Objectives: This research examines client, case manager, and agency factors including funding, that are associated with client satisfaction at community-based mental health agencies (CMHAs) in Ohio. There were three specific research objectives. The first was to examine the ways in which client satisfaction data are collected and used by CMHAs. Second, this research evaluated the differences between client and case manager perceptions of client satisfaction. Finally, this research evaluated the extent to which agency funding and other factors influence levels of client satisfaction.

Methods: A cross sectional survey-based study was completed using three questionnaires administered to agency administrators (N=38), clients (N=338), and case managers (N=185) at CMHAs in Ohio. The independent variables and cofactors examined in this research include agency expenditure per client, mean staff salary, proportion of funding from Medicaid, state dollars, ADAMH Boards, private insurance, and grants, agency characteristics (location, years providing services, size), county-level tax revenue per capita, and client and case manager socio-demographic variables (including race, gender, age, education status, chronic physical disease status, and relationship status). Level of client satisfaction was the dependent variable. Both logistic and multivariable regression were used to explore the relationships between independent variables and client satisfaction scores and to account for the differences between client and case manager perceptions of client satisfaction. A stepwise model building process was used to develop a best-fit model using the independent variables explored in this study.

Results: All respondent agencies (N=38) report collecting client satisfaction data and using data to improve services. Agency characteristics including size, location, and years providing services were not associated with whether agencies considered client satisfaction data to be a priority. Based on the data gathered in this study, the mean client satisfaction score for participating agencies was 83.9%. On average, case managers perceived clients to be less satisfied than the clients' report. Agency expenditures per client and average staff salary were not found to have a statistically significant relationship with client satisfaction scores. However, the proportion of funding from grants, from state dollars, and caseload size was found to be associated with client satisfaction scores. Overall, the cofactors that had the most explanatory power involved clients' perspectives about whether agency staff sought client feedback, and clients' overall outlook on mental health services.

Conclusion: Variables that are most closely related to clients' perspectives and outlook seem to have the most influence on client satisfaction scores when compared to agency-related and funding related variables. Agencies may improve client satisfaction scores by demonstrating that client feedback is an important part of the agencies self-evaluation and by decreasing caseload size. The study also shows variation in the methodology used to collect client satisfaction data. Creation of standardize client satisfaction data collection methodology may improve the transparency and the usefulness of client satisfaction data for CMHAs. Finally agencies should always adjust for social desirability, past service experience, and perception of impairment in analysis of quantitative client satisfaction data.