Keeping Current #99-5

What Makes Parents Satisfied and Dissatisfied with Rehab Services for their Children?

© King, G., King, S., Rosenbaum, P., & Cathers, T.,
CanChild Centre for Childhood Disability Research

©1999 King, G., King, S., Rosenbaum, P., & Cathers, T. Published and distributed by CanChild Centre for Childhood Disability Research

Who looked at this topic?

Gillian King and Tamzin Cathers (TVCC), and Susanne King and Peter Rosenbaum (CanChild) studied the experiences of parents whose children received services from rehabilitation centres across Ontario.

Why research this topic?

Little is known about the aspects of service delivery that underlie parents' satisfaction with children's rehabilitation services. Determining the most important elements of satisfaction and dissatisfaction will help managers and service providers know what to do when delivering services. Ultimately, this will mean that families will experience greater satisfaction with the services their children receive.

What was done?

From a pool of 645 parents who took part in three separate studies, 130 highly satisfied and 101 relatively dissatisfied parents were identified based on their scores on a standardized satisfaction measure. These parents had listed the three things they liked most and the three things they liked least about the services received from children's rehabilitation centres or programs in Ontario. Their comments were coded by two independent raters, using a coding scheme based on elements of satisfaction mentioned in the medical and rehabilitation literatures.

What was found?

• highly satisfied parents most often mentioned elements of the service delivery process, particularly respectful and supportive care
• relatively dissatisfied parents most often mentioned both structural elements (particularly lack of access to existing services) and process elements (both the presence and absence of respectful and supportive care, as well as lack of continuity and coordination of care)
• parents made very few comments about the outcome of care for their child or family. This was surprising given the literature that leads us to expect that outcome of service is an important part of satisfaction
• the study findings show that both structural and process aspects of service provision are important to satisfaction and dissatisfaction for parents of children receiving rehabilitation services

What do the findings mean?

The findings tell us the key structural and process elements we should focus on to ensure parents' satisfaction and prevent dissatisfaction. It is not enough to provide family-centered service which deals with the process. We need to focus more on the systems of service delivery by considering structural elements such as lack of access to services.

The key element of satisfaction is...

Respectful & supportive care

• means that parents are pleased with the way they and their child are treated
  • professionals demonstrate good interpersonal skills (e.g., they are friendly, have a positive attitude, are warm, caring, helpful, polite, dedicated, they are able to establish rapport and are patient)
  • parents feel professionals listen to parents' or children's viewpoints or concerns
  • professional knows child or parent well (as a person) and maintains an ongoing relationship or rapport support
  • staff are pleasant and welcoming

The key elements of dissatisfaction are...

Lack of access to existing services

• inconvenience in accessing existing services
  • (e.g., long travel distance to services, inflexibility of service providers in arranging appointments and scheduling services, long waiting lists, poor hours of opening, difficult to get appointments)

Lack of respectful & supportive care

• refers to displeasure with the way self and/or child are treated
• professionals demonstrate poor interpersonal skills
• (e.g., they are unfriendly, have a negative attitude, are distant, not caring, not helpful, are impolite, are not understanding; professionals do not listen to parents' or children's viewpoints or concerns, they are not able to establish rapport, they are pushy)
• professional does not know child or parent well - ongoing relationship or rapport has not been developed
• support staff are not pleasant or welcoming

Lack of continuity & coordination of care

• lack of continuity and/or coordination in service delivery
• (e.g., high staff turnover, service providers change over time, staff are not well-known to families, service delivery is not coordinated amongst teams delivering services, there is a difficult transition between programs or services, staff do not work with other agencies, staff do not share information among themselves, there are delays in service provision, and the future needs of the child are not planned for)