Consumer Satisfaction Services, Inc.

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1 Consumer Satisfaction Services, Inc. Capital Region Annual Report July 2013-June 2014 PREPARED FOR: Capital Area Behavioral Health Collaborative (CABHC) Prepared By Consumer Satisfaction Services 4775 Linglestown Road Suite 201 Harrisburg, PA (717)

2 Consumer Satisfaction Services, Inc. Board of Directors Chair Vice Chair Secretary Treasurer Brian Havlik Steve Barndt Cindy Galliher Jaime Melnicove Chris Kroft Staff Executive Director C/FST Manager Survey Specialists Jessica Eaken Abby R. Robinson Martha Mercurio Trisha Ballester Bridget Horn Mary Bowen Consumer Satisfaction Services, Inc. (CSS), is a non-profit, tax exempt organization recognized by the Internal Revenue Service under Section 501 (C) (3) of the United States Tax Code.

3 Table of Contents Executive Summary. I. Overview of Improvement Activities 1 Request for Assistance.. 2 Demographic & Survey Information... 3 Satisfaction Results Implementation Outcomes Treatment Environment 32 Questions Regarding PerformCare Survey Question Tables by County and Age Group. 45

4 Executive Summary Who was surveyed? The survey represents 1,768 (n=1,768) respondents from the Capital Region representing 1,233 adults (69.7%) and 535 children (30.3%). Of the 1,233 adult consumers 1,215 (98.5%) responded for themselves. Parents and guardians responded for the remaining 18 adult consumers (1.5%). Parents and guardians responded for 488 of the 535 child consumers (91.2%). The remaining 47 child consumers (8.8%) responded for themselves. Data was collected by 7 interviewers from 45 treatment facilities in the Capital Region. The 1,233 adult consumers received treatment at 41 of the 45 facilities. The 535 child consumers received services from 20 of the 45 treatment facilities. Overall, 1,723 of the 1,768 interviews (97.5%) were face-to-face interviews and 45 (2.5%) were conducted by phone. Of the 1,233 adult interviews 1,203 (97.6%) were face-to-face interviews, the remaining 30 (2.4%) were conducted by phone. Of the 535 child interviews 520 (97.2%) were face-to-face interviews and the remaining 15 (2.8%) were conducted by phone. Gender: Overall, the sample is 48.4% female (856) and 51.6% male (912). Of the 1,233 adult consumers, 699 were female and 534 were male. Of the 535 child consumers, 157 were female and 378 were male. Type of Treatment: In all, 9 types of treatment were accessed by the respondents. The 1,233 recipients of adult services received 8 types of treatment including (24.2%) Mental Health Outpatient, (20.4%) Mental Health Inpatient, (16.8%) D&A Residential Rehab, (16.2%) Crisis Intervention, (9.5%) TCM Resource Coordination, (8.3%) TCM Intensive Case Management, (2.5%) Buprenorphine Coordination, and (2.0%) TCM Blended Case Management. The 535 recipients of child services received 8 types of treatment including (51.4%) Mental Health Outpatient, (13.1%) TCM Resource Coordination, (9.0%) TCM Blended Case Management, (7.3%) Crisis Intervention, (6.2%) TCM Intensive Case Management, (5.0%) RTF, (4.7%) Mental Health Inpatient, and (3.4%) D&A Residential Rehab. I

