Adult Consumer and Family Member Perceptions of Care...

Adult Consumer and Family Member Perceptions of Care 2012

Adult Consumer and Family Member Perceptions of Care 2012: Findings from the Annual Survey of Pennsylvania Behavioral Health Service Recipients


CONTENTS

INTRODUCTION ……………………………………….. 1 METHODOLOGY ……………………………………….. 2 ADULT SURVEY FINDINGS ……………………………………….. 4 Access to Care 4 Quality and Appropriateness 5 Outcomes of Care 5 Participation in Treatment Planning 6 General Satisfaction 6 Social Connectedness 7 Functioning 7 FAMILY SURVEY FINDINGS ……………………………………….. 8 Access to Care 8 Outcomes of Care 9 Participation in Treatment Planning 9 Cultural Sensitivity of Staff 10 General Satisfaction 10 Social Connectedness 11 Functioning 11


INTRODUCTION

It has been said that one of the most significant performance indicators available for measuring the success of a health care service delivery system is the assessment of how the actual recipients of those services are doing in their lives; as a direct result of those services that they received. Accordingly, what better way to evaluate how individuals perceive they are doing than to simply ask them? This performance outcomes report offers a summary view of recent thoughts on that very topic, as reported by a statewide sampling of adult recipients (and family members of youth recipients) of the Commonwealth’s publicly-funded, behavioral health service system. The Pennsylvania Department of Public Welfare’s Office of Mental Health and Substance Abuse Services (OMHSAS) has conducted an annual survey of behavioral health service recipients each year since 2000. OMHSAS, like fifty-one (51) other state and territory mental health authorities, uses the nationally-recognized Mental Health Statistics Improvement Program (MHSIP) survey instrument to assess adult consumer perception of care. The MHSIP survey and the companion Youth Services Survey for Families (YSS-F) – which is used by forty-two (42) states and territories, were created, tested and refined over the course of several years by groups of mental health consumers, family members of children/adolescents, state government data experts, researchers and federal government project officers. The annual survey is a mandatory component of the data reporting requirements within the Community Mental Health Services Block Grant (CMHSBG) that OMHSAS receives from the federal government. Consumer and family perception of outcomes of care together represent one of nine National Outcome Measures (NOMS) adopted by the federal Center for Mental Health Services (CMHS) for mental health services. The NOMS are derived from the Uniform Reporting System (URS) data tables. The URS was developed in response to the need for federal accountability for the expenditure of community mental health block grant funds received by States. The intent of the URS tables is to allow for both the tracking of individual State performance over time, and the aggregation of state information to develop a national picture of the public mental health system. States are encouraged to use the URS data in planning, program development, and evaluation efforts. This consumer/family survey study and report was funded, in part, by federal Grant Number: 5 SM059989-03. The Pennsylvania Office of Mental Health and Substance Abuse Services wishes to acknowledge the support of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services for its State Mental Health Data Infrastructure Grants for Quality Improvement.

1


METHODOLOGY

During calendar year 2012, the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) conducted a mailed survey campaign to assess adult consumer and family member perception of care. The three populations surveyed were:

1) Adult consumers who had received Medicaid-funded peer support services during Calendar Year 2011, under either the HealthChoices Behavioral Health program or the Medical Assistance Fee-For-Service program.

a. Every one (100%) of the unduplicated 1,732 peer support recipients statewide were selected to receive the Mental Health Statistics Improvement Program (MHSIP) consumer survey instrument. Peer Support service recipients were identified through a query of the Department of Public Welfare (“Department”) Enterprise Data Warehouse (EDW), examining all Medical Assistance (aka, Medicaid) Fee-For-Service claims and all HealthChoices Behavioral Health encounters where the service occurred between January 01, 2011 and December 31, 2011.

2) Adult consumers who had received Medicaid-funded behavioral health services

during Calendar Year 2011, under the HealthChoices Behavioral Health program (i.e., Medicaid managed behavioral health care).

a. Using a convenience sample approach, 5,000 adult service recipients were selected from among all behavioral health service recipients statewide to receive the Mental Health Statistics Improvement Program (MHSIP) consumer survey instrument. The sample did not include persons who had received peer support services. Adult behavioral health service recipients were identified through a query of the Department’s EDW, examining all HealthChoices Behavioral Health encounters where the service occurred between January 01, 2011 and December 31, 2011.

