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Kansas Consumer Satisfaction Survey Children’s Mental Health: Statewide Report FY2009

Megan O’Brien, PhD, MPH, Project Manager Kathy Byrnes, MSW, Project Coordinator/Family Evaluator Susan Corrigan, PhD, Principal Investigator Lora Swartzendruber, MSW, Intern

May 2009 This project was supported through a contract with the Kansas Department of Social and Rehabilitation Services Disability and Behavioral Health Services (SRS-DBHS)

Office of Child Welfare and Children’s Mental Health Twente Hall ♦ 1545 Lilac Lane ♦ Lawrence, Kansas 66044-3184

Tel: (785) 864-4720 ♦ Fax: (785) 830-8026

Website: http://www.socwel.ku.edu/occ/

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TABLE OF CONTENTS

Executive Summary.......................................................................................................... iii Introduction ..................................................................................................................... 1

Purpose ............................................................................................................................ 1 Overview .......................................................................................................................... 2 Methods ........................................................................................................................... 3 Participation Rates ............................................................................................................ 3

Results from KFSS (Parent Survey) ................................................................................ 4 KFSS: Sociodemographic Characteristics ............................................................................. 4 KFSS: Receipt of Information ............................................................................................. 5 KFSS: Grievance Procedures .............................................................................................. 5 KFSS: Training of Staff ...................................................................................................... 5 KFSS: Summary Indicators of Performance ......................................................................... 6 Consumer Perception of Access - Convenience of Service .................................................... 6 Consumer Perception of Quality and Appropriateness .......................................................... 8 Consumer Perception of Cultural Competency and Responsiveness ...................................... 9 KFSS: Consumer Perception of Change ............................................................................ 10 KFSS: Medication Management ........................................................................................ 11 KFSS: Crisis Services ....................................................................................................... 12 Comparison of Services ................................................................................................... 14 Case Management .......................................................................................................... 14 Individual Therapy .......................................................................................................... 17 Attendant Care ............................................................................................................... 20 Respite Care ................................................................................................................... 23 Parent Support ............................................................................................................... 26 Psychosocial Group ......................................................................................................... 29 Wraparound Services ...................................................................................................... 32 Family Therapy ............................................................................................................... 35 In-Home Family Therapy ................................................................................................. 38 Group Therapy ............................................................................................................... 41

Statewide Summary of KFSS Qualitative Results ........................................................ 44 Results from KYSS (Youth Survey) ...................................................................................... 47

KYSS: Overall Satisfaction ............................................................................................... 48 KYSS Consumer Perception of Care Indicators .................................................................. 48 KYSS: Service Appointments ............................................................................................ 54

Overall Summary ............................................................................................................ 56 Conclusion ...................................................................................................................... 58

APPENDICES

Appendix A: Calculation of Participation Rates ...................................................................... 59 Appendix B. Survey Instruments ......................................................................................... 60

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CONSUMER SATISFACTION WITH CHILDREN’S MENTAL

HEALTH SERVICES: ROUND 12

Executive Summary

The Kansas Family Satisfaction Survey (KFSS) and the Kansas Youth Satisfaction Survey (KYSS), under the auspices of the Kansas Department of Social and Rehabilitation Services, are conducted annually to measure client satisfaction with children’s mental health services at all community mental health centers (CMHCs) in Kansas. Fiscal Year 2009 represents Round 12 of data collection.

The participation rate statewide for KFSS was 54.5% (compared to 49.4% for Round 11); for KYSS, the participation rate was 27.9% (compared to 25.7% for Round 11). Participation rates at the individual mental health centers ranged from 39.3% to 67.3% for KFSS participation and 10.8% to 54.8% for KYSS participation.

Overall, results from both the parent (KFSS) and youth (KYSS) surveys were positive and similar to those from Round 11. While the results varied by individual mental health center, overall statewide quantitative results for KFSS reflected general satisfaction in the following areas:

Receipt of information about services

Quality and appropriateness of services

Cultural competency and responsiveness of staff

Convenience of services

Management of medication services

Overall statewide quantitative results for KFSS reflected the potential for improvement in the following areas:

Training of staff to provide services

Grievance procedures

Crisis services

Qualitative comments organized by service are provided to each mental health center in an individual report. These comments should be used in conjunction with the quantitative results as a guide to judge performance. The qualitative comments reflect particularly well the value of the interpersonal relationship between parents, youth, and staff. The qualitative comments also support the quantitative findings and suggest that CMHCs may want to investigate flexibility in the scheduling of services to accommodate the needs of school children and working parents; employee turnover and reassignments; and treatment-related communication.

Generally, the results from the revised youth satisfaction survey were positive in terms of overall satisfaction with services, access to services, and cultural sensitivity of service staff.

The results presented here offer families and CMHC staff a framework within which past-year service performance can be evaluated. Enhancement to the surveys, methodology, and dissemination components is ongoing.

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A PDF version of this report is available by contacting Dr. Megan O’Brien, 785-830-8082, [email protected]; or accessing the following websites: www.kidstraining.org (restricted access); http://www.srskansas.org/hcp/MHSIP/MHSIPChildrensReports.htm or http://www.socwel.ku.edu/occ/viewProject.asp?ID=46 (open access).

mailto:[email protected]

http://www.kidstraining.org/

http://www.srskansas.org/hcp/MHSIP/MHSIPChildrensReports.htm

http://www.socwel.ku.edu/occ/viewProject.asp?ID=46

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CONSUMER SATISFACTION WITH CHILDREN’S MENTAL HEALTH SERVICES:

ROUND 12: STATEWIDE RESULTS

Introduction

Purpose

The Kansas Department of Social and Rehabilitation Services/Disability and Behavioral Health Services (formerly Health Care Policy) (SRS/DBHS) has adopted a philosophy of community-based, strengths-oriented, family-centered service that defines the delivery of mental health services to children and families. In this model, the client and family are seen as integral members of a team, actively participating in the development of goals and objectives and the selection of appropriate services. Taken even further, family members are seen as experts who can offer the insight and experiential details that lead to the identification of strengths and needs, accurate diagnoses, and effective services. This approach to service provision planning is facilitated through a wraparound model whereby parents have the option to invite other family members or caregivers, mental health center staff, significant others, school personnel, and members of the community to participate in the planning process as equal team members directing the provision of services. This individualized process seeks to coordinate mental health services with other community services and resources to develop the most comprehensive and realistic plan possible.1,2

A wide range of supportive and therapeutic services are provided to children and families. Among the array of services offered are attendant care, case management, crisis stabilization, family therapy, home-based family therapy, individual therapy, medication management, parent support, psychosocial groups, respite care, and wraparound meetings. Standards for quality mental health care in Kansas are defined, in part, as providing convenient and timely access to services, providing a full range of services, and providing them in a culturally competent and responsive manner.2,3

It is vital to the continued growth and improvement of children’s mental health services to seek the opinions and suggestions of the youth who receive the services as well as those of their parents and caregivers who navigate the system on their behalf. The Kansas Family Satisfaction Survey (KFSS) and the Kansas Youth Satisfaction Survey (KYSS) were developed to gather this feedback from youth and parents. In 1996, the Kansas SRS/DBHS, in response to a legislative request, contracted with the University of Kansas School of Social Welfare for the development of a survey instrument. The purpose of developing this instrument was to measure client satisfaction with children’s mental health services at all community mental health centers

1 Barfield, S.T., Chamberlain, R., & Corrigan, S.K. (2005). Community-Based Services. Mental Health Programs for Kansas Children and Families: Wraparound Fidelity and Quality of Care. Lawrence, KS: University of Kansas School of Social Welfare. 2 Stroul, B. A., & Friedman, R. M. (1986). A system of care for severely emotionally disturbed children and youth. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center. 3 U.S. Department of Health and Human Services - Substance Abuse and Mental Health Services

Administration (SAMSHA). (1996, April). The MHSIP consumer-oriented mental health report card. Retrieved September 25, 2006, from http://mentalhealth.samhsa.gov

http://mentalhealth.samhsa.gov/

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(CMHCs) in Kansas. Providing the feedback to the mental health centers annually would allow them to celebrate their strengths and offer them an opportunity to respond to criticisms and engage in quality improvement activities.

The reader should be aware that the Kansas Public Mental Health System responsible for delivering the services of which client satisfaction is measured underwent a significant change on July 1, 2007. At that time, the system was converted from that of a fee-for-service model to a managed care entity. SRS/DBHS contracted management of the new Prepaid Ambulatory Health Plan (PAHP) with Kansas Health Solutions, a corporation sponsored by the CMHCs. Also as of that date, Medicaid reimbursement for delivery of a portion of services was opened to mental health practitioners beyond those employed by CMHCs in an effort to enhance consumer choice and service access. Round 12 data represent the first complete year under the new system. On KFSS and KYSS items, we do not make a distinction between services provided by a CMHC staff or those delivered by another practitioner.

Overview

Project Management

The Consumer Satisfaction Survey: Children’s Mental Health project is overseen by an Advisory Committee comprised of members representing parents, CMHC Executive Directors, Community Based Services (CBS) Directors, SRS Mental Health Lead Quality Assurance Staff, CMHC Parent Support Providers, SRS Central Office staff, and KU. The committee meets on a quarterly or as-needed basis. Day-to-day operations of the project are overseen by Drs. O’Brien and Corrigan from the University of Kansas School of Social Welfare. The subcontractor for data collection is the University of Kansas Institute for Policy and Social Research Survey Research Center (ISPR), directed by Don Haider-Markel, Ph.D.

