Family Engagement and Consumer Satisfaction in the New

Family Engagement and Consumer Satisfaction in the New Era of Child and Adolescent Inpatient Psychiatric Care Mary Brinkmeyer and Sheila Eyberg ABSTRACT Project TRIO (Together Reaching Improved Outcomes), is an ongoing research project examining the role of family engagement and consumer satisfaction in predicting outcomes for the mentally ill children and adolescents admitted to Shands at Vista inpatient psychiatric unit. So far, 29 participant families have been recruited (project goal is 40 participants). Participants are male and female inpatients ages 7 -17 (mean age = 13) and their parents. At the time their child is discharged, parents complete a demographic questionnaire, the Achenbach Child Behavior Checklist (CBCL), the Family Relationship Index (FRI), and the Inpatient Parental Satisfaction Index (IPSI). At the same time, the child’s psychiatrist completes the Family Engagement Questionnaire (FEQ). Preliminary results indicate that engagement is related to satisfaction (r =. 44, p =. 04), prior inpatient treatment is negatively related to engagement (r = -. 41, p =. 05), and satisfaction with prior inpatient services is highly predictive of satisfaction with current services (r =. 81, p =. 01). Nine months after their child is discharged, families will be contacted to assess treatment outcome. BACKGROUND AND SIGNIFICANCE The Impact of Managed Health Care on Inpatient Services Decline in length of stay More stringent criteria for admission Increase in illness severity (acuity) Shift in focus of treatment from extensive individual and family work to diagnosis and acute crisis stabilization More time spent on physical management of out-of-control behavior The “revolving door” pattern: cycling from one hospitalization to the next without ever resolving the underlying issues What We Don’t Know About the New Model of Care How much engagement is possible? How do parents feel about their children’s care? Is satisfaction related to engagement? Does engagement even matter when average length of stay is only 5 days? Related Research Factors that impact child inpatient outcome beyond diagnosis and illness severity: Parent involvement in aftercare plans (+) , disengaged family interaction (-), prior mental health treatment of parent and child (-) Studies of engagement in child outpatient treatment have shown the following links to treatment outcome: Perceived relevance and demandingness of treatment, perceived therapist empathy, and therapist-rated treatment alliance No study has been published linking engagement to inpatient treatment outcome. Factors that predict parent satisfaction with child inpatient care: Extent to which the child’s home situation was addressed, satisfaction with parent services, and length of stay. No study has examined the association between child inpatient engagement and consumer satisfaction. University of Florida RESULTS Predictors of Engagement and Satisfaction PARTICIPANTS (n = 29) Inpatients on Shands at Vista Child and Adolescent Psychiatric Unit and their parents Demographics Mean Child Age = 13 (range 7 – 17) Mean parent age = 42 (range 26 – 69) 59% boys, 41% girls 78% mothers, 13% fathers, 9% other 83% Caucasian, 8% Biracial, 4% Hispanic, 4 % African-American Parent Education Level 13% Some high school 26% Some College 13% Post -college degree 22% High school grad 26% College grad Mental Health Treatment History Prior Inpatient Treatment: 44% of Children, 5% of Parents Prior Outpatient Treatment: 83% of Children, 48% of Parents Diagnoses (available for 17 participants) 82% Major Depressive Disorder 24% Post Traumatic Stress Disorder 12% Attention Deficit Hyperactivity Disorder (ADHD) 6% Oppositional Defiant Disorder, Adjustment Disorder, Anorexia, Bipolar Disorder Mean Length of Stay = 6 days (range = 2 – 25) MEASURES & PROCEDURE Participants recruited on the unit by undergraduate research assistants. Participants receive a $10 Wal-Mart gift certificate for participating. At time of discharge, parents complete demographic questionnaire, the Child Behavior Checklist (CBCL), the Family Relationship Index (FRI), and a new consumer satisfaction measure, the Inpatient Parent Satisfaction Index (IPSI), created for this study. Child’s psychiatrist completes the Family Engagement Questionnaire (FEQ) Nine months after the child is discharged, parents contacted to assess child’s treatment outcome. CBCL and FRI are re-administered, and functional outcome (re-hospitalization, police contacts, compliance with aftercare plans) assessed. RESULTS Relations between Engagement and Satisfaction (Engagement rated by child’s psychiatrist, Satisfaction rated by parent) Total Engagement related to Total Satisfaction r =. 44, p =. 04 Perceived parent alliance is related to total satisfaction: r =. 43, p =. 04 Parent alliance is related to parent perception of staff empathy r =. 67, p =. 000 Parents perceived as hostile are less satisfied overall r = -. 55, p =. 01 Perceived child alliance is related to parent perceptions of treatment relevance r =. 37, p =. 09 Child Age Engagement Parent Satisfaction Older children are less hostile Parents of older children are less satisfied r = -. 44, p =. 02 r = -. 51, p =. 01 But parents of older children are more hostile r =. 33, p =. 09 Parent Education Level Engagement Parent Satisfaction Children of more educated parents are less hostile r = -. 56, p =. 01 But more educated parents are more hostile r = -40, p =. 06 Prior Child Inpatient Treatment Engagement Prior inpatient treatment predicts less engagement r = -. 41, p =. 05 More educated parents are less satisfied r = -. 40, p =. 06 Parent Satisfaction Prior inpatient treatment predicts less satisfaction r = -. 38, p =. 10 Satisfaction with prior treatment highly predicts current satisfaction r =. 81, p =. 01 CBCL Scores, Diagnosis, and Length of Stay Engagement Parent Satisfaction Externalizing CBCL related to child hostility r =. 46, p =. 04 PTSD diagnosis related to engagement r =. 45, p =. 07 Length of stay related to child hostility r =. 60, p =. 01 No relation to CBCL scores No relation to diagnosis No relation to length of stay DISCUSSION Revolving Door” concept supported Prior inpatient treatment predicts poorer engagement and poorer parent satisfaction Unexpected findings Older children are perceived as less hostile but their parents are perceived as more hostile and are less satisfied Children from higher SES families are perceived as less hostile but their parents are perceived as more hostile and are less satisfied Do more educated parents have higher initial expectations for their child’s inpatient stay? Diagnosis and behavior rating scale scores have little effect on staff perceptions of family engagement or on families’ satisfaction with treatment Children perceived as more hostile to staff have longer hospital stays