudes towards, and knowledge about homosexuality of three groups of health care professionals. Subjects were 97 registeres nurses, social workers, and psychologists who responded to a six-page mailed questionnaire. Professional discipline of the subject, gender of the client, and gender of the client's lover in a fictitious scenario did not significantly affect ratings or suggested diagnoses of the client. Most subjects felt that they needed moer training in working with homosexual clients, which was consistent with their high but not perfect scores on a knowledge test. Subject's mean scores of the Attitudes Toward Lesbians (ATL) and Gay Men (ATGM) scales of Herek (1998) reflected significantly less prejudice than his college samples. More knowledgeable respondents were less prejudiced and had more positive attitudes about working with gay and lesbian clients; those with more positive attitudes toward clients also showed less prejudice on the ATL and ATGM scales. The authors argue that training health care professionals to be more knowledgeable about gay and lesbian issues would lead to more positive attitudes and better services for gay and lesbian clients.     

Analysis of Pre and Posttest Gender Differences in Family Satisfaction of Divorce Mediation Couples

To determine if divorcing spouses experience the family reorganization process through mediation differently, we tested divorcing couples before and after child custody/visitatior mediation, using the Family Satisfaction scale. The pretest family satisfaction scores of husbands as a group were significantly lower than those of the wives (p = .004), but significantly improved after mediation (p = .005). The family satisfaction of wives as a group did not change. Within-couple differences in family satisfaction did not change for either spousal group before and after mediation, an indication that an improvement in the family satisfaction of the husband is not necessarily at the expense of the wife.     

Stability and Validity of the Holden Psychological Screening Inventory (HPSI) in Psychiatric Inpatients

Abstract

Forty-seven psychiatric inpatients in a Canadian psychiatric hospital participated in an evaluation of the stability and validity of the Holden Psychological Screening Inventory (HPSI). Stability coefficients over a 1-month period were .85, .79, and .66 for the HPSI Psychiatric, Social, and Depression Symptomatology scales, respectively, and coefficient alpha reliabilities for these scales ranged between .76 and .89 across both time periods. Staff rating composite scales corresponding to the self-report HPSI scales had stability coefficients of .74, .85, and .82, respectively. As well, they had inter-rater reliabilities that ranged between .65 and .84 across both time periods. The 3 staff rating composites at time 1 correlated equivalently with the corresponding 3 primary HPSI scales at times 1 and 2 (p > .05). Similarly, the 3 staff rating composites at time 2 correlated equivalently with the corresponding 3 primary HPSI scales at times 1 and 2 (p > .05). Over a 1-month period, HPSI scale scores were very stable and correlations with criterion ratings were stable. Using a confirmatory factor analysis, with each of the 3 dimensions defined by the time 1 and 2 measures for the 3 HPSI scales and 3 staff rating composites, evidence for discriminant as well as convergent validity was obtained. In summary, the self-report HPSI and the staff rating composite measures evidenced sufficient reliability and validity to meet the requirements for routine clinical assessment work with psychiatric inpatients. Additionally, the stability data provide effects of retesting baseline data for assessing treatment outcome in this population.     

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.     

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.     

A cross-national validation of the client satisfaction questionnaire: the Dutch experience

A Dutch translation of the eight-term version of the Client Satisfaction Questionnaire (CSQ-8) was administered to community mental health outpatients in the Netherlands (n = 110). Data analyses indicate that the Dutch CSQ-8 has highly similar operating characteristics and psychometric properties compared with the English language version. Results also indicate that one general satisfaction factor was found in the Dutch CSQ-8 data. All eight of the scale items loaded heavily on this general factor, strong inter-item correlations were found, and the scale demonstrated high internal consistency. On these grounds, we can conclude that the Dutch CSQ-8 has the same properties as the original questionnaire and can be used as such in Holland. It was also found that those clients who decided to stop therapy on their own were less satisfied than other clients. Clients who made a common decision with their therapist or let him/her make that decision were more satisfied than clients who stopped by themselves. Additional research is planned to investigate whether clients who complete treatment goals are indeed more satisfied and whether this line of research could be a means of studying the external validity of the scale.     