Data Collection and Dissemination Data are collected from each of the 26 Community Mental Health Centers (CMHCs) that serve youth and families once each year.4 Each CMHC receives an individual center report as well as a report of statewide results. At the request of SRS/DBHS, CMHCs reply in writing to SRS/DBHS regarding plans to address areas for improvement. The current round of data collection (Round 12) took place during FY2009. Data collection began in September 2008 and concluded in April 2009. The current report is the final report which presents statewide data in comparison to individual CMHC results for selected variables.

All data were collected by ISPR. ISPR exists to conduct local, state, national, and international survey research. Additional information about the subcontractor can be found at http://www.ipsr.ku.edu/srvylab/.

Dissemination of the survey results to the widest audience possible remains a top priority. To meet this goal, PDF versions of the statewide reports for each round are available on the kidstraining.org, SRS, and KU websites. The links are www.kidstraining.org (restricted access), http://www.srskansas.org/hcp/MHSIP/MHSIPChildrensReports.htm, and http://www.socwel.ku.edu/occ/viewProject.asp?ID=46 (open access). All individual center

4 Sunflower Center closed in September 2007. Franklin County absorbed these clients and was renamed Elizabeth Layton Center.

http://www.ipsr.ku.edu/srvylab/

http://www.kidstraining.org/

http://www.srskansas.org/hcp/MHSIP/MHSIPChildrensReports.htm

http://www.socwel.ku.edu/occ/viewProject.asp?ID=46

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reports for Round 12 were sent out electronically in PDF format to the Executive Directors, Children’s Directors, and Mental Health Field Staff for each center. This allows each mental health center to easily email the report to constituents and colleagues and to post the report on their respective websites, if desired.

Methods

Procedure The population for this survey included youth ages 12 and older and their parents as well as parents of youth from all ages whose services are funded by Medicaid and who were currently or recently had been receiving services from a Medicaid provider (predominantly CMHC affiliates). The goal of data collection was to obtain a census or convenience sample (i.e., survey the entire population from the Medicaid database) rather than a random sample.

The total Medicaid population increased substantially from 6562 in Round 11 to 7581 in Round 12. In August 2008, the Medicaid billing records for youth receiving case management were accessed for the preceding six months. A pre-survey mailing was sent to the parents or guardians of all youth listed in the Medicaid database. Documents in the mailing described the survey and consent procedures. A minimum of 12 attempts were made to contact consumers first by telephone; those who could not be reached by telephone or who had expressed a preference for mailed surveys were sent a mail survey. Surveys were collected for a six to eight week period after they were mailed. KYSS surveys were conducted only with those youth who were 12 years of age or older. The entire data collection period took approximately eight months.

Participation Rates

Table 1 displays KFSS and KYSS participation rates statewide and by individual mental health center. Statewide, 7581 children met the inclusion criteria of having at least one session of case management that occurred during the previous six months. This six-month time period was chosen to eliminate overlap between one round of data collection and the next.

The participation rate statewide for KFSS was 54.5% (compared to 49.4% for Round 11); for KYSS, the participation rate was 27.9% (compared to 25.7% for Round 11). The variance in participation rates across centers for KFSS ranged from 39.3% to 67.3% and 17.2% to 54.8% for KYSS. The majority of the youth in the Medicaid database (52.9%) were 12 years of age or older and thus eligible to participate in KYSS. Details about the calculation of participation rates are provided in Appendix A.

CMHCs with fewer than five participants and a participation rate less than 15% did not receive individual reports because the small sample size would compromise the confidentiality and representativeness of the sample. All mental health centers met the criteria for inclusion for KFSS reporting. For KYSS, five mental health centers did not meet the inclusion criteria and, therefore, did not receive an individual report.

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Table 1. KFSS and KYSS Participation Rates Statewide and by CMHC KFSS

Original

N*

Eligible

Contacts

Completed

Surveys

%

Participation

KYSS Original

N**

Eligible

Contacts

Completed

Surveys

%

Participation

Statewide 7581 3177 1730 54.5 4131 1688 471 27.9

Area 367 149 82 55.0 194 74 23 31.1

Bert Nash 124 58 34 58.6 84 39 12 30.8

Center for C&C 200 58 35 60.3 121 31 17 54.8

Central 199 65 39 60.0 111 30 7 23.3

Cowley 255 73 43 58.9 132 33 11 33.3

Crawford 198 68 31 45.6 67 19 7 36.8

East Central KS 318 151 86 57.0 192 85 25 29.4

Family Life 133 56 22 39.3 70 29 5 17.2

Family Services 532 239 121 50.6 299 132 28 21.2

Four County 320 130 86 66.2 139 54 18 33.3

Elizabeth Layton 194 81 38 46.9 98 36 8 22.2

Guidance Ctr. 307 147 78 53.1 134 69 17 24.6

High Plains 180 77 39 50.6 105 48 11 22.9

Horizons 360 152 84 55.3 178 75 23 30.7

Iroquois 50 17 10 58.8 26 13 4 30.8

Johnson 380 229 137 59.8 201 123 33 26.8

Kanza 53 23 11 47.8 32 12 4 33.3

Labette 103 35 19 54.3 64 22 4 18.2

Pawnee 527 208 111 53.4 294 119 36 30.3

Prairie View 356 170 91 53.5 172 81 22 27.2

Sedgwick 1025 467 249 53.3 652 290 81 27.6

South Central 156 52 35 67.3 85 26 9 34.6

Southeast 270 113 66 58.4 127 54 23 42.6

Southwest 39 14 9 64.3 25 5 2 40.0

Sumner 117 40 26 65.0 51 15 3 20.0

Wyandot 818 305 148 48.5 478 176 39 22.2

*KFSS Original N is the number of youth names received from Medicaid.

** KYSS Original N is the number of youth age 12 and older.

Results from KFSS (Parent Survey)

KFSS: Sociodemographic Characteristics

Table 2 displays sociodemographic information for KFSS participants. Of the 1730 children represented in the completed KFSS (parent) surveys, age ranged from 5 to 19 with a mean age of 15.1 years (SD=2.0). Parents/caregivers of boys comprised more than two-thirds (68%, n=1182) of the group surveyed. The majority of children (84%, n=1,448) self-identified as White, with 11.5% (n=198) identified as African-American, 3.9 % (n=67) as Hispanic, 4.9% (n=85) as Asian, Native American, or Unspecified.

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Table 2. Sociodemographic Characteristics

The KFSS was completed mainly by women with 66.2% (n=1136) of the respondents being the children's mothers. Fathers completed the survey at a rate of 10.1% (n=173) and grandparents at the rate of 11.4% (n=195). Step-parents completed 2.1% (n=36). The “Other” category, which included other relatives, foster parents, adoptive parents, and legal guardians, comprised 10.2% (n=175) of respondents. These values are roughly equivalent to those from Round 11. Nearly half of participants reported about a child who received services under the SED waiver at some point during the data collection period (48.5%, n=839). KFSS: Receipt of Information

Most (88.5%) of respondents agreed that staff provide information necessary to make informed decisions about treatment. Statewide, 81.6% of respondents reported that someone from the CMHC had told or given them information about the different services available for their child and family. Similarly, most (88.4%) of respondents statewide reported that staff makes sure they understand the family understands their rights.

KFSS: Grievance Procedures Seventy-five percent (75.6%) of respondents reported that someone from the CMHC had told them whom to call if they had a problem with services, up from 70.7% last year Two-thirds (65.9%) of respondents indicated that someone from the CMHC had told them how to make a complaint if they wanted to, a rate slightly higher than last year’s (62.6%).

KFSS: Training of Staff

Statewide, 62.7% of respondents believed the CMHC staff were very well trained to provide services. Slightly more than one-fourth (29.3%) believed the level of CMHC training to be only “average.” Fewer than 3.5% statewide thought the CMHC staff were “not well trained at all.”

KFSS

N = 1730

n %

Sex of Child*

Male

Female

1182

548

68.3

31.7

Race/Ethnicity*

White

African-American

Hispanic

Asian/Native American/Other

1448

198

69

85

83.7

11.5

3.9

4.9

Relationship to Child

Mother

Father

Step-parent

Grandparent

Other

1136

173

36

195

175

66.2

10.1

2.1

11.4

10.2

Waiver Status*

Yes or both

Non-Waiver

*Obtained from Medicaid data.

839

891

48.5

51.5

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KFSS: Summary Indicators of Performance

The first 22 items of the KFSS instrument are designed to measure satisfaction across the array of CMHC surveys. Interpretation of this many individual items can often be cumbersome and inefficient. Organizing survey item responses into groups is advantageous because it allows for more concise, yet still thorough, presentation of the results. We utilized a rational-empirical approach, taking into consideration theoretical and statistical information about which items should be grouped together. Answers to the KFSS survey items were organized into scales based on guidelines from the MHSIP Mental Health Report Card. A scale can be thought of as a group of items that each measure or “tap into” the same domain. Four scales were indicated: 1) Convenience of Services, 2) Full Range of Service Options, 3) Quality and Appropriateness, and 4) Cultural Competency and Responsiveness. Centers interested in their scores on individual items that make up each scale can consult their individual reports.

