Mental Health Treatment Quality, Access, and Satisfaction: Optimizing Staffing in an Era of Fiscal Accountability

Boden, Matthew Tyler; Smith, Clifford A.; Klocek, John; Trafton, Jodie A.

doi:10.1176/appi.ps.201800229

Cited by 18 publications

(28 citation statements)

References 18 publications

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“…efficient availability of outpatient and inpatient services for all consumers, is likely to improve consumer outcomes for the mental health services provided [11,12]. This finding aligns with previous research, for example, Kunkel, Rosenqvist [11] who found a significant correlation between the health systems structure and process indicators on the outcome of mental health services in Sweden.…”

Section: Plos Onesupporting

confidence: 86%

“…This finding aligns with previous research, for example, Kunkel, Rosenqvist [11] who found a significant correlation between the health systems structure and process indicators on the outcome of mental health services in Sweden. Similarly, Boden, Smith [12] concluded that mental health staffing ratios had substantial positive relationships with overall mental health treatment access and quality in the USA. Although previous studies in Sweden and USA have emphasised the positive impact of the health systems structure on outcome of mental health services, they were limited to the perspectives of mental health professionals, without input from consumers.…”

Section: Plos Onementioning

confidence: 99%

“…Although some studies have suggested the need to incorporate consumers' perspectives into mental health quality assessment [10], there is little evidence to suggest that this is occurring successful, particularly into clinical practice. Research evidence on mental health quality assessment has been limited to service providers, particularly in developed countries (eg, Sweden [11], USA [12].…”

Section: Introductionmentioning

confidence: 99%

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Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana – structural equation modelling.

Badu¹,

O’Brien²,

Mitchell³

et al. 2020

PLoS ONE

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Introduction Incorporating consumers' perspectives into the quality of mental health service measurement is a growing priority among mental health professionals' and policymakers. Despite this, there is limited empirical evidence related to consumer perspectives of quality of mental health services. This study, therefore, aims to measure the mediation and moderation effects of health system structure and process on mental health quality in Ghana. Methods A random sample of 510 consumers were recruited to complete the Verona Satisfaction Scale (54-items), together with the WHO Disability Assessment Instrument (36 items) using the Redcap application. Confirmatory factor analysis (CFA) and Structural Equation Modelling were used to test the hypothesised theory using STATA 15. Results The CFA showed that the hypothesised model had a good fit to the data. The findings confirmed the hypothesis that the process constructs mediate the relationship between the health system structure and the outcome of mental health services. Specifically, the health system structure had a positive and significant causal relationship with the mediator-process (β = 0.60; p<0.01) and outcome (β = 0.47; p<0.01). Additionally, the mediator-process had a positive causal relationship with the outcome of the mental health services (β = 0.32; p<0.01). Insurance status (β = 0.07; p>0.05) and type of services (β = 0.025; p>0.05) had a positive moderating effect on the relationship between health system structure and outcome but were not significant.

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Section: Plos Onesupporting

confidence: 86%

Section: Plos Onementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana – structural equation modelling.

Badu¹,

O’Brien²,

Mitchell³

et al. 2020

PLoS ONE

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“…Reliance upon efficiency-based models, and specifically, modification of productivity, to improve treatment outcomes is appealing given the high direct costs of adding and maintaining staff. Yet, we have found that a population-based model is of greater importance than an efficiency-based model for ensuring treatment quality and population access to the full continuum of mental health services [ 4 ]. Specifically, using data from the from the Veterans Health Administration (VHA), the largest integrated mental health treatment program in the United States, we found that mental health staffing ratios (a) moderately (and positively) predicted mental health treatment quality, access, continuity and satisfaction, and (b) were stronger predictors of these outcomes than were staff productivity and wait-times.…”

Section: Introductionmentioning

confidence: 99%

“…In the current study, we advance the empirical literature on mental health staffing, staff productivity and treatment while addressing the limitations of Boden and colleagues [ 4 ] and other studies on mental health staffing models (e.g., which focus on the psychiatry workforce [ 3 ] or on community mental health caseload calculations [ 5 ]) by conducting a longitudinal investigation of VHA mental health staffing, staff productivity and treatment based on an information-theoretic approach. Longitudinal analyses that include repeated measurements of individual respondents, which in this study are VHA facilities: (a) reduce the likelihood that results are not biased by anomalous results obtained at one moment in time (i.e., cross-sectional design), and (b) allow for examination of both within- and between-facility variation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Investigation of population-based mental health staffing and efficiency-based mental health productivity using an information-theoretic approach

2021

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Background Healthcare systems monitor and improve mental health treatment quality, access, continuity and satisfaction through use of population-based and efficiency-based staffing models, the former focused on staffing ratios and the latter, staff productivity. Preliminary evidence suggests that both high staffing ratios and moderate-to-high staff productivity are important for ensuring a full continuum of mental health services to indicated populations. Methods & findings With an information-theoretic approach, we conducted a longitudinal investigation of mental health staffing, productivity and treatment at the largest integrated healthcare system in American, the Veterans Health Administration (VHA). VHA facilities (N = 140) served as the unit of measure, with mental health treatment quality, access, continuity and satisfaction predicted by facility staffing and productivity in longitudinal mixed models. An information-theoretic approach: (a) entails the development of a comprehensive set of plausible models that are fit, ranked and weighted to quantitatively assess the relative support for each, and (b) accounts for model uncertainty while identifying best-fit model(s) that include important and exclude unimportant explanatory variables. In best-fit models, higher staffing was the strongest and most consistent predictor of better treatment quality, access, continuity and satisfaction. Higher staff productivity was often, but not always associated with better treatment quality, access, continuity and satisfaction. Results were further nuanced by differential prediction of treatment by between- and within-facility predictor effects and variable interactions. Conclusions A population-based mental health staffing ratio and an efficiency-based productivity value are important longitudinal predictors of mental health treatment quality, access, continuity and satisfaction. Our longitudinal design and use of mixed regression models and an information-theoretic approach addresses multiple limitations of prior studies and strengthen our results. Results are discussed in terms of the provision of mental health treatment by healthcare systems, and analytical modeling of treatment quality, access, continuity and satisfaction.

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Barriers and Facilitators to Staff Recruitment and Retention for ACT Teams: Perspectives of Staff and Participants

Tepper,

Le Beau,

Clark

et al. 2024

J Behav Health Serv Res

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Mental Health Treatment Quality, Access, and Satisfaction: Optimizing Staffing in an Era of Fiscal Accountability

Cited by 18 publications

References 18 publications

Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana – structural equation modelling.

Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana – structural equation modelling.

Investigation of population-based mental health staffing and efficiency-based mental health productivity using an information-theoretic approach

Barriers and Facilitators to Staff Recruitment and Retention for ACT Teams: Perspectives of Staff and Participants

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