The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Differences in Refugee Anxiety and Depression

ABSTRACT

Using the HSCL-25, the lev els of anx i ety and de pression were mea sured for ref u gees from Viet nam, So ma lia, and the for mer Yugoslavia (N = 60) who were clients of a community social services agency. De pression and anx i ety lev els were high est among the Viet nanr ese cli ents, anx i ety lev els were high est among the Somalians, and both anxiety and depression level were lowest for former Yugoslavians. Based on gen der, anx i ety lev els were high for both the Viet nam ese and Somalian males, while de pression lev els were high est for the Viet nam ese males. Single fe males as a group ex ceeded the cut ting score at higher rates than single males; in con trast, mar ried males ex ceeded the cut ting score at a higher rate than mar ried fe males. A highly cor re lated re lation ship was dem on strated between anx i ety and de pression (£ = 0.70, p < 0.001). Using ANO VA, de pression sig nif i cantly differed be tween the ref u gee groups (p = 0.007); differ ences in anx i ety be tween ref u gee groups were not sta tis ti callysignificant.     

A multi-dimensional client satisfaction instrument

Development of a client satisfaction measure through successive factor analyses is described. Five factors, each defined by five items and accounting for at least 11% of the total variance, were identified and replicated. A single second order factor also emerged in both studies. Reliability of the second order factor, and of three of the first order factors is sufficient for most purposes. The second order factor, which is a linear combination of the first order factors, was not significantly correlated with sex, age, race, or number of attempts made before receiving a client response. The distribution of scores was highly skewed, with most respondents scoring near the upper (satisfied) end.     

A National Study of Involuntary Protective Services to Adult Protective Services Clients

ABSTRACT

A questionnaire was sent to state administrators of Adult Protective Services Programs (APS) to learn about involuntary protective services provided by APS to vulnerable adults at risk of abuse, neglect, or exploitation. Data were obtained on criteria used to assess the need for involuntary services, types of services provided, sources of authority for involuntary intervention, the nature and extent of public concern about involuntary services, and the protection of the rights of incapacitated clients. Based on responses from 43 states, less than 10 percent of APS recipients receive services without their consent; and all states providing services involuntarily take steps to ensure the protection of rights. Available information from the study does not support the general belief that adults who self-neglect are more likely than other APS clients to have protective services imposed.     

Self-Esteem,Locus of Control,and Suicide Risk

Abstract

Past research suggests that African American clients in need of mental health services are less likely to be properly diagnosed and receive appropriate treatment compared to White Americans. It has been further suggested that this may be even a greater problem for those who are both African American and female. In the current study, 2 groups of hospitalized clinically depressed females (92 African American females; 99 White females) were administered the Self-Esteem Rating Scale, Internal Control Index, and Suicide Risk Scale. Results indicated more similarities than differences between the two groups. For instance, there were no differences in locus of control or suicide risk between groups. In addition, although there were differences in self-esteem between groups, self-esteem was the best predictor of suicide risk within groups (White, R² =42%; African American, R² = 19%). African American females possessed higher self-esteem than White females (p = .05). For African American females age and self-esteem were positively correlated (r = .27, p =.01). Clinically depressed females could benefit from treatment focusing on improving self-esteem within a context of multicultural sensitivity.     

Gambling and problem gambling among clients,and staff attitudes,in an alcohol and drug problems treatment service in the English Midlands

A self-completion questionnaire containing items about recent gambling and problem gambling used in the British Gambling Prevalence Survey (BGPS) was completed by 274 clients of alcohol and drug problems services in the English West Midlands. Compared to BGPS data, matched to the client sample for age and sex, clients were significantly more likely in the previous 12 months to have engaged in forms of gambling carrying a high risk of problems, to have engaged in four or more separate forms of gambling, and to have scores on a brief form of the South Oaks Gambling Screen (SOGS) indicating problem gambling. A self-completion scale on attitudes towards working with problem gamblers, with good psychometric properties according to present data, was completed by 91 members of staff of the same services. With the exception of a sub-scale measuring perceived adequacy of knowledge and skills for working with problem gamblers, staff expressed moderately positive attitudes. It is concluded that British substance misuse services are appropriate locations for the development of services for problem gambling.     

