Abstract
This study explored the concept of service satisfaction and its relationship to outcome in a mental health setting. Data collection spanned approximately two years and data was collected from two sites at two different points in time, intake referred to as Time A and discharge/six months into therapy, referred to as Time B. Children/adolescents, their parents and their therapists were asked to complete a number of psychometric instruments at Time A and Time B. These instruments included the Adolescent Satisfaction Questionnaire (ASQ) an instrument specially designed for use with a population of Irish youngsters with mental health difficulties (O’Flaherty, 1998). One hundred and nine children and their parents participated in Time A. Of these it was possible to follow up 65 children and 59 parents at Time B. Results indicated that children and parents were satisfied with the service they received overall. There was a moderate positive correlation between overall child satisfaction scores as assessed by the ASQ and overall parent satisfaction scores as assessed by the PSQ (r=.46, p=.000). Multiple regression analysis with child satisfaction (as assessed by the ASQ) as the dependent variable yielded no significant predictor variables. Multiple regression analysis with parent satisfaction (as assessed by the PSQ) as the dependent variable yielded one significant predictor variable - the child’s functioning at Time B (as assessed by the Parent visual analogue scale). Satisfaction was not related to outcome. Child satisfaction scores as assessed on the ASQ were found not to be related to improvement from Time A to Time B on the YSR scales measuring total behaviour problem scores (r=.03, p=.426). Parent satisfaction scores as assessed on the PSQ were found not to be related to improvement from Time A to Time B on the CBCL scales measuring total behaviour problem scores (r=.12, p=.203). However, results indicate improvement on a number of measures from Time A to Time B. Children reported significant improvement from Time A to Time B on the YSR total problems (t=3.52, p=.001) and internalising problems (t=3.21,p=.002). Parents reported significant improvement on the CBCL total problems (t=-3.64, p=.001), internalising problems (t=3.83, p=.000), externalising problems (t=2.99, p=.004). Similarly, both children and parents reported significant improvement on the visual analogue scales of problem severity (t=3.91, p=.000 and t=4.66, p=.000 respectively). Therapists reported significant improvement in their clients as assessed on the HoNOSCA (t=8.59, p=.000) and the GAF (t=-6.64, p=.000). Correlational analyses between children and parents’ ratings of their problems at intake and between their perceptions and therapist perceptions of change in problems from Time A to Time B indicated low to moderate positive correlations. Multiple regression analyses with change in HoNOSCA scoring as the dependent variable, identified complexity and duration of presenting problems at intake as significant predictor variables. This research also compared treatment drop-outs to people who persist with treatment. No significant differences except on one variable (parents’ marital relationship) were found χ2(1, N=105) =10.45, p=.001. Qualitative data analyses yielded further information about children’s and parents’ perceptions of the service. This research attempted to combine a number of quantitative measures of outcome with qualitative methods in order to assess process and outcome in a child/adolescent mental health service.