Abstract: Provider Perceptions of Client Mental Illness during System Transformation (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Schedule:

Friday, January 13, 2017: 6:15 PM

Preservation Hall Studio 7 (New Orleans Marriott)

* noted as presenting author

Karissa Fenwick, MSW, Doctoral Candidate, University of Southern California, Los Angeles, CA

Sarah Starks, PhD, Postdoctoral Fellow, University of California, Los Angeles, Los Angeles, CA

Marcia Meldrum, PhD, Associate Researcher, University of California, Los Angeles, Los Angeles, CA

Erin L. Kelly, PhD, Research Associate, University of Southern California, Los Angeles, CA

John S. Brekke, PhD, Frances Larson Professor of Social Work Research; Fellow, American Academy of Social Work and Social Welfare, University of Southern California, Los Angeles, CA

Joel Braslow, MD, PhD, Associate Professor, University of California, Los Angeles, Los Angeles, CA

Background: Provider attitudes, beliefs, and perceptions play a key role in mental health treatment. Providers' beliefs impact the quality of their care, their ability to build rapport, and the culture of mental health agencies. This study analyzes change in provider perceptions of mental illness during a large-scale effort to transform California's mental health system into a recovery-based system. In a recovery-based system, providers should believe that recovery from mental illness is possible and communicate hope and optimism to clients. However, clinic characteristics such as whether a clinic is a publicly or privately owned may impact providers' perceptions and responsiveness to change. Therefore, this study also examines differences in provider perceptions of client mental illness in public versus privately owned clinics.

Methods: The present study uses three waves of longitudinal data collected annually between fiscal years 2007/08 and 2009/10 with a total sample of 225 community mental health providers across five Los Angeles County clinics. Provider perceptions of client mental illness were measured using a modified version of the Brief Illness Perceptions Questionnaire. A latent growth curve model was used to examine changes in provider perceptions of client mental illness over time, and to compare whether there are differences among providers in publicly owned versus privately owned clinics in terms of their 1) initial perceptions of client mental illness (intercept); and 2) change in perceptions of client mental illness over time (slope). Missing data was handled using Full Information Maximum Likelihood. Model fit was evaluated using chi square (χ²) misfit statistics, comparative fit index (CFI), Tucker-Lewis index (TLI), and the root mean square error of approximation (RMSEA).

Results: Overall, provider perceptions of client mental illness improved significantly over time (b= 0.22, p < .001). There was no significant difference in initial perceptions of client mental illness for providers in private versus publicly owned clinics. However, perceptions of client mental illness improved more for providers in privately owned clinics compared to providers in publicly owned clinics (b = 0.20, p < .05). Model fit was very good (χ² = 7.63 (0.12); CFI = 0.91; TLI = 0.87; RMSEA = 0.06).

Discussion: There are several characteristics of privately owned clinics that may explain the greater improvement in provider perceptions of client mental illness. Due to fewer hiring restrictions and more resources, privately owned clinics have greater flexibility to hire new providers that are aligned with a recovery philosophy. In addition, they are less likely to serve indigent clients with complicated treatment trajectories that may negatively affect provider perceptions of client mental illness over time. Overall improvement in provider perceptions of client mental illness during system transformation was small, suggesting that more research is needed to determine how to target this outcome since it can impact communication of hope, empowerment, and optimism to clients.