Data are displayed in Figures 1 through 4 to allow the reader to compare the score of an individual CMHC to that of Kansas overall on each satisfaction scale. One measure of performance may be whether an individual CMHC score is greater than the statewide score. We also offer a cutoff score which may be considered indicative of a positive response. However, individual CMHCs may choose to set the standard somewhat higher or lower than these criteria.

Consumer Perception of Access - Convenience of Service

Convenience of Services is one of two scales that comprise the MHSIP-defined Consumer Perception of Access domain. The six items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .856. Each item is measured on a 5-point scale where 1 equals None of the Time and 5 equals All of the Time. The scale is a sum of the scores for each item with 30 being the highest possible score and indicating most satisfaction. A cutoff of 21 was chosen as indicative of reporting positively about convenience of services. A score of 21 would occur when individuals gave at least a 4 (Most of the Time) to three of the six items and at least a 3 (Some of the Time) to the other three items. The following six items are included in the Convenience of Service scale:

Scale 1. Convenience of Services

a. How often do you feel your child and your family are able to get the services needed from your center?

b. How often do you feel your child and your family are able to get the services in a timely manner when you need them?

c. How often are the services your child and your family receive scheduled at a reasonable location?

d. How often are the services for your child and your family scheduled at a reasonable time of day?

e. Does your child and your family receive the services as often as planned based on the plan of care or treatment goals?

f. During times when workers or services changed, did you feel like your family had continuing, consistent care?

The average score statewide for Convenience of Services was 25.6 and is represented by the diamond studded line (Figure 1). Most respondents (86.5%) statewide gave scores of 21 or higher for this scale. All of the individual CMHCs achieved scores of 21 or higher.

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Figure 1. Consumer Perception of Access: Convenience of Services

Full Range of Service Options

Full Range of Service Options is the second of two scales comprising the MHSIP-defined Consumer Perception of Access domain. The five items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .926. Each item is measured on a 5-point scale where 1 equals None of the Time and 5 equals All of the Time. The scale is a sum of the scores for each item with 25 being the highest possible score and indicating most satisfaction. A cutoff of 18 was chosen as indicative of reporting positively about range of service options. A score of 18 would occur when individuals gave at least a 4 (Most of the Time) to three of the five items and at least a 3 (Some of the Time) to the other two items. The following five items are included in the Full Range of Service Options scale:

Scale 2. Full Range of Service Options

a. The staff helps your family get services from other agencies or programs in the community.

b. If hospitalization or out-of-home placement was discussed, other community-based options were presented to you.

c. The staff assists you in learning ways to improve your child's ability to function in a community setting.*

d. If your child has another major challenge such as substance abuse or a developmental disability, the staff works with you to get services for those other issues.

e. The staff helps you get support from informal sources such as your family, friends, and community.

*Changed from Round 9 question which read “The staff helps you do regular activities with your child such as going to the store or visiting friends.”

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CMHC Statewide

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The average score statewide for Full Range of Service Options was 20.4 and is represented by the diamond studded line (Figure 2). Most (88.5%) of respondents statewide gave scores of 18 or higher for this scale.

Figure 2. Full Range of Service Options

Consumer Perception of Quality and Appropriateness

The five items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .90. Each item is measured on a 5-point scale where 1 equals None of the Time and 5 equals All of the Time. The scale is a sum of the scores for each item with 25 being the highest possible score and indicating most satisfaction. A cutoff of 18 was chosen as indicative of reporting positively about access. A score of 18 would occur when individuals gave at least a 4 (Most of the Time) to three of the five items and at least a 3 (Some of the Time) to the other two items.

Scale 3. Quality and Appropriateness

a. The staff tries to help your family meet your needs as you see them.

b. The staff points out what your child and family does well.

c. The members of your child’s treatment team build services around your child’s strengths.

d. When needed, the staff involves your child in making decisions about the treatment plan and services.

e. When needed, the staff offers to adjust services if they do not seem to be working for your family.

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The average score statewide for Quality and Appropriateness was 21.4 and is represented by the diamond studded line. Most (96.2%) of respondents statewide gave scores of 18 or higher for this scale.

Figure 3. Quality and Appropriateness

Consumer Perception of Cultural Competency and Responsiveness

The six items that make up this scale have good high internal consistency as indicated by a Chronbach’s alpha value equal to .865. Each item is measured on a 5-point scale where 1 equals None of the Time and 5 equals All of the Time. The scale is a sum of the scores for each item with 30 being the highest possible score and indicating most satisfaction. A cutoff of 21 was chosen as indicative of reporting positively about access. A score of 21 would occur when individuals gave at least a 4 (Most of the Time) to three of the six items and at least a 3 (Some of the Time) to the other three items.

Scale 4. Cultural Competency and Responsiveness

a. Services were provided in ways that were sensitive to your child and your family’s cultural/ethnic background.

b. The members of your child’s treatment team respect and honor your family’s beliefs and traditions.

c. You feel you have a say if your child is ready to exit services.

d. The staff encourages you to speak up during meetings with professionals when there is something you want to say.

e. The staff communicates and provides information to you in a way that you can understand.

f. The staff makes sure you understand your family’s rights.

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Figure 4. Consumer Perception of Cultural Competency and Responsiveness

The average score statewide for Cultural Competency and Responsiveness was 27.5 (up from 22.7 last year) and is represented by the diamond studded line. All but twelve CMHCs scored higher than the statewide average. Almost all (93.2%) of respondents statewide gave scores of 21 or higher for this scale.

KFSS: Consumer Perception of Change Consumer Perception of Change is an indicator of perceived outcomes. In the KFSS survey, this was measured with a single item rather than a summary scale score. Each respondent was asked: “Thinking back to the reasons that brought your child to this center for services, about how much do you think he or she has improved overall?” 5

The pie chart below displays the results for Round 12. One-half of parents felt their child was a lot better (49.8%) and just over one-third felt their child was a little better (37.1%). Only 8.4% felt there had been no change, and 4.7% believed their child’s condition had worsened.

5 Gerkensmeyer, J.E. and Austin, J.K. (2005). Development and testing of a scale measuring parent satisfaction with staff interactions. Journal of Behavioral Health Services & Research, 32(1), 61-73.

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Figure 5. Outcomes: Perception of Change Statewide

KFSS: Medication Management

Of the respondents who reported their child takes medications prescribed by a doctor/nurse at the CMHC, 83.7% reported feeling satisfied or very satisfied with the medication management services (Figure 6).

The majority (92.4%) indicated that all or most of the time, this doctor/nurse explained why their child should take the medications; 93.1% indicated that all or some of the time, this doctor/nurse asked about how the medications are working for the child; 88.4% felt included as a partner in decisions about their child’s medication management all or some of the time; and 82.8% reported that the nurse/doctor explained what the side effects might be all or some of the time.

A lot worse2.1%

A little worse2.6%

No change8.4%

A little better37.1%

A lot better49.8%

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Figure 6. Medication Management Services: Overall Satisfaction

KFSS: Crisis Services

Parents are generally satisfied with crisis services provided by the CMHCs. Statewide, 68.0% reporting feeling satisfied or very satisfied (Figure 7). CMHCs not represented with a bar indicates insufficient data.

Over two-thirds of parents 73.4% reported having a crisis plan. Of those who did have a crisis plan, 95.5% felt they were included as a partner in the decision making about the plan.

Fewer than one half (40.9%) reported having a crisis in the past year where they used the mental health center, but over three quarters of these individuals (73.3%) felt their needs were met when their family had a crisis.

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Overall, how satisfied would you say you have been with the Medication Management services provided by this mental health center?

CMHC Statewide

How do you define crisis for this survey?

“A crisis is when the parent feels the child is a danger to himself or others and the parent seeks immediate assistance and calls the Mental Health Center.”

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Figure 7. Crisis Services: Overall Satisfaction

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CMHC Statewide

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Comparison of Services

The following figures provide a comparison across mental health centers and services on five questions pertinent to all services provided by a community mental health center. Examination of Figures 8 through 58 allows the reader to compare results across CMHCs and to the statewide value for each question. CMHCs not represented with a bar indicates insufficient data. The service “Independent Living” was omitted due to insufficient data across all CMHCs.

Case Management

78.8% of parents statewide reported being satisfied or very satisfied with Case Management services (individual CMHCs range 60.0% to 95.0%) (Figure 8).

94.9% of parents statewide reported having been told the reason for this service (CMHCs range from 83.3% to 100.0%) (Figure 9).

89.0% of participating parents statewide reported that Case Management was a helpful service (CMHCs range 76.9% to 100.0%) (Figure 10).

Feedback from Case Managers was received by 87.0% of parents statewide (CMHCs range 69.2% to 100.0%) (Figure 11).

Finally, 92.5% of parents felt they were treated as a partner when it came to decision making (CMHCs range 72.7% to 100.0%) (Figure 12).

Figure 8. Case Management: Overall Satisfaction

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Figure 9. Case Management: Informed of Reason for Service

Figure 10. Case Management: Helpful Service

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Figure 11. Case Management: Received Feedback

Figure 12. Case Management: Treated Like a Partner

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Individual Therapy

Of those receiving Individual Therapy:

78.5% of parents reported being satisfied or very satisfied with Individual Therapy services (individual CMHCs range 62.5% to 94.4%) (Figure 14).