3) Family members of children and adolescents who had received Medicaid-funded behavioral health services during calendar Year 2011, under the HealthChoices Behavioral Health program.

a. Using a convenience sample approach, 5,000 child/adolescent service recipients were identified from statewide universe child or adolescent behavioral health service recipients (ages 17 and under), and their parents/guardians were selected to receive the Youth Services Survey for Families (YSS-F) instrument. Child and adolescent behavioral health service recipients were identified through a query of the Department’s EDW, examining all HealthChoices Behavioral Health encounters where the service occurred between January 01, 2011 and December 31, 2011.

2


Each survey was sent to the recipient/family member’s mailing address, as identified within the Department’s Client Information System (CIS). The survey mailing consisted of a cover letter (which served to explain the purpose of the survey and to request participation), the respective survey instrument, and a postage-paid, business reply return envelope. A Spanish-translation version of each letter and survey was mailed to those consumers and family members whose CIS-identified preferred language was Spanish. A postcard reminder was mailed approximately 14 days following the initial mailing, as a means of maximizing the survey return rates. Of the total 6,732 MHSIP surveys sent to adults, 6,695 surveys were deliverable, and 1,994 (or 29.78%) of that subtotal were completed and returned by adult consumers. Of the total 5,000 YSS-F surveys sent to families, 4,991 were deliverable, and 1,253 (or 25.11%) of that subtotal were completed and returned by family members. The survey responses were entered into the OMHSAS survey database by contracted Temporary Clerical Personnel, and the responses were then analyzed by the OMHSAS Division of Systems Management’s Data Analytics Group. The survey results were reported to the Substance Abuse and Mental Health Services Administration (SAMHSA), as part of our required Uniform Reporting System (URS) measures. This presentation of the survey findings allows for more detailed information-sharing. Table 1. 2012 Survey Sample Results

Family Member of Child or Adolescent

Service Recipient

Adult Service Recipient

Peer Support Service

Recipient Totals

Surveys mailed (Attempted contact)

5,000 5,000 1,732 11,732

Undeliverable (Unable to contact)

9 29 8 46

Delivered (Contacted)

4,991 4,971 1,724 11,686

Survey Responses (Form Returned)

1,253 1,411 583 3,247

Response Rate (Survey Responses/

Contacted) 25.11% 28.38% 33.82% 27.79%

Total family survey response rate = 25.11%, as calculated by 1,253 responses divided by 4,991 delivered surveys. Total adult survey response rate = 29.78%, as calculated by (1,411 + 583 responses) / (4,971 + 1,724 delivered).

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ADULT SURVEY FINDINGS

For the purpose of this report, all adult survey responses (i.e., those surveys completed and returned to OMHSAS by recipients of Peer Support services as well as those responses from adult recipients of any other behavioral health service) have been aggregated into an “Adult Consumer” group. Additional analysis of the Peer Support survey responses will be presented in a separate OMHSAS performance outcomes report. Aggregating the responses here allows for consistency in how OMHSAS reported the summary-level 2012 adult consumer survey findings to SAMHSA. The following survey results are presented by Mental Health Statistics Improvement Program (MHSIP) adult consumer survey “domain” (aka, survey scale). Each domain represents a combined indicator score created from a specific set of MHSIP consumer survey items. Domain scores are calculated using surveys that had 2/3 or more of the corresponding survey items completed for that domain. The percentage of adult consumers “Reporting Positively” about a particular survey domain is determined by those who responded that they “Strongly Agree” or “Agree” to the statements on the survey, when compared to all applicable responses. United States (U.S.) averages are based on 2011 data - the most recent national figures available at the time of the report. Figure 1. Adult Consumer Access to Care

Access Quality and

Appropriateness Outcomes

Participation in Treatment Planning

General Satisfaction

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83.24% 84.67% 82.00% 81.79%

84.51%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about Access to Care: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%

Pennsylvania U.S. Average

84.51% 85.60%

Adult Consumers Reporting Positively about Access to Care: FY 2012 Comparison


Figure 2. Adult Consumer Quality and Appropriateness

Access Quality and




Figure 3. Adult Consumer Outcomes of Care

Access Quality and




5

81.78% 82.75%

81.77% 82.39% 83.20%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about Quality and Appropriateness of Care:

PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


83.20% 88.80%

Adult Consumers Reporting Positively about Quality and Appropriateness of Care: FY 2012 Comparison

65.04% 64.15% 63.39%

56.84%

62.97%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about Outcomes of Care: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


