Measuring empowerment in client-run self-help agencies

Empowerment connotes a process of gaining control over one's life and influencing the organizational and societal structures in which one lives. This study defines and validates three measures: the Personal Empowerment Scale, the Organizational Empowerment Scale, and the Extra-Organizational Empowerment Scale.Measurement efforts are based on observational work, baseline interviews (N=310), and six month follow-ups (N=241) in four client-run self-help agencies (SHAs) for persons with severe mental disabilities. All three study scales demonstrated strong internal consistency and stability. They were sensitive to user changes over time and have construct validity.This research is supported by grants from the National Institute of Mental Health (#MH47487), the Zellerbach Family Fund, and the San Francisco Foundation.This paper was presented at the American Public Health Association's 121st Annual Meeting on October 24–28, 1993 in San Francisco, California.     

Job satisfaction in mental health agencies

Mental health professionals working in community agencies give much of themselves in aiding clients to live more productive and satisfying lives. Consideration should now be given to assist these mental health professionals in meeting their own job-related needs. Industrial and organizational job satisfaction literature is reviewed to aid mental health agencies in their efforts to express and act on a greater concern for the job satisfaction (work morale) of agency staff. It is encouraged that ways of maintaining or increasing job satisfaction be investigated.     

Community membership and social networks in mental health self-help agencies

This article explores community membership among self-help agency (SHA) participants. It is suggested that SHAs foster the enhancement of peer-oriented social networks, leading to the experience of shared community. Social network analysis was used to examine the structure of support mechanisms, and to assess levels of community membership through peer inclusion. Results indicate that both individual and organizational characteristics play roles in predicting peer presence in social networks. Organizational empowerment is a key factor, with the SHA emerging as a promising locus for peer support development through enhanced social networks. Implications for the organization of consumer-based services are discussed.     

Use of self-help services and consumer satisfaction with professional mental health services

This study tested the hypothesis that users of mental health self-help services would be more satisfied with professional mental health services than clients who did not use self-help services. A survey was administered to 311 clients of professional mental health services, 151 (49 percent) of whom were users of self-help services. A multiple regression model showed that the use of self-help services was associated with greater satisfaction with professional mental health services. This finding provides support for the idea that the use of self-help services encourages appropriate use of professional services. The study provided evidence that self-help and traditional mental health services can function complementarily rather than in competition with one another.     

Measuring client satisfaction with assertive community treatment

OBJECTIVE: A mailed survey was used to measure satisfaction of seriously mentally ill clients with services provided by an assertive community treatment team. METHODS: A detailed 35-item questionnaire was mailed in 1995 to all 174 clients of the Brockville (Ontario) Psychiatric Hospital's assertive community rehabilitation program. RESULTS: The rate of return was 51 percent. Compared with clients who did not return the survey, the respondent group had significantly fewer males and fewer clients with a diagnosis of schizophrenia; respondents had been associated with the program for less time. Factor analysis of the survey responses revealed three principal components accounting for 46 percent of the total variance in responses. The factors were interpersonal aspects of care, client involvement in treatment, and medication and treatment issues. Respondents were generally satisfied with service from the program, but they were dissatisfied with side effects of medication and the amount of medication they were taking. CONCLUSIONS: A mailed survey appears to be an efficient and nonintrusive way to collect satisfaction data anonymously from persons with serious mental illness who are clients of an assertive community treatment team. The results highlight areas of need that the team can address.     

Characteristics of new clients at self-help and community mental health agencies in geographic proximity

OBJECTIVE: Self-help agencies are funded as adjuncts of, referral sources for, or alternatives to community mental health agencies. Little is known about how these two types of organization in geographic proximity interact, whom they attract as prospective clients, and what their clients bring to the service situation. The authors compared the characteristics and past service use of new enrollees of self-help agencies and community mental health agencies serving the same geographic area. METHODS: Interview assessments were conducted with 673 new users at ten pairs of self-help and community mental health agencies serving the same geographic areas. Client characteristics were evaluated with multivariate analysis of variance and chi square tests. RESULTS: Clients of community mental health agencies had more acute symptoms, lower levels of social functioning, and more life stressors in the previous 30 days than clients of self-help agencies. The self-help agency cohort evidenced greater self-esteem, locus of control, and hope about the future. Clients of self-help agencies had received more services from facilities other than self-help or community mental health agencies in the previous six months, and clients of self-help agencies who were not African American had more long-term mental health service histories. CONCLUSIONS: Although self-help and community mental health agencies both provide services to people with major mental disorders, community mental health agencies deliver primarily acute treatment-focused services, whereas self-help agencies provide services aimed at fostering socialization, mutual support, empowerment, and autonomy.     

Factors in decisions to seek help from self-help and co-located community mental health agencies

This study examined 673 new users of co-located mental health self-help agencies run by consumers and community mental health agencies to evaluate the relative importance of predisposing, enabling, and need factors in site selection. Although need dominated help site choice, clients' attitudes toward the helpfulness of mental health treatment and their fears of coerced or inadequate care played an important role in setting choice, a choice indicative of a more complex motivational dynamic in help seeking.     

