THE RELATIOJSHIE OF CLIENT MOTIVATIOT TO AGENCY STIM”LATIC” IHIMHIIWIII"NIH"IIHIHIIIHHHWIIUlllllllUHl 93 00790 2335 LIBRARY Michigan State University 1 ET n'i Rift-321 IrEF If”. S: '5- _ .—”—-——-. I ' i' 'L-x. 1.” LJJ- “7.10:3 t'J .‘ . LIBRARIES remove 1’57; " LL-c. 3-L : from “: 3'01? !"~.‘-C.:'"‘. 1393““ be Chargec if [30+ :2 THE RELATIONSHIP OF CLIENT MOTIVATION TO AGENCY STIMULATION by James H. Goodwin Stephen S. Ockaskis, Ir. Kay E. Reid, Chairman John B. Richardson ABSTRACT Submitted in partial fulfillment of the requirements for the degree of MASTER OF SOCIAL WORK Michigan State University School of Social Work East Lansing, Michigan 1967 THESIS cl} mama? Miehigan State University \— ABSTRACT This study is designed to test the hypothesis that failure of the client to continue contact into a treatment relationship following the initial interview is due to agency failure to activate the client's motivation. A questionnaire, consisting of thirty-two questions, was formulated to identify data about the client, the agency's effect on the client, and the client's response to the agency. Distribution of the questionnaire went to 168 former clients of the Flint (Michigan) Mental Health Clinic who had been accepted for treatment. Results of the study came from the response of fifty-six clients. The data failed to support the major hypothesis. However, the initial motivation of the client prior to clinic contact was a predictor of his continuation. Two of the three sub-hypotheses proved significant; the first being that lower-class clients will voluntarily terminate more than middle-class clients and the second being that where motivation is high and termination occurs before treatment, the client will seek help elsewhere. The importance of clinic resource allocation being based on the characteristics of clients seeking service was concluded from the data. The authors suggest that the Flint Mental Health Clinic individualize the initial interview to meet the various levels of client motivation. Realistic treatment policies could be derived on such a basis. THE RELATIONSHIP OF CLIENT MOTIVATION TO AGENCY STIMULATION by James H . Goodwin Stephen S. Ockaskis, Ir. Kay E. Reid, Chairman John B. Richardson RESEARCH PROJECT Submitted in partial fulfillment of the requirements for the degree of MASTER OF SOCIAL WORK Michigan State University School of Social Work East Lansing, Michigan 1967 ACKNOWLEDGMENTS We wish to extend our appreciation to Dr. Raymond Bodwin and Dr. Kenneth Snead of the Genesee County Community Mental Health Services Board (which, under Public Act 54, absorbed the Flint Mental Health Clinic) for permitting us to use the agency. Appreciation is also extended to the following: secretaries Ruth Sinsel and Joyce McElderry, for helping us select the appropriate cases for this study, and to Janet Jensen and Catherine Pichette for typing and arranging this research project. A special thanks is extended to Dr. Gwen Andrew who spent many hours helping us to conduct and coordinate our research project. Her suggestions were appreciated and helpful in analyzing our data. Table of Contents Abstract Acknowledgments Chapter I Introduction Chapter II Method Hypothesis Definition of terms Sample Chapter III Data Analysis Sugge stions for future research Bibliography Appendix I Que stionnaire Appendix 11 Tables Page 10 Page 10 Page 10 Page 11 Page 12 Page 14 Page 18 CHAPTER I INT ROD UC TION The Flint Mental Health Clinic has been concerned with the high rate of client1 discontinuance. These people are not returning even though they have been screened and accepted by the agency for treatment. Besides being interested in what happens to these applicants, the agency is concerned because screening and diagnosis is an expensive process. The question arises as to whether failure to return is due to the agency2 or the client or to a combination of both. In a report on factors involved in the high rate of client discontinuance, the Family Service Association of America noted that one of the variables involved in the drOpout rate was the length of the waiting list. 3 Since the Flint Mental Health Clinic had an average waiting list duration of two weeks during the period studied, the authors felt that this would not be the major factor producing failure to return at this particular agency. Thus, other factors, which involve both the client and the agency, needed to be examined . 1Although the term 'client' usually refers to an applicant who establishes a 'contract' with a therapist, the meaning is extended here to include applicants that are acceptable by the agency for treatment ie. , these people are seen as being able to benefit from this agency's services . sz 'agency‘ the authors mean not only the physical structure, but also the professional and clerical staff with whom the client interacts. 