Parent satisfaction in a child psychiatric service

Determinants of parents' experiences with outpatient child and adolescent mental health services

Background

Few studies have investigated how demographic, clinical and organizational characteristics influence parents' experiences with child and adolescent mental health services (CAMHS). The objective of this study was to determine the effects of these characteristics on parents' experiences using data from a large national postal survey.

Method

A questionnaire was mailed to 17,871 parents or other primary caregivers whose children were attending 1 of the 86 outpatient CAMHS in Norway in 2006. Multiple regression analysis was used to explore the associations between demographic, clinical and organizational characteristics, and three scales of parents' experiences.

Results

The questionnaire was completed by 7906 parents (46%). Organizational characteristics such as involvement of the parents in treatment and accessibility to the clinic explained most of the variation in all three scales of parents' experiences. Although the effects of demographic and clinical characteristics of the children in some instances were statistically significant, they only accounted for a small amount of the total explained variance.

Conclusion

Accessibility to the clinic and involvement of the parents in treatment are much stronger predictors of parental experiences with outpatient CAMHS than are demographic and clinical variables. Accessibility and involvement are at least partly influenced by the clinics themselves, and hence parental satisfaction may be enhanced by making the clinics more accessible and by involving the parents/caregivers in the treatment.

Child and adolescent service experience (ChASE): measuring service quality and therapeutic process

OBJECTIVES. Dissatisfaction with services has been associated with poorer child mental health outcomes, early treatment termination as well as disagreements over the nature of mental health difficulties, reasons for referral and therapy goals. The development of straightforward, reliable, and accurate methods of eliciting service users' views is essential within child and adolescent mental health care. This paper describes the development of the child and adolescent service experience (ChASE), a tool to measure children and young people's service experience DESIGN. The study comprises a non-experimental, cross-sectional design. METHODS. Participants were 132 mental health service users aged 8-18 years. Participants and their main carer completed the ChASE, Parent Satisfaction Questionnaire (PSQ) (Stallard, 1996) and Strengths and Difficulties (SDQ) Impact Supplement. Clinicians completed the SDQ Impact Supplement and provided clinical activity data. A sub-sample of participants completed the ChASE on a second occasion, 6 weeks after the completion of the first questionnaire. RESULTS. Scrutiny of ChASE data indicated high levels of completion. Principal axis factoring identified three factors within the ChASE: Relationship, Privacy, and Session Activity. The ChASE has good internal consistency and test-retest reliability. Significant correlations were found between the ChASE and carer satisfaction, service use, and youth clinical outcomes. CONCLUSIONS. The ChASE is a short, psychometrically robust tool for routine measurement of children, and young people's experience of mental health services, which users can complete easily. The results underline the importance of alliance factors to children and young people and their association with clinical improvement as well as the potential for the ChASE to be used a measure of children's therapeutic progress and alliance.

Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit.

A Survey of Parent Satisfaction with Pediatric Neuropsychological Evaluations

Satisfaction with pediatric neuropsychological evaluations was surveyed by asking parents or guardians of children who completed pediatric neuropsychological evaluations at a large children's hospital over a 2-year period to complete a 30-item rating scale. The scale included items drawn from published measures of consumer satisfaction, and incorporated a well-validated measure of general satisfaction. A total of 338 surveys were distributed, with 117 completed, for a return rate of 35%. Respondents were generally similar to non-respondents, except that respondents had a higher average level of maternal education and were more likely to have been referred for neuropsychological evaluations by sources outside the hospital. Parents were generally satisfied with pediatric neuropsychological evaluations, although some parents indicated that the evaluations did not provide as much help as expected. A factor analysis of the survey instrument revealed four dimensions of satisfaction: General Satisfaction, Clinician Acceptance/Empathy, Provision of Help, and Facilities/Administrative Assistance. Maternal education was negatively correlated with all four factors, but no other demographic, patient, or clinician variables were significantly related to satisfaction. Future studies could survey physicians and educators to provide a more complete understanding of satisfaction with pediatric neuropsychological evaluations.

Longitudinal assessment of parental satisfaction with children's psychiatric hospitalization

OBJECTIVE

To examine trends over time in parents' satisfaction with their children's prior psychiatric hospitalization and whether such trends are related to postdischarge outcomes.

STUDY DESIGN/DATA COLLECTION

Parents of 107 child inpatients completed a satisfaction survey at discharge. Satisfaction with the same inpatient stay was re-assessed 3, 6, and 12 months after discharge. Parents also provided ratings of behavioral symptoms at admission, discharge, and at postdischarge follow-ups.

