1. Utility of Neuropsychology in a Psychiatric Inpatient Setting: Consumer and Referral Feedback
Cathryn E. Richmond1, Ashley Reno2, Beth C. Arredondo2,3, Julie-Ann Kent2 & Bernice A. Marcopulos1
1James Madison University, 2University of Virginia Health System, 3Western State Hospital
Introduction
Results
Figure 1. Consumer Feedback Responses
Consumers of neuropsychological services are frequently satisfied with services, rate them as positive or neutral, and find feedback and recommendations helpful (Bennett-Levy, Klein-Boonschate, Batchelor, McCarter, & Walton, 1994; Donofrio, Piatt, Whelihan, & DiCarlo, 1999; Westervelt, Brown, Tremont, Javorsky, & Stern, 2007). Referral sources are also generally satisfied with the process, find the evaluation useful, agree with the recommendations, and are likely to refer similar consumers in the future (Braun et al., 2011; Hilsabeck, Hietpas, & McCoy, 2013; Temple, Carvalho, & Tremont, 2006; Tremont, Westervelt, Javorsky, Podolanczuk, & Stern, 2002). However, the majority of prior research has focused on primarily medical settings. Therefore, the present study seeks to extend the current research regarding the utility of neuropsychological assessment to include consumers and staff in a psychiatric inpatient setting using data collected from consumer and referral source feedback surveys.
Overall, the neuropsychological assessment process was viewed positively by both consumers and staff. Consumer average ratings ranged from 4.20 (SD = .15) to 4.65 (SD = .11), while staff average ratings ranged from 4.44 (SD = .24) to 4.89 (SD = .11). Example comments are presented in Tables 1 and 2.
After controlling for familywise error using a Bonferroni-adjusted alpha level of , there were no statistically significant differences among responses based on consumer education level, diagnosis, age, age of illness onset, duration of illness, presence of secondary gain, gender, ethnicity, or IQ.
However, a small association was detected between consumer education level and perceived friendliness of the evaluator, with consumers with higher education levels reporting higher ratings.
Table 1. Consumer Feedback Example Comments
Discussion
Very polite people administering the test. Fully explained the results.
Timewise I was not ready, and I brought with me fear of being labeled Alzheimer's.
I get a sense of my strengths and weaknesses that will be able to help me in daily life.
I've learned things that I had to work on and things that I already knew.
It was so frustrating at times, just the reading.
The personality questionnaire had too many questions, 800?
Overall, the current findings extend previous research that suggested both consumers and referral sources of neuropsychological services are satisfied with services to an inpatient psychiatric hospital setting. Referral source comments further support the importance of answering specific referral questions (Brenner, 2003; Tremont, et al., 2002) and providing timely feedback (i.e., within two weeks; Hilsabeck, et al., 2003). Consumer comments highlighted the need for adequate preparation of the consumer and the potential impact of lengthy testing appointments (Bennett-Levy, et al., 1994). Finally, the findings support the importance of obtaining consumer feedback so that future providers may improve the overall quality and clinical utility of services (Brenner, 2003).
Study limitations included a small sample size and unique neuropsychology setting. Future research should continue to examine referral source and consumer satisfaction with larger samples and in diverse settings to validate the current findings and clarify the impact of consumer education on perceived friendliness of the evaluator. It will also be important to examine the outcomes of neuropsychological evaluation (e.g., impact on differential diagnosis, treatment planning).
Methods
Consumers (n = 56) and selected referral sources (n = 9) completed feedback surveys between April 2012 and February 2014 following neuropsychological evaluations. Consumers rated their experiences with four questions (Figure 1), and the referral sources rated their satisfaction with the evaluations with four different questions (Figure 2). Ratings were made on a scale of 1 to 5, with 5 being better, and we computed means and standard deviations to assess the hypothesis that neuropsychological assessment is viewed as a useful and informative process by both consumers and staff. We also reviewed comments to determine potential areas for improvement.
Approximately half of the consumer sample was male (45%). Age ranged from 18 to 64 (M = 40.38, SD = 14.63). Education level ranged from 7 to 20 years (M = 12.34, SD = 2.95). The sample was 69.6% Caucasian, 25.0% African American, and 5.4% Other. Patients had mostly schizophrenia spectrum disorders (53.6%) and major affective disorders (28.6%). Onset of illness ranged from age 1 to 49 (M = 20.83, SD = 19.46, Median = 18), and duration ranged from 1 to 49 years (M = 19.58, SD = 13.94, Median = 17). IQ ranged from 50 to 115 (M = 80.50, SD = 16.14). Referral sources who provided feedback included 7 psychologists and 2 physicians.
Figure 2. Referral Feedback Responses
Table 2. Referral Feedback Example Comments
Really thorough and helpful evaluation.
Helpful elaboration of initial testing elsewhere.
We were somewhat surprised the personality testing wasn't more informative, but
otherwise very useful.
The results reinforced the deleterious effects of alcohol.
Thanks for quickly testing!
Very helpful with the differential between depression and alcohol.
References
References available from the first author upon request: