190
ATTITUDES AND PERCEPTION OF ATTITUDE CHANGES WITHIN THE INTERDISCIPLINARY STAFF OF AN EVENING MENTAL HEALTH CLINIC ROY H.
SCHLACHTER,
M.S.W., WILLIAM C. HOUSE.
and SHELDON I. MILLER,
PH.D.
M.D.
ABSTRACT
A study was made of the attitudes of a multidisciplinary staff of an evening mental health clinic. The focus of the clinic is on short-term treatment, and one of the main purposes of the study was to investigate the reactions of staff members to this type of treatment orientation. Results indicated that staff members, when considered as a whole felt that their confidence in their short-term treatment skills and their belief in the effectiveness of a short-term, interdisciplinary treatment center increased over the course of the first year the clinic was open. These results were not consistent across disciplines, and possible reasons for this inconsistency were discussed. the paucity of mental health services and the of mental health practitioners in the Cleveland area, the Mental Health was established at Cleveland Metropolitan General Hospital. Funding provided by the Cuyahoga County Mental Health and Retardation Board enabled the hiring of 25 part-time psychiatrists, psychologists and social workers to attempt to provide interdisciplinary, short-term crisis-oriented treatment services to citizens of Cuyahoga County, 12 years old and older. Led by a full-time clinic director (M.S.W.), the 25 staff members were divided into teams for each of the five week nights. One psychiatrist, two psychologists and two social workers on each team would attempt to work together to provide needed services between 6.00 p.m. and 10.00 p.m. All of the staff members with exception of the full-time director and the fulltime secretary were employed during the daytime hours in other settings. Individuals were hired representing public services, private practice and academic interests. The diversity in backgrounds as well as in discipline posed the potential for problems to develop among the staff members, but also offered a potential for the development of mutual understanding, interdependence and coordinated efforts. As the clinic developed, an opportunity existed to evaluate not only the needs for services in the community, but also to evaluate the attitudes and reactions of this diverse staff both to the function of the clinic and to each other. Given the relatively large number of staff members at the clinic, and also considering the fact that three of the traditional mental health professions were represented, it seemed that the situation offered a valuable opportunity for systematic research into the question of the attitudes which the staff members held for each other and toward their work. Since all of the staff came from full-time work settings within the community, a further question involved the effect of this experience on their attitudes towards their own work and towards their own colleagues in their full-time employment.Whereas in
existing RECOGNIZING matching shortage Clinic Evening
for Ambulatory Roy H. Schlachter is currently Administrative Assistant to the Department of services Cleveland Metropolitan general Hospital; William C. House is an Assistant Professor of Psychiatry, Case Westerin Reserve University at Cleveland Metropolitan General Hospital; Sheldon I. Miller is Associate Professor of Psychiatry, Case Western Reserve University and Associate Director of Psychiatry at Cleveland Metropolitan
Psychiatry
General
Hospital.
Downloaded from isp.sagepub.com at The University of Iowa Libraries on June 17, 2015
191 the clinic most of the staff was primarily involved in direct patient service, the same staff was heavily involved in other aspects of health delivery during their full-time job. For many, this experience could well change their feelings about their full-time occupation, particularly for those primarily involved in either teaching or administration. Another area in which the staff functioned differently at night versus during their full-time daytime occupation was in the variety of treatment used in the evening clinic versus the daytime job. For many of the staff, this was their first experience in planned short-term treatment, and for some it was hypothesized that this switch from longer term therapy to which they were accustomed, might require a considerable adjustment. In an attempt to answer some of these qustions (which in a sense apply to the larger issues of team and professional identity and professional competence) a study was conducted to assess the attitudes of the members of the Evening Mental Health Clinic. A questionnaire was developed which contained items attempting to define many of the above variables. This report, however, will concentrate on that portion of the study which attempted to measure the perceived change in attitudes toward the function and competence of the various disciplines and toward the effectiveness of short-term and long-term treatment methods. This study was performed almost exactly one year after the opening of the clinic. Twenty-five of the respondents to the questionnaire were the members of the original clinic staff, and had therefore functioned in the setting for a full year. METHOD