5 Implementation According to survey responses, consumers report some level of satisfaction with their services. This is reflected in an 79.6% satisfaction rate (Mean Satisfaction Level/Highest Possible Score) among the reports received from consumers as well as consumer responses to Question# 30, Overall, I am satisfied with the services with 85.8% agreement (Responses of 4 or 5). This pattern is consistent when consumers of adult and child services are considered separately with consumers of adult services reporting 84.3% overall satisfaction and consumers of child services reporting high overall satisfaction 89.3%. Respondents of reported high levels of satisfaction (85% or greater) for the following questions: (95.4%) child respondents and (87.2%) adult respondents reported that were informed about their rights and responsibilities regarding their treatment (Q18). (94.0%) child and (86.7%) adult consumers reported their provider asks before sharing personal information (Q21). (93.6%) of child and (88.9%) adult respondents felt comfortable asking questions about their treatment (Q19). consumers, (93.6%) reported that they are included in the development of their treatment plan (Q26), and (93.6%) of child consumers felt that they are an important part of the treatment process (Q27). (92.3%) of child and (88.2%) adult consumers feel that program staff respects their ethnic, cultural, and religious background (Q22). Additionally, child consumers (91.4%) and adult consumers (86.8%) reported that they feel safe at the facility (Q24). (89.0%) of child consumers report that they trust their service provider (Q23), (88.8%) reported that their provider explained the advantages of their therapy (Q28), and (87.9%) feel that their provider spends adequate time with them (Q20). Finally, (86.7%) of child consumers report that their provider informed them who to call with questions (Q13), and (85.0%) were offered to involve family, friends, significant others in their treatment (Q25). While satisfaction is generally high, further exploration is warranted regarding a few items: Approximately 1 in 3 of both child (26.9%) and adult (36.6%) respondents reported they did not have a choice when selecting their service provider (Q16). Additionally, about 1 in 4 consumers who received adult services (26.5%) and child services (18.9%) reported that they were not given information on how to get other needed services (Q14). consumers (22.5%) did not feel they had the option to change their service provider (Q17). Consumers who received adult services (21.0%) reported they were not given information on all the services available to them (Q15). Respondents who received adult services (20.0%) also reported that their provider did not inform them who to contact if they have questions about their services (Q13). Respondents who received adult services (19.5%) also felt their provider did not explain the limitations of their treatment (Q29). Finally, consumers of adult services (18.2%) did not feel that their provider informed them who to call if they have questions about their services (Q13). II

6 Outcomes The majority of consumers perceive that services have made their lives better in handling personal and social issues. Overall, approximately 38.2% to 71.2% of consumers believe services have improved their lives in each outcome area. Approximately 20.1% to 36.6% of consumers believe that no change has resulted from their services. Only 6.7% to 10.4% believes that things are worse as a result of services. Overall, the highest ratings for adult (74.3%) and child (63.9%) respondents reported improvement with (Q41) dealing with the specific problems or issues that led them to seek services. consumers reported high improvement (69.0%) with feeling good (hopeful) about the future (Q35), (69.0%) with managing daily problems (Q31), and (67.2%) with how they feel about themselves. Additionally, adult (65.7%) and child (67.7%) consumers also rate marked improvement with enjoying their free time (Q36). consumers reported improvement (65.0%) with feeling in control of their life (Q32, and child consumers (63.7%) reported improvement in strengthening their social support network (Q37). Recipients of adult services 28.1% reported things as being better when dealing with school or work (Q39) and 18.2% reported things as worse. As noted, 47.9% of the respondents reported this question did not apply to them. When these cases are removed, 54.0% report they were better dealing with school or work and 11.0% report it as worse. These figures represent a more accurate picture of the results. We welcome questions, comments and suggestions. Please contact: Ms. Abby Robinson C/FST Manager 4775 Linglestown Road, Suite 201 Harrisburg PA, (717) III

7 Overview of Improvement Activities The Capital Area Behavioral Health Collaborative (CABHC) represents Cumberland, Dauphin, Lancaster, Lebanon and Perry Counties and contracts with CSS to annually survey a sampling of Medicaid recipients in this five county area who have received mental health or addiction related services. The Survey During this annual reporting period of July 2013 until June 2014 Consumer Satisfaction Services (CSS) conducted 1,768 interviews with consumers at various locations: drug and alcohol facilities, consumer homes and the CSS office. Overall, 1,723 of the 1,768 interviews (97.5%) were face-toface interviews and 45 (2.5%) were conducted by phone. Data CSS upgraded from the Nexus 7 tablets to Verizon G-Pads. They have the same functionality and allow the surveyors to complete paperless interviews. However, they differ from the Nexus 7 in their ability to connect to the mobile internet. Data is now immediately transferred to a secure website instead of queuing on the tablet until a WI-FI connection is made. This significantly reduces the chances of lost data. System Focus The CABHC contract provides for a CSS System Improvement Committee (SIC). This committee is meant to identify specific improvements needed in services to consumers, utilizing the data gathered by the CSS surveys. There are 12 members from CABHC, the five counties, including but not limited to providers of D&A services, Single County Authorities, county mental health agencies, representatives from PerformCare. This year the SIC has focused on the high rates of recidivism for consumers of mental health inpatient services. A mini survey was created that would explore the cause of these high rates and hopefully shed some light on initiatives to decrease recidivism. The survey focuses on adult consumers of mental health inpatient services who were discharged and then readmitted within 30 days. The survey questions are focused on possible barriers to supports including natural, peer, and professional that may have contributed to the readmission. 1