3Dorothy Fahs Beck. Patterns in Use of Family Agency Service. New York: Family Service Association of America, 1962. -2- Client motivation, social-class, the expectations he has of the agency, client and agency roles, and anxiety level are all factors to be taken into consideration. The agency may have failed to foster or stimulate client motivation or to establish a contract4 with the client. Also, personality characteristics of the worker may have produced the client's negative reaction to the agency. Factors of a less emotional nature that may have influenced discontinuance are: the physical atmosphere of the agency, the fee, and the source from which the client was originally referred. Some clients may have felt the Flint Mental Health Clinic was an inappropriate source of help and looked, therefore, to another agency as a means of solving their problem. According to Perlman, a client's motivation to continue working with the agency can be expected to increase or diminish in relation to whether he thinks he can gain what he is after. 5 The authors felt that how the agency handled all of these factors determined to a great extent which clients returned and which did not. The initial interview has been recognized by social workers as having crucial importance for the subsequent course of treatment, especially when a high prOportion of clients seen at social agencies and psychiatric out-patient 4By 'contract' the authors mean the mutual discussion of what the client wants and expects and what the agency can give and expects from the client. From this a working agreement is arrived at. 5Helen Perlman. "Content in the Beginning Phase, " Social Casework: A Problem-Solving Process, Chicago: The University of Chicago Press, 195 7, p. 130. .-3- 'i clinics drop out after that first interview..6 Studies have been conducted regarding the early dr0pouts, and the researchers can be roughly placed in two categories. The first group operates on the philosOphy that a screening process should be achieved, whereby those clients who are less likely to continue would simply not be accepted for treatment. For example, Hunt speculates that the time has arrived when the helping professions must consider the possibility that psychotherapy, at least as presently Constituted, is a treatment whose efficacy is confined to middle and higher class client pOpulat- 'ions.7 However, the second group points out that the clients in question still need treatment. Therefore, these researchers feel that procedures should E be examined and improved to lessen the likelihood of premature termination. I Attention needs to be directed not only toward the client, but the therapist (who personifies the agency) and their interactions as well. There are attitudinal differences between the social classes. Richard Centers believesthat social classes hold different attitudes as seen in their 8 It is feelings toward economics, politics, and religion to mention a few. implied then that these differences can also be seen in attitudes toward 6Jane H. Pfouts & Gordon E. Rader. "The Influence of Interviewer Characteristics and the Individual Interview." Sogial Casework, Vol. XLIII, No. 10, (December 1962), p. 548. 7Betty Overall 8: H. Aronson. “Expectations. of. Psychotherapy in Patients of Lower Socioeconomic Class, " American .Lgurnal of Orthopsychiatry, Vol. xxxm, No. 3, (April 1963), p. 429. 8Richard Centers. ThLPsychology of Social Classes, New Jersey: Princeton University Press, 1949, p. 77. -4... psychiatrists, social workers, and other members of the helping professions. Because of these attitudinal differences, people from different social classes will respond to a certain situation in a way typical of their own social class-- and this sometimes leads to conflict and/or withdrawal. The importance of the socio-economic status of the peOple that the agency is serving has been noted. In addition. the agency's middle-class orientation must be considered, especially when it differs from the client's cultural or class background. It is frequently assumed that the ability to postpone "gratification, to bear tension, and to trust that. the agency's helping process will be useful are attributes characteristic of middle-class rather than lower- class persons. 9 Therefore, it could be expected that the middle-class client would be-less likely to terminate than the lower-class client. Pfouts and Rader concentrate on the interviewer's characteristics, since they are ". . . aware that the caseworker's personality and his professional and personal value systems have a strong impact upon the client in the initial interview. ” therapy, but this; prbved to be a complicated variable with different meanings for different observors in different situations. 11 9Helen Perlman. "Some Notes on the Waiting List,” Social Casework, Vol. XLIV, No. 4, (April 1963) pp. 202. lopfouts and Rader, 22. c_:_i__t., p. 548. “Ibid” p. 552. They assumed that 'warmth' would be a part of successful -5- From a different angle, Overall and Aronson examined the expectations of clients from the lower socio—economic class. One of the greatest obstacles to psychotherapy, they saw, was this kind of patient's minimal involvement in the initial phases of treatment. 