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Consumer Quality Index for Shelter
                         Services
       Measuring client experiences with shelter services
  for homeless adults, homeless youth and battered women
                                       in the Netherlands

                                                  Judith Wolf
                                      Mariëlle Beijersbergen
                                        Jolanda Asmoredjo
                                             Milou Christians


       Research Centre for Social Care (Omz)
Content

1. Background
2. Pilot survey
3. Psychometric analyses
4. Multilevel analyses
5. Adjusted instrument
6. Future developments
1. Background


     What is a Consumer Quality Index?


     • Standardised method to measure client experiences with health
     care.

     • Strict guidelines for development, use of instrument, data
     analyses and reporting (developed and monitored by Centre for
     Client Experience with Care - CKZ).

     • Two types of CQ-questionnaires: experience and importance

     • Measurements can be used for internal quality control and
     external accountability purposes.

     • Information for clients, shelter organisations, government, etc.
1. Background


     Importance of a CQI for shelter organisations
     • Little known about how clients experience shelter services

     • Little known about what clients find important about care

     • Sector uses variety of instruments:
         • developed for other target groups
         • no standardised instruments (reliability, validity, etc)
         • no comparisons possible


     Necessities:
     • Standardised instrument

     • Possibility for benchmarking
1. Background


    Preparatory research pilot CQI Shelter services

    Sources:
    • Literature search
    • Expert interviews
    • Focus group discussions with stakeholders (clients, workers)
    • Concept mapping method (clients, workers)


    Process:
    • Pre-pilot & pilot survey
    • Monitored by Centre of Client experiences with Care (CKZ) &
    advisory council
2. Pilot survey

  • 3 target groups: battered women, homeless adults and
  homeless youth (20 shelter facilities per target group)


  • 2 versions of CQI-SS: ambulant (67) & residential (78)


  • Pilot questionnaire: 42-52 items on clients’ experience:
           - Contact with worker
          - Appropriate care & counselling
          - Information
          - Children
          - Received care
          - Outcomes of care
          - Living conditions (residential version)


  • Standard CQI answer categories: 1=never - 4=always
2. Pilot survey

   Response pilot questionnaire


   • 848  744 questionnaires to be used (+ 116 retest)


   • Battered women 34%
   • Homeless adults 37%
   • Homeless youth 29%


   • 12 respondents per shelter
3. Psychometric analyses

  Factory analyses

 • 3-4 reliable scales (Cronbach alphas .72 - .91)
  Table: Cronbach’s alphas per CQI scale
                                   Hom.     Bat.     Hom.
   Scale (nr. items)   Total      adults   women     youth
                        (N)         (N)      (N)      (N)
   Client-worker        .84         .85      .81      .86
   interaction (4)     (693)       (269)    (246)    (215)
   Received care        .90         .90      .89      .91
   (10)                (693)       (255)    (231)    (207)
   Outcomes of          .87         .87      .87      .86
   care (5)            (709)       (264)    (237)    (208)
   Living conditions    .77         .79      .72      .77
   (residential) (6)   (499)       (207)    (183)    (109)
3. Psychometric analyses

  Retest stability

 Table : Pearson’s Correlations Test-retest: sufficiently reliable over time
 Scale                         Total           Homeless           Battered
                         (NRange=114-115)        adults            women
                                             (NRange=57-58)     (NRange=57-58)

 Client interaction            .67                 .62                .71

 Received care                 .67                 .69                .66
 Outcomes                      .52                 .59                .47