94.1% of parents reported having been told the reason for this service (CMHCs range 77.8% to 100.0%) (Figure 15).

86.7% of parents statewide reported that Individual Therapy was a helpful service (CMHCs range 71.0% to 100.0%) (Figure 16).

Feedback was received by 87.0% of parents/caregivers statewide (CMHCs range 75.0% to 100.0%) (Figure 17).

89.6% of parents felt they were treated as a partner when it came to decision making (CMHCs range 77.8% to 100.0%) (Figure 18).

Figure 14. Individual Therapy: Overall Satisfaction

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Figure 15. Individual Therapy: Informed of Reason for Service

Figure 16. Individual Therapy: Helpful Service

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Figure 17. Individual Therapy: Received Feedback

Figure 18. Individual Therapy: Treated Like a Partner

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Attendant Care

Of those receiving Attendant Care:

75.7% of parents reported being satisfied or very satisfied with Attendant Care services (individual CMHCs range 55.0% to 100.0%) (Figure 19).

95.6% of parents reported having been told the reason for this service (CMHCs range from 80.0% to 100.0%) (Figure 20).

87.8% of parents statewide reported that Attendant Care was a helpful service (CMHCs range 72.7% to 100.0%) (Figure 21).

Feedback was received by 85.3% of parents statewide (CMHCs range 68.8% to 100.0%) (Figure 22).


Figure 19. Attendant Care: Overall Satisfaction

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Figure 20. Attendant Care: Informed of Reason for Service

Figure 21. Attendant Care: Helpful Service

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Figure 22. Attendant Care: Received Feedback

Figure 23. Attendant Care: Treated Like a Partner

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Respite Care

Of those receiving Respite Care:

75.8% of parents reported being satisfied or very satisfied with Respite Care services (individual CMHCs range 58.3% to 100.0%) (Figure 24).


88.2% of parents statewide reported that Respite Care was a helpful service (CMHCs range 66.7% to 100.0%) (Figure 26).



Figure 24. Respite Care: Overall Satisfaction

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Figure 25. Respite Care: Informed of Reason for Service

Figure 26. Respite Care: Helpful Service

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Figure 27. Respite Care: Received Feedback

Figure 28. Respite Care: Treated Like a Partner

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Parent Support

Of those receiving Parent Support Services:

84.8% of parents reported being satisfied or very satisfied with Parent Support services (individual CMHCs range 53.3% to 100.0%) (Figure 29).


92.1% of parents statewide reported that Parent Support was a helpful service (CMHCs range 66.7% to 100.0%) (Figure 31).



Figure 29. Parent Support Services: Overall Satisfaction

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Figure 30. Parent Support Services: Informed of Reason for Service

Figure 31. Parent Support Services: Helpful Service

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Figure 32. Parent Support Services: Received Feedback

Figure 33. Parent Support Services: Treated Like a Partner

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Psychosocial Group

Of those included in a Psychosocial Group:

74.8% of parents reported being satisfied or very satisfied with Psychosocial Group services (individual CMHCs range 46.2% to 100.0%) (Figure 34).


88.8% of parents statewide reported that Psychosocial Group was a helpful service (CMHCs range 60.0 to 100.0%) (Figure 36).



Figure 34. Psychosocial Groups: Overall Satisfaction

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Figure 35. Psychosocial Groups: Informed of Reason for Service

Figure 36. Psychosocial Groups: Helpful Service

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Figure 37. Psychosocial Groups: Received Feedback

Figure 38. Psychosocial Groups: Treated Like a Partner

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Wraparound Services

Of those receiving Wraparound Services:

78.2% of parents reported being satisfied or very satisfied with Wraparound Services (individual CMHCs range 60.0% to 100.0%) (Figure 39).


89.0% of parents statewide reported that Wraparound Services are helpful (CMHCs range 60.0% to 100.0%) (Figure 41).



Figure 39. Wraparound Facilitation: Overall Satisfaction

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Figure 40. Wraparound Facilitation: Informed of Reason for Service

Figure 41. Wraparound Facilitation: Helpful Service

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Figure 42. Wraparound Facilitation: Received Feedback

Figure 43. Wraparound Facilitation: Treated Like a partner

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Family Therapy

Of those receiving Family Therapy:

82.9% of parents reported being satisfied or very satisfied with Family Therapy services (individual CMHCs range 66.7% to 100.0%) (Figure 44).


91.2% of parents statewide reported that Family Therapy was a helpful service (CMHCs range 60.0% to 100.0%) (Figure 46).



Figure 44. Family Therapy: Overall Satisfaction

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Figure 45. Family Therapy: Informed of Reason for Service

Figure 46. Family Therapy: Helpful Service

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Figure 47. Family Therapy: Received Feedback

Figure 48. Family Therapy: Treated Like a Partner

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In-Home Family Therapy

Of those receiving In-Home Family Therapy:

89.6% of parents reported being satisfied or very satisfied with In-Home Family Therapy services (individual CMHCs range 71.4% to 100.0%) (Figure 49).


94.4% of parents statewide reported that In-Home Family Therapy was a helpful service (CMHCs range 83.3% to 100.0%) (Figure 51).



Figure 49. In-Home Family Therapy: Overall Satisfaction

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Figure 50. In-Home Family Therapy: Informed of Reason for Service

Figure 51. In-Home Family Therapy: Helpful Services

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Figure 52. In-Home Family Therapy: Feedback

Figure 53. In-Home Family Therapy: Treated Like a Partner

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Group Therapy

Of those receiving Group Therapy:

81.2% of parents reported being satisfied or very satisfied with Group Therapy services (individual CMHCs range 68.8% to 100.0%) (Figure 54).


89.0% of parents statewide reported that Group Therapy was a helpful service (CMHCs range 80.0% to 100.0%) (Figure 56).


84.4% of parents felt they were treated as a partner when it came to decision making (CMHC range 66.7% to 100.0%) (Figure 58).

Figure 54. Group Therapy: Overall Satisfaction

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Figure 55. Group Therapy: Informed of Reason for Service

Figure 56. Group Therapy: Helpful Service

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Figure 57. Group Therapy: Received Feedback

Figure 58. Group Therapy: Treated Like a Partner

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Statewide Summary of KFSS Qualitative Results

For each of the 13 services, parents were asked “Is there anything else you would like to say about [service]?” The answers were stripped of identifying information; organized by service; and coded into the categories of Service Delivery (staff related, service related, effectiveness), Access (scheduling, workload, turnover), and Communication and Information (treatment related communication and information about specific services) (see sidebar).

With their individual preliminary reports, each CMHC received a complete record of all de-identified comments. However, to conserve space, only a sample of comments is presented in this final report. When interpreting the qualitative data, one should keep in mind that, for any given service, only about one-half of participants chose to provide additional comments. Research also indicates that not responding to open-ended questions does not always indicate satisfaction and negative comments don’t necessarily indicate dissatisfaction. In the latter situation, the respondents could be satisfied but also could be trying to be specific and helpful.3

The reader can use the values displayed in Table 4 in combination with the sample of quotes beginning on page 54 to gain a full sense of the qualitative data. Looking at Table 4, the reader can see, by column, the percentage of the Service Delivery comments that were positive or negative; the percentage of the Access comments that were positive or negative; and the percentage of the Communication and Information comments that were positive or negative. Neutral comments are indicated in the column labeled “+/-“. Overall, CMHC services received an equal number of positive and negative comments although Medication Management, Individual Therapy, Attendant Care, Respite Care, and Crisis received a larger proportion of negative comments. Parent Support and Group Therapy received the greatest proportion of positive comments.

To get a better sense of the comments received for each service, the reader should examine Tables 4a-4c, row by row. For example, the first row of Table 4a reveals that comments related to effectiveness of crisis services were largely positive but comments related to Scheduling (Table 4b) were mostly negative. Centers interested in additional details should refer to their individual reports.

Definitions for Qualitative Data Categories Service Delivery: -Staff related: Person(s) providing the service. -Service related: Service in general. -Effectiveness: Helpfulness or effectiveness of the service. Access: -Scheduling: Issues with timing and location of appointments. -Workload: Effect of workload on staff ability to meet child/family needs. -Turnover: Changes in staff. Communication and Information: -Treatment related communication: Staff sharing information about treatment with the parents. -Information about specific services: Knowledge of service options and availability.