12 The lower-class patient tended to expect a medical-psychiatric interview, with the therapist taking a generally active but permissive role. Futhermore, those patients whose expectations were more inaccurate were significantly less likely to return for treatment. 13 The two studies discussed here are close in their findings. Pfouts and Rader find that: "Regardless of social class or age, patients tended to equate warmth in the doctor with self assurance, sensitivity, and competence. . . .In other words, the patients were seeking neither a sweetly sympathetic mother-figure nor a non- authoritarian friendly brother-figure, but rather an all- knowing, all-powerful father-figure."14 This ties in with the lower-class client, mentioned above, who desires an active, permissive, male therapist. At the same time, Overall and Aronson's observation of the lower-class client's minimal involvement fits with Pfouts and Rader's comment, which states: "A high degree of skill is required to meet this (dependency) need in an initial interview and, at the same time, to leave the patient with the understanding that he, not the interviewer or the agency, is the one who must bear the primary responsibility for change. ” 15 Am 12Overall and Aronson, 22. 5:33., p. 421. 131bid., p. 430. I‘JtPfouts and Rader, 22. gig... p. 552. 1 51bid . -6- So far, middle-class interviewer characteristics and lower-class client expectations have been raised as factors leading to premature termination. If there is difficulty between these two classes, regarding agency participation, even more conflict could be expected from those clients considered to be in 17 poverty---the Poor.16 Poverty means institutional nonparticipation. Whether Negro or White, Mexican or Indian, the Poor do not make or participate in institutions, but they are subject to them. 18 Another factor leading to dr0pouts could be race difference. Gochros says that insights provided by the "Negro revolution" suggest that it is essential to explore racial attitudes quickly and directiy as a general ruie rather than as an exception.19 This should be done whether the caseworker is White and the client Negro or vice versa, yet there is a lot of professional resistance to Opening this "Pandora's Box." According to Gochros, ”even the most ardent white civil rights worker may harbor private fears that Negro anger, once unleashed, may become uncontrollable and 'irrational' (ie. directed at him). Such fears may also belong to the white caseworker. 20 16The Poor signifies a way of life as compared to being poor, ie. financially embarrassed. McKenzie, in a paper footnoted below, says that Poverty is a relatively meaningless word, which is clouded with myths and misconceptions, However, he describes being Poor as "living by someone else's rules in someone else's world." p. 9. 17William R. McKenzie. The Face of the Enemy, a paper presented at the Midwest Philosophy of Education Society Meeting, held in Chicago, Illinois, on December 4, 1965 . p. 8. 1 81bid . 19Jean S. Gochros. "Recognition of Anger in Negro Clients, ” Social Work, Vol, II, No. 1, (January 1966), p. 28. ZOIbid. , p. 31. -7- Cultural differences and social class have been considered as factors determining client motivation and therapist effectiveness. Although the class system of the United States is ‘open'; as everywhere else, pe0ple are socially differentiated and evaluated according to their qualities, performances and possessions.21 In considering a person's class level, probably the greatest determinant of social position in the United States is occupation. The signif- icance of occupation in our class system is revealed most clearly when occupation is related to wealth, income and education, all of which are import- ant criteria of social prestige. 22 The authors feel that the client's motivation is important in determining continuance of treatment. People are accustomed to think of anxiety as something to eradicate. Without it, however, motivation lags, as anxiety is an important component in motivation. With too much, on the other hand, there may be immobilization. "The ideal therapeutic situation is one in which the client is anxious enough to want help and to keep coming for it, but not so afraid that fear interfere with his ability to use help. 23 One determinent of motivation is the client's own degree of discomfort 21Karl P0pper. The Open Society and Itig Enemies, rev. ed. New Jersey: Princeton University Press, 1950, p. 169. 2‘ZElaine Mercer. The Study of Society, New York: Harcourt, Brace and Co., 1957. 