8 Request for Assistance During the interview, if a Consumer indicates they are unhappy about something with their provider (based on the service and provider that is the focus of the survey), PerformCare or any other part of the MH system that can reasonably be addressed, the surveyor will ask the Consumer if they would like them (surveyor/css) to communicate this concern to the party they have a concern with, this is known as the Request for Assistance (RFA). A completed Request for Assistance is forwarded to PerformCare and Capital Area Behavioral Health Collaborative (CABHC) for action steps and follow up. There were three Requests for Assistance this contract year. CSS had two requests for assistance during the 1 st Quarter A RFA submitted August 27, 2013 was made by a consumer of a Philhaven day program who reported that she was discharged from the program without being given a chance. The new psychiatrist immediately discharged her when finding out that she was using an illicit substance without consulting her regular doctor. The consumer was upset because the new psychiatrist responded that if she was unwilling to quit, that there was nothing that they could do to help her. Her regular doctor apologized about the experience but she has since been unable to get back into the program. The consumer would like an apology from the facility and to be given a second chance. The program director responded from Philhaven by apologizing for the way that she was treated. This person also at the time of the incident requested that the discharging psychiatrist reconsider his decision but he remained firm that she was to be discharged. The program director mentioned in her letter that if the consumer was interested in re-admission that her case would be reviewed and she would not have to meet with the discharging psychiatrist. During a follow up call with this consumer, she stated that she was still not receiving services. Several attempts to contact consumer were made following provider response without success. A RFA submitted July 30, 2013 was made by a consumer who visited the Holy Spirit hospital emergency room for depression. She talked with crisis intervention. After an extremely long wait, a doctor came into the room, talked for a few minutes then discharged her. She was very upset that her issues were not taken more seriously and that she was sent home in the state that she was in. This was the second time that she needed help but was not admitted. The consumer requested an apology from the provider and for them to change their procedure and not turn away people in need who may leave there and die. The provider responded to the request by stating that they regretted the consumer was not kept informed of the wait time during her stay. The consumer was not satisfied with this response as it did not address the issue at hand which was being discharged without getting the help that she needed. This consumer was referred to the Complaint and Grievance department of PerformCare. CSS had no requests for assistance during the 2 nd Quarter CSS had one request for assistance during the 3 rd Quarter A RFA submitted on February 28, 2014 was made by a consumer of PA Counseling outpatient services who reported that he had not been able to see a psychiatrist in over a year. He reported that he needed his medication and was unable to obtain it without first seeing a psychiatrist. The consumer requested to see a psychiatrist and be given the correct medications that had helped him in the past. PA Counseling responded by informing the consumer that they did have a psychiatrist who would be able to see him in 2-3 weeks. Follow up calls to the consumer confirmed that he did receive an appointment and that he was satisfied with the outcome. CSS had no Request for Assistance for the 4 th Quarter

9 Capital Region Annual Report July June 2014 This section presents information collected during the contract year which includes data from July June Demographic and Survey Information Please Note: The use of the word significant in this document indicates that the observed differences in the data have been evaluated using appropriate statistical methods with the alpha level set =.05. A significant trend indicates a probability level which approaches significance i.e. the probability level is between.05 and 1.0. Frequencies may not sum to total (n=1,768) as individuals may have chosen not to respond to certain questions. Percentages may not sum to 100.0% due to rounding. The survey represents 1,768 (n=1,768) respondents from the Capital Region representing 1,233 adults (69.7%) and 535 children (30.3%). Of the 1,233 adult consumers 1,215 (98.5%) responded for themselves. Parents and guardians responded for the remaining 18 adult consumers (1.5%). Parents and guardians responded for 488 of the 535 child consumers (91.2%). The remaining 47 child consumers (8.8%) responded for themselves. consumers who responded for themselves reported significantly lower satisfied than those whose parent/guardians answered for them. There were no significant differences among adult consumers concerning who was interviewed. Who was Interviewed? 1400 Self (Consumer) Parent/Guardian Is the interview for an ADULT or CHILD 3