Explaining Client Satisfaction with an Employee Assistance Program

ABSTRACT

The first objective of this paper is to explore the psychometric qualities as well as the usefulness of an employee assistance program client satisfaction scale. The responses obtained from 82 clients of an external service provider permitted a validation of the satisfaction scale and ultimately the selection of five items showing stronger convergent validity as well as high reliability (alpha = .89). The second objective is to explore the possible relationships between demographic (gender, age), treatment (referral-type, type of problem, urgency, degree of resolution) and organizational variables (unionization, job category, sector, size), and variations in client satisfaction levels. The results of bivariate analysis indicate that the type of referral, the type of problem, and the degree of resolution of the problem are related to client satisfaction. This study provides some support for the inclusion of treatment variables in a comprehensive explanatory model of client satisfaction. It is further argued that client satisfaction is an adequate measure of the success of an employee assistance program. Finally, some methodological issues surrounding the use of such surveys are discussed.     

How do they see themselves? Self-perception and functioning for people with chronic schizophrenia

In a supervised living situation, 15 individuals whose physical health was considered stable and who had diagnoses of chronic schizophrenia expressed varying perceptions of their mental health. Most perceived themselves as mentally well. This is in opposition to findings reported by Estroff (1981) and Dzurec (1986) that suggested that clients with schizophrenia tended to have negative self-perceptions. The author posits that this positive self-perception might be a function of respondents' expressed satisfaction with their housing situation. This is an area in which ongoing research is being conducted (Bininger, 1989; Dzurec, 1989). Housing satisfaction is thought by some researchers to precede successful community adaptation for the severely mentally disabled (Blanch, 1988). Respondents' perceptions of their mental health, as expressed in response to the interview protocol, appeared to be couched within primarily mundane, day to day issues. This finding is consistent with Estroff's conclusion that clients "seemed to have less control of their time, space, resources, and information than did outside and inside normals" (Estroff, 1981). The respondents gave themselves higher than average scores (ie, 3 or above on a five-point scale) overall on the PES, an instrument that measured aspects of their daily functioning. Their caretakers gave them somewhat lower overall scores on the PES. There was a moderate association between individual pairs of respondent-caretaker scores on the PES. Personal mental health perception did not appear to influence daily functioning.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Biracial Sensitive Practice

Abstract

Although literature acknowledges the existence of a biracial population, there has been minimal discussion of the differences indicative of biracial clients and how these differences impact provision of services. Too frequently, race criterion has been utilized to categorize biracial clients resulting in an all but invisible population. A biracial individual may then assume a multiplicity of identities, including African-, Asian-, Latino- and Native-American, when negotiating with macro institutions, including social services. As an alternative to racial paradigms, identity across the lifespan is suggested as a more comprehensive model for biracial clients. In the aftermath said clients will be rendered visible by identity models that prevail less on the basis of race and more on the basis of experience extended across the lifespan.     

Physical and psychological outcomes of a supported physical activity program for older carers

This study evaluated health benefits of a supported physical activity program for 116 older carers (mean age 64.4 [SD = 7.9], 85% women). Participants undertook a 6-month center-based physical activity program (strength training, yoga, or Tai Chi). Eighty-eight participants (76%) completed the program. Multivariate repeated-measures ANOVA identified overall significant improvement postintervention (p = .004). Univariate analyses revealed significant improvements for balance, strength, gait endurance, depression, and SF-36 (physical component; p < .05). There was no change in the Zarit Carer Burden Scale (p > .05). Change in performance scores did not differ significantly between those with higher and lower attendance at classes, although there was significantly greater improvement in gait endurance and balance (p < .05) in those attending classes run twice weekly than in those attending once-weekly classes. In conclusion, a carer physical activity program, providing additional carer support to facilitate participation, can achieve high levels of involvement by carers and significant health benefits.     

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.