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Table 4a. Qualitative Codings. Percents within each category Category Staff Service Effectiveness

+/- + - +/- + - +/- + -

Service

Crisis 0.0 38.5 61.5 6.0 25.0 69.0 2.7 61.6 35.6

Medication Mgmt. 12.2 65.3 22.4 17.6 17.6 64.7 20.7 52.9 26.4

Case Management 20.0 60.0 20.0 14.2 59.0 26.9 0.0 85.2 14.8

Individual Therapy 17.9 57.1 25.0 16.7 28.3 55.0 7.4 61.7 30.9

Attendant Care 14.7 47.1 38.2 7.3 31.7 61.0 11.8 73.5 14.7

Respite Care 0.0 83.3 16.7 18.2 15.2 66.7 13.3 66.7 20.0

Parent Support 7.7 64.1 28.2 11.6 48.8 39.5 8.3 76.7 15.0

Psychosocial Group 0.0 37.5 62.5 9.2 40.2 50.6 2.3 88.6 9.1

Wraparound Services 12.5 37.5 50.0 8.0 28.0 64.0 2.7 59.5 37.8

Family Therapy 7.7 69.2 23.1 19.0 28.6 52.4 4.8 81.0 14.3

In-Home Fam. Ther. 0.0 100.0 0.0 8.3 66.7 25.0 0.0 80.0 20.0

Group Therapy 0.0 0.0 0.0 29.4 35.3 35.3 8.3 75.0 16.7

Independent Living * * * * * * * * *

Table 4b. Qualitative Codings. Percents within each category Category Scheduling Workload Turnover

+/- + - +/- + - +/- + -

Services

Crisis 2.9 14.7 82.4 0.0 0.0 100.0 0.0 0.0 100.0

Medication Mgmt. 9.1 18.2 72.7 0.0 0.0 100.0 50.0 0.0 50.0

Case Management 0.0 6.7 93.3 25.0 25.0 50.0 5.7 0.0 94.3


Attendant Care 17.6 0.0 82.4 7.7 7.7 84.6 3.4 3.4 93.1

Respite Care 0.0 0.0 100.0 16.7 0.0 83.3 0.0 0.0 100.0

Parent Support 7.7 0.0 92.3 33.3 0.0 66.7 50.0 0.0 50.0



Family Therapy 0.0 0.0 100.0 0.0 0.0 100.0 0.0 0.0 100.0

In-Home Fam. Ther. 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 100.0

Group Therapy 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0


Table 4c. Qualitative Codings. Percents within each category

Category Information from

Staff Information

about Services

Information about Specific

Services

+/- + - +/- + - +/- + -

Services

Crisis 25.0 0.0 75.0 0.0 0.0 100.0 0.0 0.0 100.0

Medication Mgmt. 8.8 41.2 50.0 25.0 25.0 50.0 0.0 0.0 100.0

Case Management 9.1 21.2 69.7 0.0 0.0 0.0 0.0 0.0 0.0


Attendant Care 15.0 10.0 75.0 0.0 0.0 0.0 0.0 0.0 100.0

Respite Care 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0

Parent Support 33.3 33.3 33.3 0.0 50.0 50.0 0.0 0.0 0.0



Family Therapy 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 100.0

In-Home Fam. Ther. 0.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0

Group Therapy 0.0 0.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0


46 | P a g e

Sample of Qualitative Comments

Service Delivery

Positive

“I admire all of the crisis workers; I have had really good support from all of them.” “She is very good with my child; very outgoing.” “He has an excellent therapist. He listens to our child’s concerns and offers positive feedback.” “We have been with this center for 15 years and have gotten excellent service and we are satisfied with the service.”

Negative

“He just does not work on the issues that need to be worked on.” “The doctors listen to me but not really hear me about what I think is happening.” “They seem to have good intentions but they don’t always work to accommodate our family.” “The complaints/concerns are never resolved but turned back on the parent as their fault.”

Access

Positive

“Services have always been there when we needed them.” “Good at making themselves available.” “They work with my schedule.” “Absolutely awesome, available day and night.”

Negative

“It seems like the caseload is so full that it is hard to get in.” “They are overloaded and they can only get to you when they get to you.” “Spread too thin. Paperwork cuts into their time with the children.” “I know they have lots of turnover but my child needs stability.”

Communication and Information

Positive

“We have open communication with all involved.” “Even if it’s off topic, our case manager provides information and will make calls for us.” “If I have any questions, I just call and they call me back.” “The reason I am satisfied is because the case manager does group therapy, so I see her and get the feedback from her as well.”

Negative

“Doesn’t communicate with us or give us feedback.” “I think there needs to be more talking. There isn’t a whole lot of communication.” “I’m not really sure what the purpose of case management is.” “Cannot get additional information or the depth of information we need.”

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Results from KYSS (Youth Survey) In December 2006, KU staff began the KYSS revision process. By March 2007, KU staff met with youth consumers to conduct individual interviews, youth focus groups, and field testing at CMHCs across the state. We also received feedback from parents at one of the larger CMHCs. During these interviews, youth completed the survey with the Research Assistant and Project Coordinator and “thought aloud” about what each question meant to them. Survey items were adjusted based on this feedback.

The primary changes included asking a new set of satisfaction questions based on the MHSIP Youth Services Survey and the addition of items youth felt were necessary to their satisfaction (e.g. “I felt safe with my workers,” and “When staff canceled appointments with me, they gave me good reasons”). In addition, all questions were phrased to reflect a 12-month recall rather than 6-months. In other words, parents/caregivers were asked to think about services received over the past year, instead of over the past six months as had been the case with previous rounds.

During FY2008, the revised KYSS (youth) survey was successfully implemented for the first time. FY2009 represents the second year of data collection with the new survey instrument. Revisions to the survey items and survey process remain an ongoing process. Copies of each survey are located in Appendix C.

KYSS: Sociodemographic Characteristics

The 471 youth participating in the KYSS averaged 15.1 years of age (standard deviation=2.0). The majority of respondents were White (86.5%, n=407), with 10.1% (n=47) African-American, 2.5% (n=12) Hispanic, and 3.5% (n=16) Asian, Native American, or Unspecified. The majority of the participants (64.2%, n=302) were male; 35.8% (n=169) were female. More than one-half (51.8%, n=244) of the total youth participants received services under the SED waiver (Table 5).

*Data obtained from Medicaid.

Table 5. KYSS: Sociodemographic Characteristics*

KYSS

N = 471

n %

Sex of Child

Male

Female

302

169

64.2

35.8

Race/Ethnicity

White

African-American

Hispanic

Asian/Native American/Unspecified

407

47

12

16

86.5

10.1

2.5

3.5

Waiver Status

Yes or Both

Non-Waiver

244

227

51.8

48.2

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KYSS: Overall Satisfaction

The majority of youth statewide (83.5%) indicated they agreed or strongly agreed that they were satisfied with the services they have received from their CMHC (Figure 59). Only 10 CMHCs scored above the statewide average.

Figure 59. KYSS: Overall Satisfaction with Services

KYSS Consumer Perception of Care Indicators Access to Services

Access to Services is one of the five scales that comprise the MHSIP-defined Consumer Perception of Care Indicators domain. The three items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .716. Each item is measured on a 5-point scale where 1 equals Strongly Disagree and 5 equals Strongly Agree. The scale is a sum of the scores for each item with 15 being the highest possible score and indicating most satisfaction. The following three items are included in the Access to Services scale:

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

% A

gre

e o

r S

tro

ng

ly A

gre

e


Overall, I am satisfied with the services I received.

CMHC Statewide

49 | P a g e

Scale 1. Access to Services

The location of services was convenient for me.

Services were available at times that were convenient for me.

I felt safe with staff.

The statewide score for Access to Services was 12.2 and is represented by the diamond studded line (Figure 60). Twelve of the individual CMHCs achieved scores at or above the statewide average.

Figure 60. KYSS: Perception of Access to Services

Participation in Treatment

Participation in Treatment is the second scale in the MHSIP-defined Consumer Perception of Care Indicators domain. The three items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .659. Each item is measured on a 5-point scale where 1 equals Strongly Disagree and 5 equals Strongly Agree. The scale is a sum of the scores for each item with 15 being the highest possible score and indicating most satisfaction. The following three items are included in the Participation in Treatment scale:

Scale 2. Participation in Treatment

I helped choose my services.

I helped choose my treatment goals.

The staff planned activities to help me meet my treatment goals.

0

3

6

9

12

15

Sc

ale

Sc

ore


Maximum score possible = 15Statewide score = 12.2

CMHC Statewide

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The statewide score for Participation in Treatment was 11.4 and is represented by the diamond studded line (Figure 61). Ten of the individual CMHCs achieved scores at or above the statewide average.

Figure 61. KYSS: Perception of Participation in Treatment

Cultural Sensitivity and Responsiveness

Cultural Sensitivity and Responsiveness is the third scale in the MHSIP-defined Consumer Perception of Care Indicators domain. The four items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .844. Each item is measured on a 5-point scale where 1 equals Strongly Disagree and 5 equals Strongly Agree. The scale is a sum of the scores for each item with 20 being the highest possible score and indicating most satisfaction. The following four items are included in the Cultural Competency and Responsiveness scale:

Scale 3. Cultural Competency and Responsiveness

The staff treated me with respect.

The staff respected my cultural/ethnic background.

The staff respected my family’s religious beliefs.

The staff spoke to me in ways I could understand.

The statewide score for Cultural Sensitivity and Responsiveness was 16.9 and is represented by the diamond studded line (Figure 62). Eleven of the individual CMHCs achieved scores at or above the statewide average.

0

3

6

9

12

15

Sc

ale

Sc

ore



CMHC Statewide

51 | P a g e

Figure 62. KYSS: Perception of Cultural Sensitivity of Services

Appropriateness of Services

Appropriateness of Services is the fourth scale in the MHSIP-defined Consumer Perception of Care Indicators domain. The five items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .871. Each item is measured on a 5-point scale where 1 equals Strongly Disagree and 5 equals Strongly Agree. The scale is a sum of the scores for each item with 25 being the highest possible score and indicating most satisfaction. The following five items are included in the Appropriateness of Services scale:

Scale 4. Appropriateness of Services

Overall, I am satisfied with the services I received.