10 Data was collected by 7 interviewers from 45 treatment facilities in the Capital Region. The 1,233 adult consumers received treatment at 41 facilities. The 535 child consumers received services from 20 treatment facilities. Overall, 1,723 of the 1,768 interviews (97.5%) were face-to-face interviews and 45 (2.5%) were conducted by phone. Of the 1,233 adult interviews 1,203 (97.6%) were face-to-face interviews, the remaining 30 (2.4%) were conducted by phone. Of the 535 child interviews 520 (97.2%) were face-to-face interviews and the remaining 15 (2.8%) were conducted by phone. Method of Interview? 1400 In Person Phone Is the interview for an ADULT or CHILD Our analysis did not identify significant differences in total satisfaction concerning method of interview for either adult or child consumers. 4

11 Mean Total Satisfaction Score Method of Interview In Person Phone Is the interview for an ADULT or CHILD Below is a table of the method of interview by county for both and services. Method of Interview Total In Person Phone Base Cumberland Dauphin Lancaster Lebanon Perry Cumberland Dauphin Lancaster Lebanon Perry - County of Residence % 13.00% 6.70% % 20.70% 15.60% % 24.90% 22.20% % 8.40% 22.20% % 2.90% 0 - County of Residence % 5.40% 4.40% % 7.70% 4.40% % 11.10% 8.90% % 4.60% 8.90% % 1.40% 6.70% 5

12 Of the 1768 consumers, 369 (20.9%) reported they had been previously interviewed in the last year, 1,248 (70.6%) reported they had not been interviewed previously and 146 respondents (8.3%) were not sure. Of the 1,233 adult consumers, 260 (18.9%) reported they were previously interviewed in the last year, 872 (71.8%) reported they had not been previously interviewed, and 97 (9.3%) reported they were not sure. Of the 535 child consumers, 109 (20.4%) reported they were previously interviewed in the last year, 376 (70.3%) reported they had not been previously interviewed, and 49 (9.2%) reported they were not sure Has your provider interviewed you on your satisfaction level with services during the last year? 872 Yes No Not sure N/A Is the interview for an ADULT or CHILD 6

13 Mean Total Satisfaction Score Has your provider interviewed you on your satisfaction level with services during the last year? Yes No Not sure N/A Is the interview for an ADULT or CHILD Our analysis indicates that adult consumers whose provider did survey them within the last year reported significantly higher satisfaction than those who were not surveyed by their provider within the last year. There were no significant differences in reported satisfaction for child consumers in regard to provider satisfaction interviews within that last year. Mean Satisfaction Levels of Respondents Total Satisf action Score N Mean Std. Dev iation N Mean Std. Dev iation Has your prov ider interviewed you on your satisfaction level with serv ices during the last year? Yes No Not sure N/A Total

14 Gender: Overall, the sample is 48.4% female (856) and 51.6% male (912). Of the 1,233 adult consumers, 699 were female and 534 were male. Of the 535 child consumers, 157 were female and 378 were male Gender Female Male Is the interview for an ADULT or CHILD There were no significant differences in satisfaction between the genders for both adult and child consumers. Mean Satisfaction Levels of Respondents Total Satisf action Score Is the interview f or an ADULT or CHILD N Mean Std. Deviation N Mean Std. Deviation Gender Female Male Total

15 Frequency Mean Total Satisfaction Score Mean Satisfaction Score By Age Group Gender Female Male Is the interview for an ADULT or CHILD Age: Age of all respondents ranged from 4-86 years, with a mean age of (SD ) and median age of 30. Our analysis found a relationship between age and satisfaction for consumers of child services. Age of All and Respondents Mean =31.39 Std. Dev. = N =1, Age 9

16 Frequency Frequency Age: Age of adult respondents ranged from years, with a mean age of (SD= ) and median age of 40. Our analysis found no relationship between age and reported total satisfaction for adult respondents Mean =40.32 Std. Dev. = N =1, Age Age: Age of child respondents ranged from 4-19 years, with a mean age of (SD= 3.330) and median age of Our analysis found that consumers whose age was reported as 15 and 17 were significantly less satisfied than consumer s whose age was reported as 5, 7, 9, and Mean =10.79 Std. Dev. =3.33 N = Age 10