The tool used was a questionnaire constructed by the authors which required each staff member to evaluate their current perceptions as well as their memory of their perceptions one year ago. The responses were made along a seven-point continuum for which one endpoint was labeled either &dquo;low confidence&dquo;, &dquo;low understanding&dquo;, or &dquo;low effectiveness&dquo;, depending on the question, and the opposite extreme was correspondingly labeled as &dquo;high&dquo; confidence, understanding or effectiveness. Responses were given a score ranging from one to seven, with one designating a response at the &dquo;low&dquo; end of the scale and seven designating a response at the &dquo;high&dquo; end. The items in the questionnaire are listed fully in Table 1. The study was done during the working hours of the clinic and required approximately one hour to complete the total questionnaire. The portion presented in this report required approximately 15 minutes. In all cases the questionnaire was filled out without consultation with other staff members and while physically present at the clinic. The only exception to this included three staff members no longer employed in the clinic and no longer present in the city. In these cases the questionnaire was mailed to each person and returned to the authors. The following directions preceded administration of the instrument : &dquo;You will be asked to make a series of ratings in order to indicate your attitude toward a number of issues. For each issue you will be asked to indicate how you feel about it now and how you felt about it one year ago. When you are rating how you feel about something one year ago, you may find it somewhat difficult to retrospectively indicate exactly how you felt at this time. In this case, all that can be asked is that you please do your best to ascertain how you felt about the issue in question 12 months ago and mark down your best estimate. In every case, the lines on the scales represent a continuum, and you may put an X over any one of the lines. For any particular issue your attitude one year ago may be the same or different from your present attitude.&dquo; Upon completion of the instrument, staff members returned to
clinic activities.
Downloaded from isp.sagepub.com at The University of Iowa Libraries on June 17, 2015
192 RESULTS
,
The mean ratings made by psychiatrists, psychologists, and social workers on the 18 questionnaire items are presented in Table 2, along with the mean change which resulted when attitudes at the time the questionnaire was administered (designated as &dquo;current&dquo; attitudes) were compared with the attitudes the staff perceived themselves to have held when the clinic opened, one year earlier. Analyses were first conducted to determine if any meaningful differences existed when the mean ratings of psychiatrists, psychologists, and social workers for any single issue were compared. The only meaningful differences appeared in regard to items 17 and 18, which dealt with current and perceived past feelings concerning the effectiveness of long-term treatment for psychological problems. For the current attitudes regarding the effectiveness of long-term treatment, a one-way analysis of variance yielded a significant F(F=3.84, df=2, 23,p
ATTITUDES AND PERCEPTION OF ATTITUDE CHANGES WITHIN THE INTERDISCIPLINARY STAFF OF AN EVENING MENTAL HEALTH CLINIC ROY H.
SCHLACHTER,
M.S.W., WILLIAM C. HOUSE.
and SHELDON I. MILLER,
PH.D.
M.D.
ABSTRACT
A study was made of the attitudes of a multidisciplinary staff of an evening mental health clinic. The focus of the clinic is on short-term treatment, and one of the main purposes of the study was to investigate the reactions of staff members to this type of treatment orientation. Results indicated that staff members, when considered as a whole felt that their confidence in their short-term treatment skills and their belief in the effectiveness of a short-term, interdisciplinary treatment center increased over the course of the first year the clinic was open. These results were not consistent across disciplines, and possible reasons for this inconsistency were discussed. the paucity of mental health services and the of mental health practitioners in the Cleveland area, the Mental Health was established at Cleveland Metropolitan General Hospital. Funding provided by the Cuyahoga County Mental Health and Retardation Board enabled the hiring of 25 part-time psychiatrists, psychologists and social workers to attempt to provide interdisciplinary, short-term crisis-oriented treatment services to citizens of Cuyahoga County, 12 years old and older. Led by a full-time clinic director (M.S.W.), the 25 staff members were divided into teams for each of the five week nights. One psychiatrist, two psychologists and two social workers on each team would attempt to work together to provide needed services between 6.00 p.m. and 10.00 p.m. All of the staff members with exception of the full-time director and the fulltime secretary were employed during the daytime hours in other settings. Individuals were hired representing public services, private practice and academic interests. The diversity in backgrounds as well as in discipline posed the potential for problems to develop among the staff members, but also offered a potential for the development of mutual understanding, interdependence and coordinated efforts. As the clinic developed, an opportunity existed to evaluate not only the needs for services in the community, but also to evaluate the attitudes and reactions of this diverse staff both to the function of the clinic and to each other. Given the relatively large number of staff members at the clinic, and also considering the fact that three of the traditional mental health professions were represented, it seemed that the situation offered a valuable opportunity for systematic research into the question of the attitudes which the staff members held for each other and toward their work. Since all of the staff came from full-time work settings within the community, a further question involved the effect of this experience on their attitudes towards their own work and towards their own colleagues in their full-time employment.Whereas in
existing RECOGNIZING matching shortage Clinic Evening
for Ambulatory Roy H. Schlachter is currently Administrative Assistant to the Department of services Cleveland Metropolitan general Hospital; William C. House is an Assistant Professor of Psychiatry, Case Westerin Reserve University at Cleveland Metropolitan General Hospital; Sheldon I. Miller is Associate Professor of Psychiatry, Case Western Reserve University and Associate Director of Psychiatry at Cleveland Metropolitan
Psychiatry
General
Hospital.