The staff who helped me stuck with me no matter what.

I could talk to staff when things were bothering me.

I got the help I wanted.

I got as much help as I wanted.

The statewide score for Appropriateness of Services was 19.7 and is represented by the diamond studded line (Figure 63). Ten of the individual CMHCs achieved scores at or above the statewide average.

0

3

6

9

12

15

18

Sc

ale

Sc

ore



CMHC Statewide

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Figure 63. KYSS: Perception of the Appropriateness of Services

Self Reported Outcomes

Self Reported Outcomes is the fifth scale in the MHSIP-defined Consumer Perception of Care Indicators domain. The six items that make up this scale have high internal consistency as indicated by a Chronbach’s alpha value equal to .883. Each item is measured on a 5-point scale where 1 equals Strongly Disagree and 5 equals Strongly Agree. The scale is a sum of the scores for each item with 30 being the highest possible score and indicating most satisfaction. The following six items are included in the Self Reported Outcomes scale:

Scale 5. Self Reported Outcomes

As a result of my services, I am better at handling daily life.

As a result of my services, I get along better with my family members.

As a result of my services, I get along better with friends and others.

As a result of my services, I am doing better in school.

As a result of my services, I am better able to deal with things when they go wrong.

As a result of my services, I am satisfied with my life right now.

The statewide score for Self Reported Outcomes was 23.1 and is represented by the diamond studded line (Figure 64). Nine of the individual CMHCs achieved scores at or above the statewide average.

0

5

10

15

20

25

Sc

ale

Sc

ore



CMHC Statewide

53 | P a g e

Figure 64. KYSS: Self-Reported Outcomes

KYSS: Medication Management Over three quarters (79.1%) of the youth stated they take medications for mental health reasons, and of them, 80.8% see a psychiatrist or medications nurse at the CMHC for medications (Table 6). Of that group, 90.1% said the professional had explained why they should take the medications, 81.1% said the professional had explained potential side effects, and 91.2% said that the professional later asked them how the medications were working for them. Seventy-eight percent expressed satisfaction with how the medications were working for them.

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Sc

ale

Sc

ore



CMHC Statewide

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Table 6. KYSS Medication Management. % responding Yes or Agree/Strongly Agree

KYSS: Service Appointments

The majority (87.1%) of the youth agreed or strongly agreed that staff at their CMHC kept most of their scheduled appointments. When staff had to cancel, 85.0% of youth believed they were given good reasons for the cancellation (See Table 7). These items are new to KYSS in Round 11 and were added based on feedback youth provided in focus groups about the survey.

N

Take Meds for

MH

Meds from MHC

Explain Why

Side Effects

Ask How Meds

Working

Satisfied w/ Meds

Statewide 471 79.1 80.8 90.1 81.1 91.2 78.0

Area 23 73.9 88.2 93.3 60.0 93.3 60.0

Bert Nash 12 91.7 90.9 80.0 80.0 90.0 50.0

Center for C&C 17 82.4 71.4 100.0 66.7 100.0 77.8

Central KS 12 85.7 100.0 66.7 50.0 83.3 83.3

Cowley 11 81.8 100.0 77.8 66.7 88.9 66.7

Crawford 7 57.1 66.7 100.0 100.0 100.0 75.0

East Central KS 25 78.3 75.0 84.6 85.7 92.9 61.5

Family Life 5 40.0 50.0 100.0 100.0 100.0 100.0

Family Services 28 92.6 92.0 91.3 87.0 95.7 69.6

Four County 18 100.0 88.9 93.3 80.0 78.6 73.3

Elizabeth Layton

8 100.0 87.5 100.0 85.7 85.7 57.1

Guidance Ctr. 17 70.6 85.7 83.3 83.3 91.7 72.7

High Plains 11 72.7 77.8 100.0 100.0 100.0 100.0

Horizons 23 68.2 88.2 100.0 80.0 93.3 86.7

Iroquois * * * * * * *

Johnson 33 90.9 76.7 90.9 86.4 86.4 90.0

Kanza * * * * * * * Labette * * * * * * *

Pawnee 36 77.1 85.2 87.0 71.4 91.3 95.7

Prairie View 22 77.3 88.2 91.7 78.6 93.3 53.3

Sedgwick 80 77.5 71.0 93.0 84.4 90.5 88.6

South Central 9 77.8 57.1 50.0 75.0 100.0 75.0

Southeast 23 76.2 88.2 93.3 73.3 100.0 80.0

Southwest * * * * * * *

Sumner * * * * * * *

Wyandot 39 67.6 80.0 85.0 95.0 90.0 85.0

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Table 7. KYSS Service Appointments. Percent Agree or Strongly Agree.

KYSS Completed

N

Staff Kept Most Appointments with

Me

Staff Gave Me Good Reasons for Canceling

Appointments

Statewide 471 87.1 85.0

Area 23 87.0 87.0

Bert Nash 12 83.3 90.9

Center for C&C 17 76.5 82.4

Central KS 12 85.7 100.0

Cowley 11 72.7 70.0

Crawford 7 71.4 66.7

East Central KS 25 88.0 79.2

Family Life 5 100.0 100.0

Family Services 28 85.2 88.0

Four County 18 94.1 68.8

Elizabeth Layton 8 75.0 87.5

Guidance Ctr. 17 88.2 80.0

High Plains 11 100.0 100.0

Horizons 23 91.3 95.2

Iroquois * * *

Johnson 33 84.8 84.4

Kanza * * *

Labette * * *

Pawnee 36 83.3 86.1

Prairie View 22 95.5 95.0

Sedgwick 80 87.2 85.1

South Central 9 100.0 100.0

Southeast 23 82.6 65.2

Southwest * * *

Sumner * * *

Wyandot 39 94.7 84.6

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Overall Summary

Consumers of children’s community-based mental health services in Kansas are generally satisfied with the performance of CMHCs. Like any other study, this study has its strengths as well as limitations.

One limitation of the current study is that it utilized a convenience sampling approach. It is important for the reader to understand that this approach, as opposed to a more rigorous random sampling strategy, undermines our ability to generalize the findings to the parents and consumers who did not respond to the survey. In other words, we cannot be sure that the individuals who chose to complete the survey represent the population of interest. In addition, while reviewing the findings, the reader should also be cautious about attributing an undue level of importance to findings based on a low number of respondents. These values are likely unstable and would be prone to wide variations if measured repeatedly. Finally, the reader should be mindful of the fact that satisfaction with services may fluctuate; a shift undetectable by measurement at a single point in time.

These limitations are offset somewhat by important study strengths. The surveys used here were developed with the input and support of CMHC personnel, parents, and youth. Compared to the standard 12 item MHSIP survey, the KFSS instrument is lengthier and potentially more comprehensive in scope. The revised KYSS survey, however, closely resembles the MHSIP survey, thereby allowing comparison with other states that also use the MHSIP youth survey. The study findings shed light on many important areas related to consumer satisfaction with mental health services. The results presented here allow the CMHC staff and consumers to gain an awareness of general levels of satisfaction as well as take note of the areas where there is room for further improvement.

Summary of KFSS Results

Unless otherwise noted, the results presented in this report are generally similar to those from last year. Areas where the results can be interpreted as positive in favor of statewide CMHC performance include:

Participation Rates

o Increased from 49.4% to 54.5%.

Receipt of Information about Services

o Nearly 90% of respondents statewide agreed that staff gave them the necessary information to make informed decisions about their child’s treatment and made sure they understood their rights. Over 80% reported receiving adequate information about available services as well as the information needed to make informed decisions about their child’s treatment.

All CMHCs achieved scores of 21 or higher on the “Access-Convenience of Services” scale.

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The scale “Quality and Appropriateness of Services” most closely resembles the family-centered and child-focused component of the Kansas system-of-care philosophy. All CMHCs achieved a score of 18 or higher out of a possible score of 25.

Cultural competency and responsiveness of staff are important aspects of the Kansas service delivery philosophy. Out of a possible score of 30, all the CMHCs achieved scores of 21 or higher and half scored higher than the statewide score of 27.5 (compared to a statewide score of 22.7 in the previous year).

The majority of parents surveyed reported about a child who receives medication management services from the CMHC. More than 90% of parents reported being informed about the reasons for medications and possible side effects. Furthermore, 88.4% reported they felt included as a partner in decision making about their child’s treatment.

Areas where the results can be interpreted as areas for improvement of CMHC performance include:

Three-quarters of respondents statewide indicated that someone from the CMHC had told them whom to call if they had a problem with services and only 65.9% reported receiving instruction on how to make a complaint if they wanted to.

Fewer than two-thirds of respondents statewide reported they felt staff was well trained to provide services at the CMHC; although fewer than 4% felt the staff was not well trained at all.

Although most parents who had a crisis plan felt included in its creation, only 70% were satisfied with the delivery of crisis services.

Using the qualitative comments as a guide, CMHCs may want to investigate the flexibility in scheduling of services to accommodate the needs of school children and working parents; employee turnover and reassignments; and treatment related communication.