23Florence Hollis. "The Choice of Treatment Objectives," Casewgrk: A ngchosocial Therapy, New York: Random House, 1964, Chap. XII. p. 209. with things as they are. 24 Has he been forced to come or is he coming voluntarily? Under either circumstance, much would seem to depend on the therapist's skill in enabling the client to re cognize that he himself may gain from following through with treatment. Also important in maintaining motivation is an attitude that there is a possibility of being helped. Helen Perlman's ideas concerning discomfort and hope have provided a basis for the authors‘ assumptions concerning motivation. She mentions discomfort and hope as the two conditions that must hold for the sustainment of responsible willingness to werk at prchlem—solving. "A shift of psychological equilibrium must be occasioned by some sense of discomfort and the attendant push to gain greater comfort or a steadier sense of balance. Thus a person must feel more uncomfortable than comfortable with his problem in order to want to do something about it, and this malaise will serve to push hirn."25 Accompanying this sense of discomfort, must also be some promise in the future of greater ease or satisfaction. "The promise is inherent in hOpe-- h0pe that is carried in the personality itself as the product of gratifications in his past experience combined with that which is inherent in the situation 26 or is given by the caseworker if he can offer valid assurances of help. " She concludes, like Florence Hollis, that the existence of either element 241mm , p. 207. 25Helen Perlman. "The Client's Workability and the Casework Goal," Social.Casework:, A Pgoblerg-Solving Process, Chicago, The University of Chicago Press, 1957, p. 186. Zérbid. , p. 187. -9- without the other, or of an excessive degree of either, will deplete motivation, Discomfort without h0pe means resignation, while h0pefulness without discomfort is the mark of the immature, wishful person. Perlman says that it is the caseworker‘s task to appraise his client's combination of discomfort and h0pe in order to judge what he should try to diminish, to modify, or to encourage, in order to rouse in his client that push or pull which will mobilize him for change. 27Ibid. -10- CHAPTER II MET HOD Hypotheses From the preceding discussion it is, therefore, assumed that pe0ple who voluntarily terminate Before treatment has begun do not have the appr0priate balance of hope and discomfort. Furthermore, agencies need to provide this balance or capitalize on it if they are to motivate the clients for treatment. Thus, the purpose of this study is to examine the following general hypothesis: Failure to continue contact into a treatment relationship is due to agency failure ‘to activate the client's motivation. Specifically, in those instances where motivation is low initially and the agency has failed to stimulate it, termination will occur before treatment has begun. Sub-hypotheses were: 1. Pe0p1e from the lower socio-economic class will voluntarily terminate more than people from the middle socio-economic class. 2. In those instances where motivation is high and termination occurs before treatment, the client will seek help elsewhere. 3. The longer the waiting period the more likely a client will terminate before treatment. Definition of Terms ~11- The following definitions will be used in this study: Voluntary termination - choosing to discontinue use of the agency‘s services. Pe0ple who were not acceptable to the agency as clients have been excluded from the sample. Treatment - Two or more interviews. ApprOpri'ate balance of hogs and dis cquort - the two conditions that are necessary for the sustainment of responsible willingness to work at problem- solving and provide motivation. Agency - the professional and clerical staff with whom the client interacts and the physical structure. Motivation - that which is within the individual, rather than without, Which incites him to action. Any idea, need, emotion or organic state that prompts one to act. The authors used three questions to determine the client's mot- ivation prior to agency contact. It was speculated that the self—referred client was more motivated than the 'other-referred' client (question 11). Furthermore, a higher motivated client would contact the agency sooner than the lower motivated client (question 12). Finally, a client who had some expectations of how the agency could help him could be expected to have more motivation than a client with no expectations (question 24). ”Other-referred” Reaple - one directed to the agency be a source other than self ie. doctor, court, another agency etc. Social-egonomic class - a person's position or status as classified by others in the community or culture, according to three major interrelated factors: occupation, income and education. -12- Another source - any individual or organization other than the Flint Mental Health Clinic. Waitiniperiod - time between application for help and initial interview. S ample The sample consisted of 168 adult (eighteen or over) clients who had their first contact with the Flint Mental Health Clinic no earlier than July 1, 1965, and who terminated on or before February 1, 1967. They were divided into two groups: (1) those people who had no more than one interview and (2.) those having two or more interviews. Method A questionnaire of thirty-two items was devised by the authors and mailed to the sample to evaluate the degree of motivation within the client and how this was created or