62.97% 70.60%

Adult Consumers Reporting Positively about Outcomes of Care: FY 2012 Comparison


Figure 4. Adult Consumer Participation in Treatment Planning

Access Quality and




Figure 5. Adult Consumer General Satisfaction with Services

Access Quality and




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83.96%

85.59%

81.43% 80.84%

83.91%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about Participation in Treatment Planning:


0%

20%

40%

60%

80%

100%


83.91% 80.70%

Adult Consumers Reporting Positively about Participation in Treatment Planning:

FY 2012 Comparison

82.93% 83.60% 82.51%

81.35% 84.57%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about General Satisfaction with Services: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


84.57% 89.00%

Adult Consumers Reporting Positively about General Satisfaction with Services: FY 2012 Comparison


Figure 6. Adult Consumer Social Connectedness

Social Connectedness

Functioning

Figure 7. Adult Consumer Functioning


Functioning

7

71.76% 70.51% 68.90%

64.09%

70.59%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about Social Connectedness: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


70.59% 70.10%

Adult Consumers Reporting Positively about Social Connectedness: FY 2012 Comparison

65.59% 63.37% 64.75%

57.83% 60.02%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Adult Consumers Reporting Positively about Functioning: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


60.02% 69.90%

Adult Consumers Reporting Positively about Functioning: FY 2012 Comparison


FAMILY SURVEY FINDINGS

Similar to the construction of the 36-item MHSIP adult consumer survey, the Youth Services Survey for Families (YSS-F) survey tool is comprised primarily of 26 items organized into seven survey domains. Each grouping of survey items that comprise a domain assesses the perceptions of the family members, specific to that domain’s area of interest. Survey items are presented in the form of statements; using a standard Likert scale to define how much the respondents agreed or disagreed with the statements. Domain scores are calculated only using surveys that had 2/3 or more of the corresponding survey items completed for that domain. As with the adult survey data, those survey item responses reported as “Not Applicable” were recoded as missing values. Other responses were recoded using numerical values, to facilitate calculations. The percentage of family members of child/adolescent service recipients “Reporting Positively” about a particular survey domain is determined by those who responded that they “Strongly Agree” or “Agree” to the statements on the survey, when compared to all applicable responses. The United States (U.S.) averages are based on 2011 data – the most recent national figures available to OMHSAS at the time this report was written.

Figure 8. Family Member Access to Care

Access Outcomes Participation in

Treatment Planning Cultural Sensitivity

of Staff General Satisfaction

8

82.39% 83.89%

86.06% 85.71%

87.05%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about Access to Care: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


87.05% 83.30%

Family Members Reporting Positively about Access to Care: FY 2012 Comparison


Figure 9. Family Member Outcomes of Care




Figure 10. Family Member Participation in Treatment Planning




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58.40% 62.41%

61.06%

64.26% 62.62%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about Outcomes of Care: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


62.62% 64.10%

Family Members Reporting Positively about Outcomes of Care: FY 2012 Comparison

92.10%

89.26% 89.58% 91.49%

93.65%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about Participation in Treatment Planning:


0%

20%

40%

60%

80%

100%


93.65% 86.90%

Family Members Reporting Positively about Participation in Treatment Planning:

FY 2012 Comparison


Figure 11. Family Member Cultural Sensitivity of Staff




Figure 12. Family Member General Satisfaction with Services




10

92.10% 92.31% 91.67% 94.62% 93.73%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about Cultural Sensitivity of Staff: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


93.73% 93.00%

Family Members Reporting Positively about Cultural Sensitivity of Staff: FY 2012 Comparison

74.54%

77.21% 80.29%

78.00% 81.26%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about General Satisfaction with Services:


0%

20%

40%

60%

80%

100%


81.26% 83.60%

Family Members Reporting Positively about General Satisfaction with Services: FY 2012 Comparison


Figure 13. Family Member Social Connectedness


Functioning

Figure 14. Family Member Functioning


Functioning

11

79.27% 79.97% 82.53% 82.17%

83.09%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about Social Connectedness: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


83.09% 85.20%

Family Members Reporting Positively about Social Connectedness: FY 2012 Comparison

59.36% 62.26% 60.74%

65.25% 62.51%

50%

60%

70%

80%

90%

100%

FY 2008 FY 2009 FY 2010 FY 2011 FY 2012

Family Members Reporting Positively about Functioning: PA Multi-Year Comparison

0%

20%

40%

60%

80%

100%


62.51% 66.80%

Family Members Reporting Positively about Functioning: FY 2012 Comparison

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