Jon M. Plapp

Parental satisfaction and outcome: a 4-year study in a child and adolescent mental health service

Objective: The aim of this paper is to examine the facets of parental satisfaction and its relationship with clinician-rated outcome in a child and adolescent mental health service. Method: Patients (n = 1278) consecutively assessed between 1992 and 1996 were included in the study. When treatment ended, clinicians rated the outcome of the intervention and parents were asked to complete a satisfaction questionnaire. Results: Sixty-nine per cent of cases were rated by clinicians as having a positive outcome. Outpatients were more likely to be given a positive rating than inpatients. Satisfaction questionnaires were returned by 40% of parents; 76% of these were mostly or very satisfied. Satisfaction scores increased with the number of outpatient sessions attended but did not differ between inpatients and outpatients. There was a significant but small agreement (27% better than chance) between clinicians’ rating of outcome and parental satisfaction. Level of agreement varied according to service provided and the number of sessions attended. While rates of positive outcome increased over the study period, ratings of satisfaction were stable. Conclusions: Overall, ratings of satisfaction were comparable with those reported in other studies. Variations in concordance between parents and clinicians show that outcome and satisfaction, although related, are different constructs influenced by different factors depending on the services provided. Focusing on specific aspects of satisfaction, as opposed to global measures, may be more useful for services, although such undertakings must be supported with efforts to improve clinical outcomes.

Family environment in attention deficit hyperactivity, oppositional defiant and conduct disorders.

Objective: This study aims to ascertain whether there were differences in family environment among patients with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct disorder. Method: The records of 233 patients, selected for high or low scores on a scale that taps ADHD symptoms, were reviewed by three clinicians who made DSM-IV diagnoses and rated the family environment with the Global Family Environment Scale (GFES). Self-report data obtained from the parent and child versions of the Child Behaviour Checklist were also used. The quality of the family environment was then compared between the various diagnostic groups. Results: A poorer family environment was associated with conduct disorder and oppositional defiant disorder and predicted a worse outcome (e.g. admission to a non-psychiatric institution, drug and alcohol abuse). Quality of the family environment did not vary according to ADHD diagnosis or gender. Conclusions: There seems to be no association between the quality of the family environment and a diagnosis of ADHD among referred adolescents. However, there is an association with conduct disorder. Interventions that improve family environment in the early years of life may prevent the development of conduct problems.

Sources of Unreliability of DSM-III Axis IV

Lists of stressors recorded for 159 adolescents and rated by two judges showed poor agreement on stressor identification but good concordance for the most severe stressor identified for each patient. Good agreement was also found for a short checklist of chronic stressors. When individual stressors were rated by four judges for 27 patients, global Axis IV ratings were largely determined by the rating of the most severe event. Those results suggest that Axis IV can be made more reliable and easier to use by concentrating on the identification of severe events.

Ratings of Psychosocial Stressors in Adolescence Using DSM-III Axis IV Criteria

Abstract Professionals working with adolescents rated the severity of 77 psychosocial stressors on either a three-point ( N = 17), a five-point ( N = 20) or a seven-point scale ( n = 17) using DSM-III Axis IV criteria, and subsequently rated frequency of encounter in their individual caseloads. Frequency of encounter (experience) had a negligible effect on ratings. Preference and reliability for the three-point scale was lowest, but mean severity ratings had within scale reliabilities and between scale correlations of 0.9 or higher. The results are compared with the DSM-III severity examples and other life event scales.