capitalized on by the agency. The first section of the questionnaire was designed to gather factual information about the client and his initial motivation in seeking help. The second section was devised to illicit various factors which increased or decreased the motivation of the client after having had contact with the agency. The final section was concerned with what the client did after he left the Flint Mental Health Clinic. Our final sample consisted of 16 pe0ple in group one and 40 pe0ple in group two. Three weeks after the questionnaire was sent out to the sample, telephone calls were made to those who could be reached by phone. Those -13- who could not be reached received a follow-up letter. Seventeen question- naires were returned to us because of insufficient address or the respondant having moved and left no forwarding address. Ninty-five did not return the questionnaire . Possible reasons for not returning the questionnaire are: (1) reluctance in giving identifying information, particularily when the name is requested, (2) failure of the questionnaire to reach the former client due to the inter- vention of family or friend, (3) "inadvertent" forgetting, (4) questionnaire being confusing for certain clients e. g. poor readers, and (5) resentment of the agency expressed through failure to return the questionnaire. The authors recognize low motivation as having a large bearing on each of these reasons for failure in returning the questionnaire. It is likely that those individuals not returning the questionnaire had a lower level of motiv- ation than those that were indluded in our sample. Agency stimulation of client motivation was determined by giving equal weight in coding to the specific answers of five questions. These concerned: (1) worker being concerned, (2) worker being accepting, (3) worker being warm, (4) worker understanding client's problem, and (5) worker indicating that the agency could be of service. The client's initial motivation was determined by giving equal weight in coding their answers to (1) type of referral (self or other), (2) time span between recognizing problem and enlisting agency's service, and (3) client's expectations in regard to agency service. -14- CHAPTER I I I DATA ANALYSIS Using that data which was available clients were divided first into the two groups specified; (a) one interview and (b) two or more interviews. This break was devised because it was assumed that clients not motivated to return would make the decision to drOp out at the first interview even though informed of the clinic opinion that they should enter treatment. The groups were then subdivided into those with low initial motivation and those with high. From this three subdivisions were made. First was the referral source where the self-referred client was con- sidered high and the other-referred was considered low. It was found that there was limited significance in the difference between high and low motivated clients and continuance into treatment (X2 3. 3, p . 10). Second, clients with expectations of agency service were divided into two groups: (a) those whose expectations were similar to the service offered and (b) those whose expectations differed from the agency's service. It was found that there ‘was a limited significance in the difference between group (a) and group((b) and continuance into treatment (X2 3. 0, p . 10). Finally, the time it took to contact the agency after the problem arose was used to determine motivation. Those seeking contact in less than one week were considered highly motivated. Results of a chi square analysis were highly significant (X2 13. O p. 001) indicating that early seeking of help was followed by entering into treatment. -15... Motivation of the client dn arrival, therefore, was concluded to be related to continuance in treatment, because of the marked impact of early seeking of help and the effect of self referral at a .10 level of significance. Comparisons were than made of the worker's behavior and client continuance. (The clients' motivation could not be controlled here because of the limited N's). Here it was found that when the client believed the worker indicated the agency could be of real service, the client tended to continue into treatment (X2 8.1, p . 01). However, no other variable indicating worker behavior toward the client differentiated between clients who continued 'and those who did not. Therefore, on the basis of this analysis and the effects of initial motivation, it was concluded that the major hypothesis of the study was untenable. Worker behavior does not appear to have affected continuance while initial motivation does. Themotivation with which the client came to the clinic seems to be the overriding effector of continuance into treatment. This was further eluded by determining the importance of non-agency variables which are not inherently indicators of motivation, but may reflect difference of motivation growing out of situational conditions of the client, and they are largely independent of the' discomfort-hope hypothesis. This included socio-economic class and waiting time for the initial appointment. -16- Here it was found that persons in the lower socio-economic class tended to terminate before treatment; middle-class clients went into treatment and upper-economic class clients terminated (X2 6. 