17 County of Residence: The table below shows the county of residence in alphabetical order. The largest number of respondents report residence in Lancaster (35.9%). The remaining respondents reported residence in Dauphin County (28.1%), Cumberland (18.20%), Lebanon (13.5%), and Perry (4.4%). County of Residence Cumberland Dauphin Lancaster Lebanon Perry County of Residence Base Total County of Residence Cumberland Dauphin Lancaster Lebanon Perry % 28.10% 35.90% 13.50% 4.40% % 29.40% 35.60% 12.50% 4.10% % 25.00% 36.40% 15.70% 5.00% Our analysis found no relationship between county of residence and reported total satisfaction for adult respondents. 11

18 Mean Satisfaction Score by County of Residence Total Satisf action Score N Mean Std. Deviation N Mean Std. Deviation County of Residence Cumberland Dauphin Lancaster Lebanon Perry Total Race: 1,162 respondents (65.7%) reported their race as White/Caucasian, 253 (14.3%) as African American, 214 (12.1%) as Latino/Hispanic, 113 (6.4%) as Multi-racial, 9 (0.5%) as Other, 9 (0.5%) as Asian/Pacific Islander, 5 (0.3%) as Native American, and 3 (0.2%) chose not to answer this question.. Our analysis found no relationship between race and reported total satisfaction for adult respondents. Base Total African American Asian/ Pacific Islander Hispanic/ Latino Native American / American Indian Race White / Caucasian Multi- Racial Other Did not answer 14.30% 0.50% 12.10% 0.30% 65.70% 6.40% 0.50% 0.20% % 0.60% 9.20% 0.40% 70.60% 3.10% 0.50% 0.20% % 0.40% 18.90% % 14.00% 0.60% 0.20% Treatment Facility: Data was collected from 45 Treatment Facilities in the Capital Region. The distribution of respondents is presented below. Mean Satisfaction scores are listed separately for and Services for each facility. To help with interpretation, scores indicate a high level of satisfaction, scores indicate some level of satisfaction and scores below 87 indicate some level of dissatisfaction. 12

19 Mean Satisfaction of Treatment Facilities Services Only Total Satisf act ion Score Name of Treatment Facility Dauphin County Philhav en Holy Spirit Hospital Lancaster County Fairmount Behav ioral Health Lancaster General Hospital PA Psy chiatric Institute Roxbury Psy chiatric Hospital Lancaster Regional Medical Center The Meadows The RASE Project Behav ioral Healthcare Corp Catholic Charities Commonwealth Clinical Group Communit y Serv ices Group (CSG) Franklin Family Serv ices NHS PA Counseling Serv ices The Stev ens Center Lebanon County Bowling Green/Brandy wine Clear Brook DA Rehab Serv ices Eaglev ille Hospital Py ramid Healthcare SACA Key stone Colonial House Valley Forge WDR Allenwood WDR Lebanon WDR York WDR Lancaster WDR Cove Forge Gaudenzia Com mon Ground Gaudenzia Concept 90 Gaudenzia Vantage Guadenzia Cham bers Hill Guadenzia Fountain Springs Firetree Conewago Sny der Firetree Conewago Place (hummelstown) Total Std. N Mean Dev iation

20 Mean Satisfaction of Treatment Facilities Services Only Total Satisf action Score Name of Treatment Facility Dauphin County Philhav en Holy Spirit Hospital Lancaster County Dev ereux Hoff man Homes Kidspeace George Jr Republic PA Psy chiatric Institute The Meadows Catholic Charities Community Serv ices Group (CSG) Franklin Family Serv ices NHS PA Counseling Serv ices The Stevens Center Lebanon Count y Clear Brook DA Rehab Serv ices Guadenzia Chambers Hill Total Std. N Mean Dev iation

