Friday, 14 January 2005 - 10:00 AM

This presentation is part of: Early Intervention in Children

MothersĄŻ Satisfaction with ChildrensĄŻ Mental Health Services: Applying Mixed Method Approaches

Purpose: Consumer satisfaction is a crucial factor in engaging potential patients and in facilitating positive treatment outcomes. In addition, satisfaction is frequently used as a quality indicator of mental health services, one that is now required by many managed care entities. However, satisfaction ratings are problematic indicators since consumers are influenced by social desirability considerations, and satisfaction surveys tend to overestimate actual satisfaction (Young, Nicholson, & Davis, 1995). Inaccuracy in satisfaction ratings makes it difficult to use such data to improve services and change policies. This study, funded by the National Institute of Mental Health and NCMHD, combined quantitative and qualitative assessments of satisfaction to examine discrepancies between results using these two assessment methods, and presents a detailed analysis of mothers' reactions to the services their children have received.

Methods: Participants included mothers who presented their children aged 6-17 for treatment at three community mental health centers. Detailed interviews with 20 mothers were transcribed and coded for satisfaction with services. Mothers also rated their satisfaction with the Charleston Psychiatric Outpatient Satisfaction Scale (CPO), a Likert-type satisfaction scale that assessed mothers' satisfaction with fifteen aspects of services from 1="Poor" to 5="Excellent".

Results: Substantial discrepancies between the interview and questionnaire assessments were uncovered, with mothers reporting less satisfaction in the interview than on the standardized measure. On the CPO scale, only 2 (10%) mothers described that the service was less than fair, whereas in the ethnographic interview, seven mothers (35%) described unambiguous dissatisfaction with services for their children. Among the seven women clearly dissatisfied according to the interviews, three reported that they would definitely recommend the program to a friend or family members and five reported the overall quality of care provided was good or better. Areas of dissatisfaction uncovered in the interview included: (a) High turnover of therapists, "In the past three years, I've probably been to five people [therapists] and that's bad"; (b) service coordination, "I made three calls and I haven't had one return'And I just like'[said the] heck with it"; (c) unhelpfulness of treatment, "Everything's gotten worse [after counseling]; and (d) mothers' desire to be better informed about child's treatment, "I don't know what goes on those sessions'they're not making me aware of what's going on with my child."

Implications for Practice: This study demonstrates the unique contribution of qualitative assessment techniques to clinicians seeking an increased understanding of the sources of satisfaction with mental health services. The specific sources of dissatisfaction that are revealed can be more helpful to clinicians than scale ratings alone. Likert-type scales, which have become a standard, and frequently required, quality of care indicator, appear to be inadequate to assess the components of satisfaction. Interviews, although more costly, are likely to provide more accurate indicators of actual service quality, as well as concrete suggestions for service improvement. The application of appropriate sampling and analysis techniques could enable agencies and quality-of-care researchers to cost-effectively use interview techniques to assess satisfaction and gain consumer feedback for quality improvement.

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