9, P . 05). It is assumed the upper-class clients went to private therapists for their treatment which accounts for their drOp-out rate, but lower-economic class clients are presumed to have a different value system regarding continuing relationships with "the agency. This is not motivation in the sense considered above, but rather as a value coming out of a different life situation. The findings, however, support the conclusion that the conditions (motivation and /or value system) under which the client enters service are more binding on his decision whether to continzne into treatment, than the behavior of the worker or ether members of the agency staff. The waiting time for the initial interview was found to have an effect on continuance with the larger waiting time clients. Those clients who waited the longest time were characterized by a higher discontinuance rate (X2 7. 8, P . 01). This is in part accounted for by upper-class clients who could obtain private service and who did not have to wait for the agency to have an opening. It's also a replication of a phenomena noted in many other studies, such as the Family Service Association of America study discussed earlier. Finally, an investigation was made to determine what happened to the client after he left the agency. Clients who said they did not receive all the necessary help at the agency did go elsewhere and these were also the clients who had dropped out of service (X2 7. 7, p . 01). This result is interesting -17- because of its implication. No doubt some who left did so because they could afford to pay a private practitioner and did not wish to wait, but many of those who left apparently did not feel the problem was solved but rather went else- where for assistance. It may be speculated that this group is looking for help with the problem without the stress and [or inconvenience of entering treatment-- perhaps, searching for a one-contact solution tb their problems. If this is the case, one could predict a community agency system caseload of individuals moving from one agency to another with little chance of a resolution of the problem but great use of agency' resources. Should that be the case, and it needs to be studied, it Cwould have great importance on community planning for treatment services . -18- Suggestions for Future Research There is a problem in measuring initial motivation of the client, because it varies with each individual person. In limiting the size of our questionnaire, three indicators were used to determine initial motivation. These were (1) the type of referral, (2) length of time before application to agency and (3) client's previous expectations of agency service. The referral group was divided into self-and other-referred; because family and friends were included in the self-referred group, we may have inaccur- ately assessed the initial degree of motivation. A referral by family and friends may reflect the same low motivation as the other-referred. It is obvious that the one ~third who returned the questionnaire were more motivated than the two-thirds that did not. Furthermore, it appeared that this group tended to respond in an overly positive manner ie.. by responding favorable to all questions concerning the agency, a tone-seemed to be set that followed throughout the questionnaire. The fact that a name was required either caused positive responses from those that returned the questionnaire, or created a fear of retaliation that resulted in no response from the rest of the population. The space provided for comments proved to be invaluable. Often there was a discrepancy between the answer given and the comment, which proved difficult to incorporate into the data. This seems to say that it may be easier for respondents to answer when they are given an opportunity to express themselves. BIB LIOGRA PHY Bitterman, Catherine M. "Serving Applicants When There Is a Waiting List," Social:gasework, Vol. XXXIX, (June 1958), pp. 356-360. Centers, Richard. The Psychology of§ocjal Classes, New Jersey: Princeton University Press, 1949. Fahs Beck, Dorothy. Patterns in Use of Familyigency Service, New York: Family Service Association of America, 1962.. Gilbert, Anita. ”An Experiment in Brief Treatment of Parents, " ‘Social Work, Vol. V, (October 1960), pp. 91—97. Gochros, Jean 5. "Recognition of Anger in Negro Clients, " Social Work Vol. 11, No. 1, (January 1966), pp. 28-34. Hallowitz, David 8: Cutter, Albert. "Intake and the Waiting List: A Diff- erential Approach," Social Casework, Vol. XXXV, (December 1954), pp. 439-445. Hollis, Florence. "The Choice of Treatment Objectives," Casewogk: A Psychosocial Therapy, New York: Random House, 1964, Chap. 12. McKenzie, William R. The Page of the Enemy, a