21 Type of Treatment: In all, 9 types of treatment were accessed by the respondents. The 1,233 recipients of adult services received 8 types of treatment including (24.2%) Mental Health Outpatient, (20.4%) Mental Health Inpatient, (16.8%) D&A Residential Rehab, (16.2%) Crisis Intervention, (9.5%) TCM Resource Coordination, (8.3%) TCM Intensive Case Management, (2.5%) Buprenorphine Coordination, and (2.0%) TCM Blended Case Management. The 535 recipients of child services received 8 types of treatment including (51.4%) Mental Health Outpatient, (13.1%) TCM Resource Coordination, (9.0%) TCM Blended Case Management, (7.3%) Crisis Intervention, (6.2%) TCM Intensive Case Management, (5.0%) RTF, (4.7%) Mental Health Inpatient, and (3.4%) D&A Residential Rehab. Is the interview for an ADULT or Total CHILD Base Level of Care Crisis Intervention RTF (Residential Treatment Facility) Mental Health Inpatient Hospitalization Buprenorphine Coordination Mental Health Outpatient Clinic TCM ICM TCM BM TCM RC D&A Non-Hospital Residential Rehab % 16.20% 7.30% % % % 20.40% 4.70% % 2.50% % 24.20% 51.40% % 8.30% 6.20% % 2.00% 9.00% % 9.50% 13.10% % 16.80% 3.40% Our analysis indicated a few incidences of significant satisfaction differences: consumers who received D&A Rehab were significantly less satisfied than all other adult levels of care. Additionally, those who received MH Inpatient services were significantly less satisfied than those who received TCM RC, TCM BM, and Buprenorphine Coordination. Finally, adult consumers who received Crisis Intervention and MH Outpatient were significantly less satisfied with services than those who received TCM BC, and Buprenorphine Coordination. consumers who received D&A Rehab were significantly less satisfied than those who received Crisis Intervention, MH Outpatient, TCM (ICM, BM, RC), and RTF. Additionally, those who received RTF and Crisis Intervention were significantly less satisfied than those who received TCM ICM. Finally, those who received MH Inpatient were significantly less satisfied than those who received MH Outpatient, TCM (ICM, BM, RC). 15

22 Total Satisf action Score Level of Care Crisis Interv ention Mental Health I npat ient Hospitalization Buprenorphine Coordination Mental Health Outpatient Clinic TCM ICM TCM BM TCM RC D&A Non-Hospital Residential Rehab Total Crisis Interv ention RTF (Residential Treatment Facility) Mental Health I npat ient Hospitalization Mental Health Outpatient Clinic TCM ICM TCM BM TCM RC D&A Non-Hospital Residential Rehab Total Std. N Mean Dev iation

23 Service Delays: Where there delays before starting these services? Total Q11 Were there delays before starting these services? Yes No N/A Base Cumberland Dauphin Lancaster Lebanon Perry Cumberland Dauphin Lancaster Lebanon Perry - County of Residence % 11.90% 13.00% 12.40% % 22.00% 18.70% 31.30% % 17.40% 25.90% 25.90% % 9.60% 8.00% 11.90% % 4.60% 2.90% 0.50% - County of Residence % 6.40% 5.00% 7.00% % 13.80% 7.60% 1.00% % 9.20% 12.50% 3.50% % 3.20% 4.80% 6.50% % 1.80% 1.70% 0 consumers who reported no delays before starting services reported significantly higher satisfaction than those who reported there were delays before starting services. Mean Satisfaction of Service Delays Total Satisf action Score N Mean Std. Dev iation N Mean Std. Dev iation Q11 Were there delays bef ore starting these serv ices? Yes No N/A Total

24 Mean Total Satisfaction Score Q11 Were there delays before starting these services? Yes No N/A Is the interview for an ADULT or CHILD 18

25 Frequency I. Satisfaction Overall Satisfaction: All CSS satisfaction items were added to form a Total Satisfaction Score (TSS). The scale contained 29 items that ranged from 1 ( ) to 5 ( Agree). Higher scores on questions represent higher satisfaction. The scale had a possible range of Scores indicate a high level of satisfaction, scores indicate some level of satisfaction and scores below 87 indicate some level of dissatisfaction. The overall mean for all respondents for Total Satisfaction Score (TSS) was with a standard deviation and median 117. The TSS scores ranged from As can be seen in the histogram below, the distribution of Total Satisfaction Scores is concentrated in the positive direction Mean = Std. Dev. = N =1, Total Satisfaction Score 19

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