Abstract
This cross-sectional survey adopting a multiple-informant perspective explores the factors that influence perceived quality (i.e., therapeutic alliance and satisfaction) in an outpatient setting within child and adolescent mental health services (CAMHS). A total of 1433 participants (parents, n = 770, and patients, n = 663) attending or having attended (drop-out) outpatient units participated in the study. The outcome measures were satisfaction (Client Satisfaction Questionnaire) and the therapeutic alliance (Helping Alliance Questionnaire). The determinants of these quality indicators were socio-demographic variables (e.g., age, gender, and mother’s socio-economic status), factors related to the extent of difficulties (number of reasons for the consultation, number of people who referred the child to the CAMHS), the approach to treatment at outset (agreeing to the consultation, feeling reassured at the first appointment), the organizational friendliness (secretary, waiting room, waiting time for the first appointment) and the organization of the therapy (frequency of sessions, time for questions, change of therapist). The approach to treatment at outset, accessibility by phone, satisfaction with the frequency of the sessions and having enough time for questions were the factors that consistently explain the quality indicators from both perspectives (patients and parents). In contrast, the socio-demographic variables as well as the extent of difficulties and factors related to the organizational friendliness and the organization of the therapy (frequency of sessions, change of therapist) were not related to the quality indicators. This study identifies key determinants of the quality indicators from the perspective of patients and parents that should be considered to improve CAMHS care quality. First appointments should be carefully prepared, and clinicians should centre care on the needs and expectations of patients and parents.
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Fombonne E (2005) Epidemiology of psychiatric disorders paediatric psychiatry. EMC-Psychiatrie 2:169–194
Hofstra MB, van der Ende J, Verhulst FC (2002) Child and adolescent problems predict DSM-IV disorders in adulthood: a 14-year follow-up of a Dutch epidemiological sample. J Am Acad Child Adolesc Psychiatry 41:182–189
Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60:709–717
Jones AL, Cochran SD, Leibowitz A, Wells KB, Kominski G, Mays VM (2015) Usual primary care provider characteristics of a patient-centered medical home and mental health service use. J Gen Intern Med 30(12):1826–1836
Bonsack C, Holzer L, Stancu I, Baier V, Samitca M, Charbon Y, Koch N (2008) Psychiatric mobile teams for the three ages of live: the Lausanne experience. Rev Med suisse 4 (171):1960–1962, 1964–1966, 1968–1969
de Haan AM, Boon AE, de Jong JTVM, Hoeve M, Vermeiren RRJM (2013) A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clin Psychol Rev 33:698–711
McNicholas F (2012) To adhere or not, and what we can do to help. Eur Child Adolesc Psychiatry 21(12):657–663
Accurso EC, Garland AF (2015) Child, caregiver, and therapist perspectives on therapeutic alliance in usual care child psychotherapy. Psychol Assess 27(1):347–352
OMS (2000) Rapport sur la santé dans le monde 2000: pour un système de santé plus performant. Organisation mondiale de la santé, Genève
Athay MM, Bickman L (2012) Development and psychometric evaluation of the youth and caregiver service satisfaction scale. Adm Policy Ment Health 39(1–2):71–77
Norcross JC (2002) Psychotherapy relationships that work. Therapist contributions and responsiveness to patients. Oxford University Press, New York
Despland J-N, Zimmermann G, De Roten Y (2006) L’évaluation empirique des psychothérapies. Psychothérapies 26(2):91–95
Shirk SR, Karver M (2003) Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review. J Consult Clin Psychol 71(3):452–464
Horvath AO, Del Re AC, Flückiger C, Symonds D (2011) Alliance in individual psychotherapy. Psychotherapy 48(1):9–16
Kazdin AE, Whitley M, Marciano PL (2006) Child-therapist and parent-therapist alliance and therapeutic change in the treatment of children referred for oppositional, aggressive, and antisocial behavior. J Child Psychol Psychiatry 47(5):436–445
Kazdin AE, Durbin KA (2012) Predictors of child-therapist alliance in cognitive-behavioral treatment of children referred for oppositional and antisocial behavior. Psychotherapy 49(2):202–217
Marker CD, Comer JS, Abramova V, Kendall PC (2013) The reciprocal relationship between alliance and symptom improvement across the treatment of childhood anxiety. J Clin Child Adolesc Psychol 42(1):22–33
Shirk SR, Gudmundsen G, Kaplinski HC, McMakin DL (2008) Alliance and Outcome in cognitive-behavioral therapy for adolescent depression. J Clin Child Adolesc Psychol 37(3):631–639
Hawley KM, Garland AF (2008) Working alliance in adolescent outpatient therapy: youth, parent and therapist reports and associations with therapy outcomes. Child Youth Care Forum 37:59–74
Stüntzner-Gibson D, Koren PE, DeChillo N (1995) The youth satisfaction questionnaire: what kids think of services. Fam Soc 71:616–625
Shapiro JP, Welker CJ, Jacobson BJ (1997) The youth client satisfaction questionnaire: development, construct validation, and factor structure. J Clin Child Psychol 26(1):87–98
Garland AF, Aarons GA, Saltzman MD, Kruse MI (2000) Correlates of adolescents’ satisfaction with mental health services. Ment Health Serv Res 2(3):127–139
