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

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