PRINCIPAL FINDINGS

Random regression analyses indicated significant decline in satisfaction from discharge to follow-up. The proportion of parents reporting that they were not satisfied doubled between discharge and 3-month follow-up. Parents whose satisfaction appraisals shifted from satisfied at discharge to not satisfied at follow-up also provided mean ratings of their child's disruptive behavioral problems at follow-up that were higher than those of parents who reported satisfaction with inpatient care at both times.

CONCLUSIONS

Findings suggest that appraisals of inpatient care are subject to change, and may become more negative when clinical improvement associated with hospitalization dissipates in the months following discharge.

The effectiveness of one session of therapy using a single-session therapy approach for children and adolescents with mental health problems

This study applied a solution-focused single session therapy (SST) approach to all clients presenting to an urban child and adolescent mental health clinic over 14 months. The effectiveness of a single 2-hour assessment and treatment session in treating mental health problems was investigated using parent, teacher and clinician outcome measures. Teachers reported low levels of psychopathology at intake with no significant change 1 month after treatment. However, using parent and clinician measures, clinical levels of psychopathology were found at intake, with significant improvement 1 month after a single session of treatment. The effect sizes for these improvements measured medium to large, demonstrating observable improvement of clinical significance from the 1 session of SST treatment. Respondents reported 95% satisfaction with service. The study adds weight to the argument that a solution-focused SST approach can be effective for the treatment of children and adolescents with mental health problems. It recommends SST as the initial choice of treatment for these clients.

Development and testing of a scale measuring parent satisfaction with staff interactions

This study tested the psychometric properties of the Parent Satisfaction Scale (PSS), a new scale measuring parents' satisfaction with their child's mental health services, primarily focusing on staff's interpersonal interactions. Data were collected by postal surveys 5 to 10 months after a child's admission to 1 of 5 mental health treatment programs. Completed surveys were received from parents of 120 of a potential 232 children (52% response rate). Internal consistency reliability of the PSS was strong (alpha = .96). Construct validity was supported by significant relationships between the PSS and constructs considered to be antecedent variables influencing parent satisfaction, including met expectations (r = 0.62, P < .001), met desires (r = 0.32, P < .001), and met needs (r = 0.55, P < .001). Convergent validity was supported, with the PSS having Pearson correlations of .86 (P < .001) with the Client Satisfaction Questionnaire-8 and .76 (P < .001) with parents' ratings of satisfaction with specific services received.

The Role and Value of a Paediatric Specialist Neurodevelopmental Diagnostic Service: Parental Perceptions

BACKGROUND

  This study was undertaken to explore parental perceptions of the role and value of a specialist service for children and families. This service offers assessment and diagnosis of children with neurodevelopmental disorders of the kind that are not evident at birth.

METHOD

  Information was collected from 37 families on expectations and experience of clinic attendance, user satisfaction and outcome through interviews and questionnaires, once before and twice after clinic attendance.

RESULTS

  87% of parents found clinic attendance worthwhile, with most expecting to be provided with a diagnosis and advice on education. Parents perceived that the clinic was best able to meet their diagnostic needs and they reported that they were more able to obtain a diagnosis and a specialist opinion at a regional centre than at local clinics. Parent satisfaction with the parent-child relationship improved following clinic attendance and parents' self-identified concerns about their child decreased.

Consumer satisfaction with an adolescent inpatient psychiatric unit

OBJECTIVE

To explore factors influencing the satisfaction of patients, parents, and referring clinicians who used the services of an adolescent inpatient psychiatric unit, and to explore how levels of satisfaction related to the patient's symptomatic and functional improvement during the admission.

METHOD

All 105 adolescents, their families, and the referring community clinicians who used an inpatient service over a 1-year period were asked to rate the patient's symptoms and functioning on admission, at discharge, and 4 months after the patient's return to the community. We obtained satisfaction ratings at discharge, and consumers were asked to rate helpfulness of the ward experience at 4 months postdischarge. Ward psychiatrists provided Children's Global Assessment Scale (CGAS) ratings and diagnoses over the course of the inpatient stay.

RESULTS

Most of the patients (83%) improved during their admission. Consumer satisfaction ratings correlated with improvement of self-identified problems and with the perceived usefulness of discharge recommendations. Satisfaction did not, however, correlate with the patient's symptomatic and functional progress. Interaction with ward staff was an important source of both positive and negative experiences.

CONCLUSION

Our study indicates that inpatient psychiatric staff should attend closely to the consumer's perception of difficulties and the need for practical discharge recommendations.