Barber AJ, Tischler VA, Healy E (2006) Consumer satisfaction and child behaviour problems in child and adolescent mental health services. J Child Health Care 10(1):9–21
Biering P (2010) Child and adolescent experience of and satisfaction with psychiatric care: a critical review of the research literature. J Psychiatr Ment Health Nurs 17(1):65–72
Buston K (2002) Adolescents with mental health problems: what do they say about health services? J Adolesc 25:231–242
Fitzpatrick R (1993) Scope and measurement of patient satisfaction. In: Fitzpatrick R, Hopkins A (eds) Measurement of patients’ satisfaction with their care. Royal College of Physicians, London, pp 1–17
Garland AF, Aarons GA, Hawley KM, Hough RL (2003) Relationship of youth satisfaction with mental health services and changes in symptoms and functioning. Psychiatr Serv 54(11):1544–1546
Garland AF, Haine RA, Boxmeyer CL (2007) Determinates of youth and parent satisfaction in usual care psychotherapy. Eval Program Plan 30(1):45–54
Godley SH, Fiedler EM, Funk RR (1998) Consumer satisfaction of parents and their children with child/adolescent mental health services. Eval Program Plan 21(1):31–45
Marriage K, Petrie J, Worling D (2001) Consumer satisfaction with an adolescent inpatient psychiatric unit. Can J Psychiatry 46(10):969–975
Achenbach TM, McConaughy SH, Howell CT (1987) Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull 101(2):213
Karver MS (2006) Determinants of multiple informant agreement on child and adolescent behavior. J Abnorm Child Psychol 34(2):242–253
Kapp C, Perlini T, Baggio S, Stefan P, Rojas Urrego A, Rengade CE, Macias M, Hainard N, Halfon O (2014) Qualités psychométriques du consumer satisfaction questionnaire (CSQ-8) et du helping alliance questionnaire (HAQ). Santé Publique 26(3):337–344
Kermarrec S, Kabuth B, Bursztejn C, Guillemin F (2006) French adaptation and validation of the helping alliance questionnaires for child, parents, and therapist. Can J Psychiatry 51:913–922
Sabourin S, Pérusse D, Gendreau P (1989) Les qualités psychométriques de la version canadienne-française du questionnaire de satisfaction du consommateur de services psychothérapeutiques. Rev Can Sci Comport 21(2):149–159
Attkisson CC, Greenfield TK (1994) Client satisfaction questionnaire-8 and service satisfaction scale-30. In: Maruish ME (ed) The use of psychological testing for treatment planning and outcome assessment. Laurence Erlbaum Associates, Hillsdale, pp 402–420
Ganzeboom HBG, Treiman DJ (1996) Internationally comparable measures of occupational status for the 1988 International Standard Classification of Occupations. Soc Sci Res 25:201–239
Perreault M, Rousseau M, Provencher H, Roberts S, Milton D (2012) Predictors of caregiver satisfaction with mental health services. Community Ment Health J 48:232–237
Heinonen E, Lindfords O, Härkänen T, Virtala E, Jääskeläinen T, Knekt P (2014) Therapist’s professional and personal characteristics as predictors of working alliance in short-term and long-term psychotherapies. Clin Psychol Psychother 21:475–494
Hart A, Saunders A, Thomas H (2005) Attuned practice: a service user study of specialist child and adolescent mental health, UK. Epidemiol Psichiatr Soc 14(1):22–31
Holmboe O, Iversen HH, Hanssen-Bauer K (2011) Determinants of parents’ experiences with outpatient child and adolescent mental health services. Int J Ment Health Syst 5:22
Biering P (2002) Caring for the involuntarily hospitalized adolescent: the issue of power in the nurse-patient relationship. J Child Adolesc Psychiatr Nurs 15(2):65–74
Starfield B (2011) Is patient-centered care the same as person-focused care? Perm J 15(2):63–69
Barry MJ, Edgman-Levitan S (2012) Shared decision making—the pinnacle of patient-centered care. N Engl J Med 366(9):780–781
McCabe MA (1996) Involving children and adolescents in medical decision making: developmental and clinical considerations. J Pediatr Psychol 21(4):505–516
Stevens SE, Hynan MT, Allen M (2000) A meta-analysis of common factor and specific treatment effects across the outcome domains of the phase model of psychotherapy. Clin Psychol Sci Pract 7(3):273–290
Feeley M, DeRubeis RJ, Gelfand L (1999) The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression. J Consult Clin Psychol 67:578–582
Karver MS, Handelsman JB, Fields S, Bickman L (2006) Meta-analysis of therapeutic relationship variables in youth and family therapy: the evidence for different relationship variables in the child and adolescent treatment outcome literature. Clin Psychol Rev 26(1):50–65
Acknowledgements
We thank the participating children, adolescents and parents, and the clinical staff for their implication in promoting this study, as well as the Department of Public Health of the Vaud state for co-funding this study. We wish also to express our gratitude to Stéphanie Habersaat, Nevena Dimitrova and Gregory Mantzouranis for their thoughtful comments on previous versions of the manuscript.
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Kapp, C., Perlini, T., Jeanneret, T. et al. Identifying the determinants of perceived quality in outpatient child and adolescent mental health services from the perspectives of parents and patients. Eur Child Adolesc Psychiatry 26, 1269–1277 (2017). https://doi.org/10.1007/s00787-017-0985-z
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DOI: https://doi.org/10.1007/s00787-017-0985-z