 Living conditions             .62                 .54                .69
 (residential)
4. Multilevel analyses
 • Controlled for client background characteristics influencing CQI score
        Table: Intraclass correlations (ICC’s)
       Scale                              N clients   ICC        ICC
                                           (units)            controlled*
       Client-worker interaction
       Homeless adults                    266 (18)    .23**      .17**
       Battered women                     231 (24)    .03        .03
       Homeless youth                     216 (18)    .15**      .16**
       Received care
       Homeless adults                    266 (18)    .37**      .31**
       Battered women                     231 (24)    0          0
       Homeless youth                     216 (18)    .23**      .22**
       Results of care
       Homeless adults                    266 (18)    .20**      .15**
       Battered women                     231 (24)    .05        .02
       Homeless youth                     216 (18)    .07*       .06
       Living conditions (residential)
       Homeless adults                    213 (14)    .35**      .20**
       Battered women                     193 (20)    .11*       .11*
       Homeless youth                     117 (10)    .16*       .15*
5. Adjusted instrument


      Content CQI-SS

      • Background questions
      • (Living conditions in shelter)
      • Client-worker interaction
      • Received care
      • Results of care
      • Overall opinion of facility (grade 0-10)
      • Final questions
5. Adjusted instrument


  Table : CQI-SS: Scales & items measuring cliënt experiences
  Scale                 Number Example
                        of items
  Client-worker             4     Does the employee take you seriously?
  interaction
  Received care            10     Do you receive as much assistance as you
                                  need?
  Results of care           5     As a result of the assistance, are you able to
                                  make better decisions about your life?
  Living conditions         6     Is it clean in the facility?
  (residential)
  Separate items           13     - Do you receive advice about your safety?
                                  - Have any agreements been made with you
                                  about the supervision of your children?
                                  - How do you rate this facility? 0 means: really
                                  poor. 10 means: excellent
6. Future developments


 CQI-Shelter Services from 2011

     • CQI-SS will be publicly available in 2011, on website
     CKZ


     • CKZ will provide Quality mark of CQI if
     measurements are done with approved CQI-instrument
     by certified research organisations.


     • Building up benchmark dataset: comparing within and
     between organisations (over time)
Conclusion

  • CQI-SS measures client experiences from the perspectives
  of the clients.




  • Widely usable instrument for homeless adults, homeless
  youth and battered women




  • Good psychometric properties: reliable and with high
  discriminative power (and valid – results not presented)
Thank you for your attention

          Contact
        Judith Wolf
     j.wolf@elg.umcn.nl

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The Psychometric Qualities of a Consumer Quality Index Assessing Clients’ Experiences with Services for Homeless People, Homeless Youth and Battered Women

