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Online ISSN: 1099-176X Print
ISSN: 1091-4358 Copyright © 1999 John Wiley & Sons, Ltd. |
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| Organizational determinants of psychosocial treatment activity of providers in Va mental health facilities |
| Jeffrey A. Alexander 1 *, Joan R. Bloom 2, James L. Zazzali 2, Kimberly Jinnett 3 |
| 1Department of Health Management and Policy, School of Public Health, The University of Michigan, and Department of Veteran's Affairs, 109 Observatory, Ann Arbor, MI 48103, USA. 2Department of Health Policy and Management, University of California, Berkeley, CA, USA 3RAND, 1700 Main St, Santa Monica, CA, USA |
*Correspondence to Jeffrey A. Alexander, Department of Health Management and Policy, School of Public Health, The University of Michigan, and Department of Veterans' Affairs, 109 Observatory, Ann Arbor, MI 48103, USA.
Funded by:
The Seriously Mentally Ill Treartment, Research and Evaluation Center,
Ann Arbor, MI
Center For Mental Health Services Research at the University of California,
Berkeley
| Abstract |
| Objective: To identify the determinants of level and intensity of psychosocial treatment
activity among staff who deliver services to the severely and mentally ill. Methods: The study sample consisted of 769 treatment providers working in 77 units in 29 VA mental health facilities. Level of psychosocial care was measured as the number of patient contacts and total hours spent in psychosocial care over a 1 week period. Intensity of psychosocial care was measured as the average time per patient contact. We used hierarchical linear modeling (HLM) to examine the association between level and intensity of care and three categories of determinants - individual provider attributes, work characteristics and treatment setting characteristics. Results: Providers' occupation is related to both the level and intensity of care. Providers with administrative responsibilities also have fewer patient contacts and lower intensity of such contacts. Providers who perceived their pay and benefits more positively had fewer patient contacts and less intensive patient contacts. Positive relationships with patients and providers were also associated with greater levels and intensity of psychosocial treatment activity among providers. Finally, statistically significant differences in psychosocial treatment activity among units were identified although such differences are not attributable to unit size, patient cohort severity or unit workload. Conclusions: Level and intensity of psychosocial treatment activity vary systematically by individual attributes of providers, characteristics of the work they perform and attributes of the treatment setting. These factors may provide the basis for designing interventions to modify provider behavior in a manner consistent with emerging financial pressures and treatment modalities for the seriously mentally ill. Copyright © 1999 John Wiley & Sons, Ltd. |