Measuring patient satisfaction following epilepsy surgery

Purpose: To systematically review primary research examining patient satisfaction with epilepsy surgery in order to obtain evidence‐based estimates of this surgical outcome; to assess methods used to measure epilepsy surgery satisfaction, overall epilepsy surgery satisfaction ratings, and predictors of epilepsy surgery satisfaction. Methods: Systematic review of published studies in English up to June 2009, focusing on patient satisfaction with all types of epilepsy surgery in patients of all ages. We excluded studies that focused on satisfaction with epilepsy treatment in general, on quality of life without specific exploration of patient satisfaction with surgery, and on satisfaction with the process of health care delivery, rather than with surgery and its outcomes. Key Findings: Eight studies met inclusion criteria. Satisfaction was assessed using one or more global questions. Four epilepsy surgery satisfaction question content patterns emerged: (1) satisfied or dissatisfied, (2) perceived success or failure, (3) overall positive or negative impact, and (4) willingness to repeat surgery or regretting surgery. Overall 71% were satisfied; 64% considered it a success; it had a positive effect for 78%; and 87% would repeat surgery. Seizure freedom was the most common predictor of epilepsy surgery satisfaction, whereas postoperative neurologic deficit predicted dissatisfaction. Significance: Patient satisfaction with interventions is an important aspect of patient‐centered care, but it has received little attention in epilepsy surgery. Future research is required to develop and validate epilepsy surgery satisfaction tools. We provide preliminary guiding principles for measuring satisfaction after epilepsy surgery.     

Measuring patient satisfaction with life in a long-stay psychiatric hospital

A survey of patient satisfaction with physical and social conditions was carried out in the long-stay wards of a large inner city psychiatric hospital in London, Britain. Patient satisfaction was assessed by means of an administered questionnaire which was developed specifically for this purpose. Factor analysis identified eight components of patient satisfaction. Of 143 eligible patients, 104 (73%) successfully completed the interview. Responses showed that patients were generally satisfied with life in the hospital, although levels of satisfaction varied significantly among wards. The factors causing greatest dissatisfaction related to failure to be treated as individuals and to feelings of isolation and apathy. Our findings showed that patients can express views about their conditions which should be useful in planning improvements in care. The questionnaire proved a simple and effective method of measuring satisfaction and may be useful to others concerned with improving the quality of the environment of patients.     

Measuring consumer satisfaction in a mental health center.

In this age of consumerism, the degree of patient satisfaction should be considered when evaluating mental health services, according to the authors. They attempted to measure consumer satisfaction of mental health center patients by correlating it with various demographic and therapeutic parameters such as length of treatment, age, socioeconomic status, and previous expectations. One surprising finding was that patients treated by the approach least popular with the therapists, extended intake, rated the services higher than those treated by approaches considered more acceptable.     

Measuring treatment outcome and client satisfaction among children and families

As the delivery and reimbursement methods for mental health services change rapidly, measuring treatment outcome and client satisfaction has become critical. This article describes a case example of a treatment outcome and client satisfaction assessment program at the Children's Health Council, a private nonprofit agency affiliated with Stanford University that provides comprehensive mental health services to children and families in Palo Alto, California. Approximately 300 families receive mental health treatment per year at the agency. The simple and inexpensive program presented herein can be used and modified by other mental health professionals and agencies struggling to develop satisfactory treatment outcome and client satisfaction evaluation programs.     

Consumer-operated self-help centers

Consumer-operated services (COS) are viewed as a legitimate alternative for mental health consumers living in the community. This article provides an overview of, outlines a consumer-operated self-help center model that has evolved in New Jersey, and illustrates how it has become a viable component of the mental health system. The goal is to inspire psychiatric rehabilitation practitioners to create COS alternatives as part of their state-run services transformation efforts.     

Measuring the consumer satisfaction of class members of a law suit

The present article describes a study of consumer satisfaction in a group of class members who are part of a mental disability law reform suit. Consumer satisfaction was considered one aspect of compliance with this lawsuit. The class members have a primary diagnosis of intellectual disability, and in most cases, a secondary diagnosis of mental illness. Conducting consumer satisfaction studies among people with intellectual disabilities is often challenging because some of these consumers have difficulty articulating their needs and concerns. An interview schedule with simple quantitative and qualitative satisfaction questions was used. The present study investigated the satisfaction of a subgroup of these class members prior to and after having a court-supported service plan. The results reveal that these consumers became considerably more satisfied, and many of their specific satisfactions and dissatisfaction were identified. The results suggest that both quantitative and qualitative consumer responses can be helpful in determining compliance with court issues.     

Being with feelings as a recognition practice: developing clients' self-understanding

TOPIC: How are shifts in clients' self-understanding related to focusing on feelings during therapy sessions? METHODS: A phenomenological study involving matched-pairs of clients and nurse-therapists using video-cued narrative reflection. FINDINGS: Feelings disclose significance within a therapy session. Dialogical relationships and involvements help clients experience the feelings they are discussing, obtain feedback from therapists, and develop self-understanding. CONCLUSIONS: Nurse educators should stress the importance of focusing on feelings in a session, and clinicians should practice this skill to facilitate a client's developing self-understanding.     

Pragmatic notes on community consultation with agencies

Some brief suggestions are offered on the implementation of consulting programs in mental health to community agencies, clinics, and schools. Although atheoretic in kind, these notes may help the beginning consultant to handle with some degree of skill what is currently a fashionable, chaotic, and dimly understood situation. Stress is laid upon the value to the consultant inherent in careful observations to make an explicit contract with defined and evaluated ends.     

Help-giving in self-help groups

A longitudinal survey of members of self-help groups for families of the mentally ill in Pittsburgh examined members' perceptions about the types of help-giving activities that took place in the groups and the relationship between those activities and members' degree of satisfaction with the group. The activities that occurred most frequently, such as catharsis, explanation, and normalization, were related to nondirective, nonthreatening aspects of social support. The least frequent activities, such as confrontation or reference to group norms, were those that were more threatening and focused on behavioral change. The nondirective, nonthreatening activities were moderately correlated with members' satisfaction with the group.