Downloaded from isp.sagepub.com at The University of Iowa Libraries on June 17, 2015
191 the clinic most of the staff was primarily involved in direct patient service, the same staff was heavily involved in other aspects of health delivery during their full-time job. For many, this experience could well change their feelings about their full-time occupation, particularly for those primarily involved in either teaching or administration. Another area in which the staff functioned differently at night versus during their full-time daytime occupation was in the variety of treatment used in the evening clinic versus the daytime job. For many of the staff, this was their first experience in planned short-term treatment, and for some it was hypothesized that this switch from longer term therapy to which they were accustomed, might require a considerable adjustment. In an attempt to answer some of these qustions (which in a sense apply to the larger issues of team and professional identity and professional competence) a study was conducted to assess the attitudes of the members of the Evening Mental Health Clinic. A questionnaire was developed which contained items attempting to define many of the above variables. This report, however, will concentrate on that portion of the study which attempted to measure the perceived change in attitudes toward the function and competence of the various disciplines and toward the effectiveness of short-term and long-term treatment methods. This study was performed almost exactly one year after the opening of the clinic. Twenty-five of the respondents to the questionnaire were the members of the original clinic staff, and had therefore functioned in the setting for a full year. METHOD
The tool used was a questionnaire constructed by the authors which required each staff member to evaluate their current perceptions as well as their memory of their perceptions one year ago. The responses were made along a seven-point continuum for which one endpoint was labeled either &dquo;low confidence&dquo;, &dquo;low understanding&dquo;, or &dquo;low effectiveness&dquo;, depending on the question, and the opposite extreme was correspondingly labeled as &dquo;high&dquo; confidence, understanding or effectiveness. Responses were given a score ranging from one to seven, with one designating a response at the &dquo;low&dquo; end of the scale and seven designating a response at the &dquo;high&dquo; end. The items in the questionnaire are listed fully in Table 1. The study was done during the working hours of the clinic and required approximately one hour to complete the total questionnaire. The portion presented in this report required approximately 15 minutes. In all cases the questionnaire was filled out without consultation with other staff members and while physically present at the clinic. The only exception to this included three staff members no longer employed in the clinic and no longer present in the city. In these cases the questionnaire was mailed to each person and returned to the authors. The following directions preceded administration of the instrument : &dquo;You will be asked to make a series of ratings in order to indicate your attitude toward a number of issues. For each issue you will be asked to indicate how you feel about it now and how you felt about it one year ago. When you are rating how you feel about something one year ago, you may find it somewhat difficult to retrospectively indicate exactly how you felt at this time. In this case, all that can be asked is that you please do your best to ascertain how you felt about the issue in question 12 months ago and mark down your best estimate. In every case, the lines on the scales represent a continuum, and you may put an X over any one of the lines. For any particular issue your attitude one year ago may be the same or different from your present attitude.&dquo; Upon completion of the instrument, staff members returned to
clinic activities.
Downloaded from isp.sagepub.com at The University of Iowa Libraries on June 17, 2015
192 RESULTS
,
The mean ratings made by psychiatrists, psychologists, and social workers on the 18 questionnaire items are presented in Table 2, along with the mean change which resulted when attitudes at the time the questionnaire was administered (designated as &dquo;current&dquo; attitudes) were compared with the attitudes the staff perceived themselves to have held when the clinic opened, one year earlier. Analyses were first conducted to determine if any meaningful differences existed when the mean ratings of psychiatrists, psychologists, and social workers for any single issue were compared. The only meaningful differences appeared in regard to items 17 and 18, which dealt with current and perceived past feelings concerning the effectiveness of long-term treatment for psychological problems. For the current attitudes regarding the effectiveness of long-term treatment, a one-way analysis of variance yielded a significant F(F=3.84, df=2, 23,p