Parental satisfaction and outcome: a 4-year study in a child and adolescent mental health service

OBJECTIVE

The aim of this paper is to examine the facets of parental satisfaction and its relationship with clinician-rated outcome in a child and adolescent mental health service.

METHOD

Patients (n = 1278) consecutively assessed between 1992 and 1996 were included in the study. When treatment ended, clinicians rated the outcome of the intervention and parents were asked to complete a satisfaction questionnaire.

RESULTS

Sixty-nine per cent of cases were rated by clinicians as having a positive outcome. Outpatients were more likely to be given a positive rating than inpatients. Satisfaction questionnaires were returned by 40% of parents; 76% of these were mostly or very satisfied. Satisfaction scores increased with the number of outpatient sessions attended but did not differ between inpatients and outpatients. There was a significant but small agreement (27% better than chance) between clinicians' rating of outcome and parental satisfaction. Level of agreement varied according to service provided and the number of sessions attended. While rates of positive outcome increased over the study period, ratings of satisfaction were stable.

CONCLUSIONS

Overall, ratings of satisfaction were comparable with those reported in other studies. Variations in concordance between parents and clinicians show that outcome and satisfaction, although related, are different constructs influenced by different factors depending on the services provided. Focusing on specific aspects of satisfaction, as opposed to global measures, may be more useful for services, although such undertakings must be supported with efforts to improve clinical outcomes.

Comparison of treatments of persistent conduct problems in primary school children: a preliminary evaluation of a modified cognitive-behavioural approach

OBJECTIVE

Treatment for persistent conduct problems in primary school children was developed using a modification of cognitive-behavioural therapy (MCBT). Its effectiveness was evaluated by comparing it with conjoint family therapy (FT) and eclectic therapy (ET).

METHOD

Children with persistent conduct problems were randomly assigned to one of three treatment groups. They were assessed prior to treatment and then 6 months after. Measures included symptoms of the child; parents' mental health; stress of parenting; family functioning; and parental relationship. In addition, parents' and children's perception of the therapy were assessed and a treatment record was developed to track the treatment process.

RESULTS

Thirty-two children were recruited for the study. No statistically significant differences were found in terms of effectiveness between the three groups. In terms of parents' perception of the therapy, there was no difference on the perception of the qualities of the therapists, but on the perception of therapy MCBT was considered to be higher in cognitive-behavioural orientation.

CONCLUSION

Further research using a larger sample is required to evaluate MCBT. The study supports the idea that controlled treatment studies can be carried out within busy mental health services.

A naturalistic study of psychotherapeutic methods and client in-therapy functioning in a child community setting

Utilized a naturalistic methodology to examine treatment responses associated with major psychotherapeutic methods in 150 youth aged 11 to 17 years old in a community mental health center. Treatment methods were not experimentally controlled but were measured retrospectively by therapist report. Treatment response was assessed by a composite of 6 measures completed by clients, parents, and therapists. Pretest/posttest comparisons indicated improved functioning in the sample as a whole. Treatment response was not related to the proportion of therapy using individual, family, or group modalities. Therapy response was positively associated with extent of use of cognitive therapy. Social skills training, behavior therapy, and family systems therapy were associated with more positive treatment response in some subgroups of clients. The number of approaches used in an individual case (technical eclecticism) was positively related to client response. Treatment response was more consistently related to level of client and parent functioning in therapy than to treatment method.

Parent satisfaction with the Minimal Motor Dysfunction Unit: a survey

This study investigated parent satisfaction with the Minimal Motor Dysfunction Unit (MMDU), a service for clumsy children based in Adelaide. A questionnaire was developed and mailed to 102 parents whose children had attended the MMDU between 1991 and 1993. The response rate was 76 per cent. The level of parent satisfaction with the overall MMDU service was 86 per cent. Parents rated the processes of service delivery and the resulting outcomes as more important to them than structural aspects of the service. Based on parent comments, recommendations were made to assist in further improving the quality of the MMDU service. Parent satisfaction should be investigated as an outcome measure for other paediatric physiotherapy services.

Parental evaluation of treatment outcome and satisfaction with an inpatient program for eating disorders

This study is concerned with the service provided to adolescent patients with eating disorders admitted to a private hospital. The patients' parents were asked to evaluate the service. Parental satisfaction was assessed by means of a questionnaire devised for this purpose and comments were elicited as to how the service could be improved. Parents of a consecutive series of 56 patients were asked to complete the questionnaire 6 months after admission; 82% (N = 46) responded. Most parents were pleased with the service provided but nevertheless many made some criticisms (35%) or suggestions for improvement (37%). The parental responses were discussed with the staff involved in treatment, resulting in changes to the service.