Summary of KYSS Results

Most youth (82.6%) agreed they were satisfied with services received. Still, there is room for improvement and the following scores indicate areas for potential focus. Statewide, Access to Services received a score of 12.2 out of a possible 15; Participation in Treatment received an average score from youth of 11.4 out of a possible 15; and Cultural Competency received a score of 16.9 out of 20 possible. Self-Reported Outcomes received an average score of 23.1 out of a possible 30 points. Each CMHC should consult their respective individual reports for additional details.

Youth feel strongly about maintaining a respectful relationship with staff. A salient indicator of respect for youth is whether a staff person keeps scheduled appointments and does not “blow them off.” Statewide, 86% of youth reported that staff kept most appointments and 85% reported that staff gave good reasons for canceling appointments.

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Conclusion

The generally positive results from the KFSS and KYSS surveys are not unexpected based on a large body of literature documenting the high levels of satisfaction consistently obtained from consumer satisfaction surveys in healthcare. While it remains unclear whether social and psychological factors such as social desirability or dependency on services may be driving these results,6 the consumer remains one of the best sources of feedback.

Even so, as outlined previously, there remains room for improvement in several areas. Research suggests the focus for improvement should be on strengthening the interpersonal relationships between the staff and consumers rather than the technical aspects of care.3 Still, determining where to center the efforts can be challenging.

Dodek, Heyland, Rocker, and Cook (2004) outlined several approaches to making use of consumer satisfaction data.7 These approaches include performing a “root cause” analysis where in-depth interviews are conducted with families to understand why they answered the way they did and trying to close the gap between family member’s expectations and perceptions of service quality. Another approach is to address the issue by asking questions such as: What are we trying to accomplish? How will we know that a change is an improvement? and What changes can we make that will result in improvement? Finally, a CMHC may choose to undertake “quality function deployment” where service qualities important to families are identified and then linked to key organizational functions responsible for performance in the specified area.

Next Steps

Data collection for Round 13 will begin in September 2009 and will conclude near late-March 2010. The procedure for Round 13 will be similar to Round 12 with data collection for all centers occurring in one group.

In addition to traditional data collection and dissemination, in FY10 project staff will undertake focused investigation with direct service providers. In 2007, youth consumers participated in focus groups and described their ideas of satisfaction which led to a revision of the Kansas Consumer Satisfaction Survey. To balance this perspective and gain a more accurate, comprehensive understanding of satisfaction with mental health services, we will conduct focus groups with staff that provides children’s mental health services through Medicaid funding. Findings from this project will inform dissemination activities for Round 13 as well as data collection activities for subsequent Rounds.

6 Edwards, C., Staniszweska, S., Crichton, N. (2004). Investigation of the ways in which patients’ reports of their satisfaction with healthcare are constructed. Sociology of Health and Illness, 26(2), 159-183. 7 Dodek, P.M., Heyland, D.K., Rocker, G.M., and Cook, D.J. (2004). Translating family satisfaction data into quality improvement. Critical Care Medicine, 32(9), 1922-1927.

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Appendix A: Calculation of Participation Rates

The participation rate for the telephone survey equals the number of completed surveys divided by the number of valid contacts made. Valid contacts (i.e., the denominator) are composed of completed surveys, refusals, and individuals who are not contacted but are known to be eligible.8 For the current survey, we assumed that, unless otherwise specified, all individuals were eligible if they were in the Medicaid database. Those not receiving services in the last twelve months or no longer living at home have traditionally been considered as a “refusal” rather than as an ineligible participant and were calculated as such for the current analyses. Telephone numbers where no valid contact information was available (i.e., wrong number, disconnected) were not included in the denominator. It is standard research practice and recommended by the Federal Mental Health Statistical Improvement Program (MHSIP) to exclude those without accurate contact information from the denominator when calculating participation rates.

8 Massey, J. T. (1995). Estimating the response rate in a telephone survey with screening. Hyattsville, MD: Centers for Disease Control and Prevention.

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Appendix B. Survey Instruments

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Kansas Family Satisfaction Survey

(KFSS)

Mail Version

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KANSAS CONSUMER SATISFACTION SURVEY FOR PARENTS

The following questions are about services that your child or your family

has received from your mental health center in the past 12 months. For

this survey, only think about the services that your child or your family

received to help your child.

1. Your relationship to this child (circle one): mother stepfather aunt uncle

father grandmother legal guardian adoptive parent

stepmother grandfather caretaker foster parent

2. Is this child still getting services from the mental health center? Yes No

2a. If YES, skip ahead to Question 4.

2a. If NO, why did this child stop getting services?

3. Even if your child is not currently receiving services, did your child receive any services from the mental health center in

the last 12 months? (Circle one) Yes No

4. These questions are about your experience

getting services in the last 12 months. (Circle

one answer for each question).

All of

the time

Most of

the

time

Some

of the

time

A little of

the time

None

of the

time

Not

Applicable

4a. How often do you feel your child and your

family are able to get the services needed

from your center?

1

2

3

4

5

9

4b. How often do you feel your child and your

family are able to get the services in a

timely manner when you need them?

1

2

3

4

5

9

4c. How often are the services your child and

your family receive scheduled at a

reasonable location?

1

2

3

4

5

9

4d. How often are the services for your child

and your family scheduled at a

reasonable time of day?

1

2

3

4

5

9

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4e. Do your child and your family receive the

services as often as planned based of

the plan of care or treatment goals?

1

2

3

4

5

9

5. Think about all the staff that works with

your child and your family, not just one or two

of the staff. (Circle one answer for each

question).

All of

the time

Most of

the

time

Some

of the

time

A little of

the time

None

of the

time

Not

Applicable

5a. The staff tries to help your family meet

your needs as you see them.

1

2

3

4

5

9

5b. The staff points out what your child and

family does well.

1

2

3

4

5

9

5c. The staff encourages you to speak up

during meetings with professionals

when there is something you want to

say.

1

2

3

4

5

9

5d. The staff helps you get support from

informal sources such as your family,

friends, and community.

1

2

3

4

5

9

5e. The staff helps your family get services

from other agencies or programs in the

community.

1

2

3

4

5

9

5f. The staff assists you in learning ways to

improve your child's ability to function in

community settings.

1

2

3

4

5

9

5g. The staff makes sure you understand

your family’s rights.

1

2

3

4

5

9

5h. The staff communicates and provides

information to you in a way that you

understand.

1

2

3

4

5

9

5i. When needed, the staff involves your

child in making decisions about the

treatment plan and services.

1

2

3

4

5

9

5j. When needed, the staff offers to adjust

services if they do not seem to be

working for your family.

1

2

3

4

5

9

5k. If your child has another major

challenge such as substance abuse or a

developmental disability, the staff

works with you to get services for those

other issues.

1

2

3

4

5

9

5l. The members of your child’s treatment

team build services around your child’s

strengths.

1

2

3

4

5

9

5m. During times when workers or services

changed, you felt like your family had

continuing, consistent care.

1

2

3

4

5

9

5n. If hospitalization or out-of-home

placement was discussed, other

community-based options were

presented to you.

1

2

3

4

5

9

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5o. Services were provided in ways that

were sensitive to your child and your

family’s cultural/ethnic background.

1

2

3

4

5

9

5p. The members of your child’s treatment

team respect and honor your family’s

beliefs and traditions.

1

2

3

4

5

9

5q. You feel you have a say if your child is

ready to exit services.

1

2

3

4

5

9

Yes

No

Don’t

Remember

Not

Applicable

5r. Has anyone from your center ever told you about or given you

information about the different services available for your child and

family?

5s. Has anyone from your center told you who to call if you have problems

with services?

5t. Has anyone from your center ever told you how to make a complaint if

you wanted to?

5u. Do you feel the staff from your center give you the information you need

to make informed decisions about your child’s treatment?

The next questions are about specific services that you have received from your center over the past 12 months

ONLY.

6. CRISIS SERVICES ( PAST 12 MONTHS ONLY)

Yes

No

Don’t

know

6a. In the past 12 months, did you have a crisis where you used the mental health center?

6b. In the past 12 months were your needs met when your family had a crisis?

6c. Even if you did not use crisis service, do you have a crisis plan?

6d. If yes, were you included as a partner in the decision making about your child’s crisis plan?

6e. Overall, how satisfied would you say you have been with the crisis services at this mental health center? (circle

one)

Very satisfied Satisfied Somewhat

Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

6f. Is there anything else you would like to say about crisis services?

7. MEDICATION MANAGEMENT (PAST 12 MONTHS ONLY)

7a. Does your child take medications for mental health reasons? Yes No

7b. Does he/she take medications prescribed by a doctor/nurse at your mental health center?

Yes No (If no, skip to Question 8)

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All of

the

time

Some of

the time

None

of the

time

c. Does (did) this doctor/nurse explain why your child should take the medications?

d. Does (did) this doctor/nurse ask you about how the medications are working for

your child?

e. Does (did) this doctor/nurse include you as a partner in decisions about your child’s

medication management?

f. Does (did) this doctor/nurse explain what the side effects might be?

7g. Overall, how satisfied would you say your have been with the Medication Management services provided by this

mental health center? (circle one)


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

7h. Is there anything else that you would like to say about your medication management experience?

8. CASE MANAGEMENT (PAST 12 MONTHS ONLY)

Check this box if you did not use this service in the past 12 months and skip to Question 9.

