ABSTRACT
The current investigation sought to provide reliability and validity evidence for the Child Outcomes Survey (COS), a brief measure designed with a dual purpose to measure functioning and therapeutic relationship and to serve as a clinician-caregiver communication tool. Exploratory (EFA) and confirmatory factor analyses (CFA) were performed using a sample of 774 responses collected from 15 provider sites throughout the state of Pennsylvania. Results of the EFA (n = 387) uncovered a three factor structure (family functioning, child functioning, and therapeutic relationship) which was confirmed in the CFA (n = 387). The internal consistency reliability of the three subscales ranged from α = .76 to α = .91. There was a significant relationship between the therapeutic relationship subscale and the use of the COS as a communication aid (r s = .50, p < .001). Findings support the COS as an accurate measure of functioning and therapeutic relationship and its utility as a communication aid between clinician and caregiver.
Subject(s)
Child Behavior Disorders/therapy , Community Mental Health Services , Outcome Assessment, Health Care/statistics & numerical data , Professional-Patient Relations , Psychometrics/statistics & numerical data , Psychotherapy , Adaptation, Psychological , Adolescent , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Child, Preschool , Cross-Sectional Studies , Data Collection/statistics & numerical data , Family Relations , Female , Humans , Male , Pennsylvania , Professional-Family Relations , Reproducibility of Results , Social Adjustment , Surveys and QuestionnairesABSTRACT
A pre-post study design was used to look at changes in behavioral health care services and costs for Medicaid-eligible individuals with schizophrenia in a managed care (MC) carve-out compared to a fee-for-service (FFS) program in Pennsylvania between 1995 and 1998. Statistically significant reductions of 59% were found in hospital expenditures in the MC program compared to 18.3% in the FFS program. The decline in hospital costs was due to dramatic fee reductions in the MC site. No significant differences in overall ambulatory utilization were found in either program; however, ambulatory expenditures rose 57% in the MC program versus a decline of 11% in fee for service. The ambulatory cost increase resulted from a cost shift between county block grant funds, and Medicaid funds, with no additional revenues provided to outpatient providers. Study implications are that cost reductions from MC are mainly due to reducing utilization and payments to hospitals, similar to the findings for private sector programs.