  • 1. Consumer Quality Index for Shelter Services Measuring client experiences with shelter services for homeless adults, homeless youth and battered women in the Netherlands Judith Wolf Mariëlle Beijersbergen Jolanda Asmoredjo Milou Christians Research Centre for Social Care (Omz)
  • 2. Content 1. Background 2. Pilot survey 3. Psychometric analyses 4. Multilevel analyses 5. Adjusted instrument 6. Future developments
  • 3. 1. Background What is a Consumer Quality Index? • Standardised method to measure client experiences with health care. • Strict guidelines for development, use of instrument, data analyses and reporting (developed and monitored by Centre for Client Experience with Care - CKZ). • Two types of CQ-questionnaires: experience and importance • Measurements can be used for internal quality control and external accountability purposes. • Information for clients, shelter organisations, government, etc.
  • 4. 1. Background Importance of a CQI for shelter organisations • Little known about how clients experience shelter services • Little known about what clients find important about care • Sector uses variety of instruments: • developed for other target groups • no standardised instruments (reliability, validity, etc) • no comparisons possible Necessities: • Standardised instrument • Possibility for benchmarking
  • 5. 1. Background Preparatory research pilot CQI Shelter services Sources: • Literature search • Expert interviews • Focus group discussions with stakeholders (clients, workers) • Concept mapping method (clients, workers) Process: • Pre-pilot & pilot survey • Monitored by Centre of Client experiences with Care (CKZ) & advisory council
  • 6. 2. Pilot survey • 3 target groups: battered women, homeless adults and homeless youth (20 shelter facilities per target group) • 2 versions of CQI-SS: ambulant (67) & residential (78) • Pilot questionnaire: 42-52 items on clients’ experience: - Contact with worker - Appropriate care & counselling - Information - Children - Received care - Outcomes of care - Living conditions (residential version) • Standard CQI answer categories: 1=never - 4=always
  • 7. 2. Pilot survey Response pilot questionnaire • 848  744 questionnaires to be used (+ 116 retest) • Battered women 34% • Homeless adults 37% • Homeless youth 29% • 12 respondents per shelter
  • 8. 3. Psychometric analyses Factory analyses • 3-4 reliable scales (Cronbach alphas .72 - .91) Table: Cronbach’s alphas per CQI scale Hom. Bat. Hom. Scale (nr. items) Total adults women youth (N) (N) (N) (N) Client-worker .84 .85 .81 .86 interaction (4) (693) (269) (246) (215) Received care .90 .90 .89 .91 (10) (693) (255) (231) (207) Outcomes of .87 .87 .87 .86 care (5) (709) (264) (237) (208) Living conditions .77 .79 .72 .77 (residential) (6) (499) (207) (183) (109)
  • 9. 3. Psychometric analyses Retest stability Table : Pearson’s Correlations Test-retest: sufficiently reliable over time Scale Total Homeless Battered (NRange=114-115) adults women (NRange=57-58) (NRange=57-58) Client interaction .67 .62 .71 Received care .67 .69 .66 Outcomes .52 .59 .47 Living conditions .62 .54 .69 (residential)
  • 10. 4. Multilevel analyses • Controlled for client background characteristics influencing CQI score Table: Intraclass correlations (ICC’s) Scale N clients ICC ICC (units) controlled* Client-worker interaction Homeless adults 266 (18) .23** .17** Battered women 231 (24) .03 .03 Homeless youth 216 (18) .15** .16** Received care Homeless adults 266 (18) .37** .31** Battered women 231 (24) 0 0 Homeless youth 216 (18) .23** .22** Results of care Homeless adults 266 (18) .20** .15** Battered women 231 (24) .05 .02 Homeless youth 216 (18) .07* .06 Living conditions (residential) Homeless adults 213 (14) .35** .20** Battered women 193 (20) .11* .11* Homeless youth 117 (10) .16* .15*
  • 11. 5. Adjusted instrument Content CQI-SS • Background questions • (Living conditions in shelter) • Client-worker interaction • Received care • Results of care • Overall opinion of facility (grade 0-10) • Final questions
  • 12. 5. Adjusted instrument Table : CQI-SS: Scales & items measuring cliënt experiences Scale Number Example of items Client-worker 4 Does the employee take you seriously? interaction Received care 10 Do you receive as much assistance as you need? Results of care 5 As a result of the assistance, are you able to make better decisions about your life? Living conditions 6 Is it clean in the facility? (residential) Separate items 13 - Do you receive advice about your safety? - Have any agreements been made with you about the supervision of your children? - How do you rate this facility? 0 means: really poor. 10 means: excellent
  • 13. 6. Future developments CQI-Shelter Services from 2011 • CQI-SS will be publicly available in 2011, on website CKZ • CKZ will provide Quality mark of CQI if measurements are done with approved CQI-instrument by certified research organisations. • Building up benchmark dataset: comparing within and between organisations (over time)
  • 14. Conclusion • CQI-SS measures client experiences from the perspectives of the clients. • Widely usable instrument for homeless adults, homeless youth and battered women • Good psychometric properties: reliable and with high discriminative power (and valid – results not presented)
  • 15. Thank you for your attention Contact Judith Wolf j.wolf@elg.umcn.nl

Editor's Notes

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  4. Niet tevredenheid.. Niet iedereen hoeft het wiel opnieuw uit te vinden Wetenschappelijk onderbouwd, met nadrukkelijke inbreng van het veld opgesteld Vergelijkbare informatie over verschillende zorgaanbieders Kwaliteitseisen
  5. Aantal vragen en verschil mo,vo, zjj
  6. Aantal vragen en verschil mo,vo, zjj