Yes

No

Don’t

know

8a. Has anyone explained to you the reason for Case Management?

8b. Do you think Case Management has been a helpful service?

8c. Does your Case Manager give you feedback on how your child is doing?

8d. Does your Case Manager treat you like a partner when it comes to making decisions

about your child’s treatment?

8e. Overall, how satisfied would you say your have been with the Case Management services provided by this

mental health center? (circle one)


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

8f. Is there anything else that you would like to say about your experience with Case Management?

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9. INDIVIDUAL THERAPY (PAST 12 MONTHS ONLY)


Yes

No

Don’t know

9a. Has anyone explained to you the reason for Individual Therapy?

9b. Do you think Individual Therapy has been a helpful service?

9c. Does the Individual Therapist give you feedback on how your child is doing?

9d. Does the Individual Therapist treat you like a partner when it comes to making

decisions about your child’s treatment?

9e. Overall, how satisfied would you say you have been with the Individual Therapy services provided by this

mental health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

9f. Is there anything else that you would like to say about your experience with Individual Therapy?

10. ATTENDANT CARE (PAST 12 MONTHS ONLY)


Yes

No

Don’t know

10a. Has anyone explained to you the reason for Attendant Care?

10b. Do you think Attendant Care has been a helpful service?

10c. Does your Attendant Care Worker give you feedback on how your child is doing?

10d. Does your Attendant Care Worker treat you like a partner when it comes to

making decisions about your child’s treatment?

10e. Overall, how satisfied would you say you have been with the Attendant Care services provided by this



Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

10f. Is there anything else that you would like to say about your experience with Attendant Care?

11. RESPITE CARE (PAST 12 MONTHS ONLY)


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Yes

No

Don’t know

11a. Has anyone explained to you the reason for Respite Care?

11b. Do you think Respite Care services have been helpful?

11c. Does your Respite Care Worker give you feedback on how your child is doing?

11d. Does your Respite Care Worker treat you like a partner when it comes to making

decisions about your child’s treatment?

11e. Overall, how satisfied would you say you have been with the Respite Care Services provided by this mental

health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

11f. Is there anything else that you would like to say about your experience with Respite Services?

12. PARENT SUPPORT (PAST 12 MONTHS ONLY)


Yes

No

Don’t

know

12a. Has anyone explained to you the reason for Parent Support Specialists (PSS)?

12b. Do you think having a PSS has been helpful?

12c. Does your PSS help you get feedback on your family’s progress?

12d. Does the PSS treat you like a partner when it comes to making decisions

about your child’s treatment?

12e. Overall, how satisfied would you say you have been with the Parent Support Services provided by this



Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

12f. Is there anything else that you would like to say about your experience with Parent Support?

13. PSYCHOSOCIAL GROUP (E.G., AFTER SCHOOL PROGRAMS) (PAST 12 MONTHS ONLY)


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Yes

No

Don’t know

13a. Has anyone explained to you the reason for Psychosocial Group?

13b. Do you think Psychosocial Group has been a helpful service?

13c. Do you receive feedback about how your child is doing in Psychosocial

Group?

13d. In Psychosocial Group, do you think you are treated as a partner when it

comes to making decisions? about your child?

13e. Overall, how satisfied would you say you have been with the Psychosocial Group provided by this mental

health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

13f. Is there anything else that you would like to say about your experience with Psychosocial Group?

14. WRAPAROUND FACILITATION (PAST 12 MONTHS ONLY)


Yes

No

Don’t know

14a. Has anyone explained to you the reason for Wraparound Facilitation?

14b. Do you think Wraparound Facilitation has been helpful?

14c. Does your wraparound Facilitator give you feedback on how your child is

doing?

14d. Does your Wraparound Facilitator treat you like a partner when it comes

to making decisions about your child’s treatment?

14e. Overall, how satisfied would you say you have been with the Wraparound Facilitation services provided by

this mental health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

14f. Is there anything else that you would like to say about your experience with Wraparound Facilitation?

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15. FAMILY THERAPY (PAST 12 MONTHS ONLY)


Yes

No

Don’t

know

15a. Has anyone explained to you the reason for Family Therapy?

15b. Do you think Family Therapy has been a helpful service?

15c. Does your Family Therapist give you feedback on how your family is doing?

15d. Does your Family Therapist treat you like a partner when it comes to making

decisions about Family Therapy?

15e. Overall, how satisfied would you say you have been with the Family Therapy services provided by this mental

health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

15f. Is there anything else that you would like to say about your experience with Family Therapy?

16. IN-HOME FAMILY THERAPY (PAST 12 MONTHS ONLY)


Yes

No

Don’t know

16a. Has anyone explained to you the reason for In-Home Family Therapy?

16b. Do you think In-Home Family Therapy has been a helpful service?

16c. Does your In-Home Family Therapist give you feedback on how your family is

doing?

16d. Does your In- Home Family Therapist treat you like a partner when it comes

to making decisions about In-Home Family Therapy?

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16e. Overall, how satisfied would you say you have been with the In-Home Family Therapy services provided by

this mental health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

16f. Is there anything else that you would like to say about your experience with In -Home Therapy?

17. GROUP THERAPY (PAST 12 MONTHS ONLY)


Yes

No

Don’t know

17a. Has anyone explained to you the reason for Group Therapy?

17b. Do you think Group Therapy has been a helpful service?

17c. Does your child’s Group Therapist give you feedback on how your child is

doing?

17d. Does your child’s Group Therapist treat you like a partner when it comes to


17e. Overall, how satisfied would you say you have been with the Group Therapy services provided by this mental

health center?


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

17f. Is there anything else that you would like to say about your experience with Group Therapy?

18. INDEPENDENT LIVING (PAST 12 MONTHS ONLY)


Yes

No

Don’t

know

18a. Has anyone explained to you the reason for Independent Living?

18b. Do you think Independent Living has been a helpful service?

18c. Does your child’s Independent Living Worker give you feedback on how your child is

doing?

18d. Does you child’s Independent Living worker treat you like a partner when it comes to


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18e. Overall, how satisfied would you say you have been with the Independent Living services provided by this



Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

18f. Is there anything else that you would like to say about your experience with Independent Living?

19. Are there services you would like to receive from this mental health center that you are not currently receiving?

Please write you answer here:

20. Overall, how well do you feel the staff at your center is trained to provide the services you receive? (circle one)

Very well trained Not well trained at all

Average Don’t know

Below average

21. Thinking back to the reasons that brought your child to this center for services, about how much do you think he

or she has improved, overall? (circle one)

A lot better A little better No change

A little worse A lot worse Don’t Know

Not applicable

22. Overall, how satisfied would you say you have been with services from this mental health center? (circle one)


Satisfied

Somewhat

Dissatisfied

Dissatisfied Very

Dissatisfied

23. Has your child lived in any of the following places in the last 12 months? (check all that apply)

Yes No Yes No

With one or both parents Residential treatment center

With another family member Hospital

Foster home Local jail or detention facility

Crisis Shelter State correctional facility

Homeless Shelter Runaway/homeless/on the street

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Group home Other (describe):

If you were provided with an option of an online survey, would you rather complete the survey online?

Yes No

Are there any other comments about your CMHC that you would like to share?

Thank You!

If you have questions or concerns about your services at the mental health center, you can call the Children’s Director at

your local mental health center. If you need additional help, you can call 1-888-582-3759.

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Kansas Youth Satisfaction Survey

(KYSS)

Mail Survey

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When answering these questions, think about the services you’ve

received over the past year. Please mark your answer with an X.

1. Overall, I am satisfied with the services I received.

__Strongly Agree __Agree __Undecided __Disagree __Strongly Disagree

2. I helped choose my services.


3. I helped choose my treatment goals.


4. The staff who helped me stuck with me no matter what.


5. I could talk to staff when things were bothering me.


6. The location of the services worked for me.


7. The times the services were offered worked for me.


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8. I got the help I wanted.


9. I got as much help as I wanted.


10. I felt safe with staff.


11. The staff treated me with respect.


12. The staff respected my cultural/ethnic background.


13. The staff respected my family’s religious beliefs.


14. The staff spoke to me in ways I could understand.


15. The staff planned activities to help me meet my treatment goals.


16. As a result of my services, I am better at handling daily life.


17. As a result of my services, I get along better with my family members.


18. As a result of my services, I get along better with friends and others.


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19. As a result of my services, I am doing better in school.


20. As a result of my services, I am better able to deal with things when they go wrong.


21. As a result of my services, I am satisfied with my life right now.


22. Staff kept most of their appointments with me.


23. When staff had to cancel an appointment with me, they gave me a good reason.


24. What has been the most helpful thing about the services you received over the last

year? (Write your answer on the lines provided)

25. What could be done to improve the services at (CMHC)? (Write your answer on the

lines provided)

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26. Did (do) you take medications for mental health reasons?

___Yes. Please answer question #27.

___No. You have completed the survey! Thanks for your time!

27. Did (do) you see someone at your mental health center for this medications?

___Yes. Please answer questions #28-31.

___No.. You have completed the survey! Thanks for your time!

28. The doctor/nurse explained why you should take the medications.


29. The doctor/nurse explained what the side effects to the medications might be.


30. The doctor/nurse asked you about how the medications were working for you.


31. I am satisfied with how the medications worked for me.


You have completed the survey! Thanks for your time!