paper presented at the Midwest Phi1080phy of Education Society Meeting, held in Chicago, Illinois, on December 4, 1965. Mercer, Elaine. The Study of Society, New York: Harcourt, Brace and Co., 1957. Overall, Betty & Aronson, H. "Expectations of Psychotherapy in Patients of Lower Socio-economic Class." American Journal of Orthgpsychiatry, - Vol. XXXIII, No. 3, (April 1963), pp. 421-430. Perlman, Helen. "Some Notes on the Waiting List," Social Casework, Vol. xmv, No. 4, (April 1963), pp. 200-205. Perlman, Helen. "The Client's Workability and the Casework Goal,” Social Casework: A_Prob1<:m-Solving Process, Chicago: The University of Chicago Press, 1957, pp. 183-203. Pfouts, Jane & Rader, Gordon. "The Influence of Interviewer Characteristics and the Individual Interview." Social Casework, Vol. XLIII, No. 10, (December 1962), pp. 548-552. Popper, Karl. The Open SocietLand It'sfiEnemiesfi, rev. ed. New Jersey: Princeton University Press, 1950. -19- APPENDIX I Name last first 1. How long have you lived in Genesee County? less than one year 1---3 years __ 4---7 years 8 or more years 2. Male Female 3. Birthdate .‘u-A— *— month day ye ar 4. What is your marital status? Single Married Divorced Separated Widowed 5. Number of Children None __ One __ 2--3 4--6 7 or more 6. Education (Check the last grade completed) 0--6 ' 7--9 10--12 1--2 years of college 3--4 years of college more than 4 years of college Other (PLEASE SPECIFY) IHHH 7. Occupation (Be as specific as possible) Wife ., a. AAL.‘ .‘A A. __ A Husband __4_ AA— 8. Total Family income (CHECK THE CHOICE WHICH COMES CLOSEST) __ Less than $3000 __ $3000 to $5999 ____ $6000 to $8999 ‘5 9000 or more -20- 9. Number of wage earners in your family? (please fill in) 10. Race _ White _ Negro __ Other (specify) 11. Who referred you to the Flint Mental Health Clinic? Self Family Friends Private Physician Clergy Court, correctional institution, police, probation, parole, protective services. Local Health Department Private Psychologist or Psychiatrist School Social Service Agency (as in family service agency, settlement house, child placement agency, marriage counseling, public welfare agency, legal aid society) Employer or place of employment __ Vocational Rehabilitation __ Other (SPECIFY) HHII 12. What was the length between learning that the Flint Mental Hfdalth Clinic could be of service and your contacting the agency? Less than one week ____ 1 to 2 weeks __ 3 to 4 weeks more than 4 weeks 13. What was the length of time between the sending in of the application form and your first appointment? Less than one week 1 to 2 weeks 3 to 4 weeks __ more than 4 weeks 14. In which way did this waiting period influence your use of the Flint Mental Health Clinic? _____ increased my interest in seeking help ___,__ partially increased my interest in seeking help __ no influence on my seeking help __ partially decreased my interest in seeking help __ decreased my interest in seeking help 15. Where you aware there would be a length of time between contact and actual appointment? __ Yes __ No ______ Comment "PLEASE REMEMBER TO ANSWER ALL QUESTIONS" l6. 17. 18. 19. 20. 21. 22. 23. 24. -21- After your first interview did you feel the agency could be of service to you? _____ Yes No Comment * Was the atmosPhere of the waiting room friendly? Yes No. Comment Did the secretaries treat you courteously? Yes No. Comment Did you feel the worker was courteous to you? Yes No Comment CHECK ONE ANSWER FOR EACH LINE. Did you feel the worker was: A. Bored - Somewhat Bored - Somewhat Interested - Interested B. Tense - Somewhat Tense - Somewhat Relaxed - Relaxed C. Indifferent - Somewhat - Somewhat Concerned - Concerned D. Domineering - Somewhat - Somewhat Accepting - Accepting E. —Cold - Somewhat Cold - Somewhat Warm - Warm Did you feel the worker understood your problem? Yes No Comment Did you feel you could talk easily with the worker? Yes No. Comment Did the worker give some indication to you that the agency could be of help? Yes No Comment Did you have any expectations as to how the agency could help you? Yes No. Comment * -22- ANSWER QUESTION 25 ONLY IF YOUR RESPONSES TO 23 AND 24 WERE YES. 25. Was the help offered by the agency similar to what you had expected? Yes - ' No Comment 26. - Did you play an active part in the decision made about your problem? Yes No . Comment 27. Did these decisions seem possible to reach? Yes No. Comment 28. How did you feel after your first interview? (CHECK ONE) comfortable and relieved hOpeful, but concerned __ unrelieved, but hopeful __ fearful and hopeless 29. AFTER your first interview, how many times did you return to this agency? _ 0 __ 4 __ l __ 5 __ 2 __ 6 __ 3 7 or more 30. Did you feel you received all the help that you could at this agency? __ Yes __ No Comment L 31. Did you seek some other form of help after you left the agency? Yes : No Comment 32. If answer to QUESTION 31 is YES, check those below which best describe the kind of help you sought. __ self __ family __ friends __ private mental hospital __ public mental hospital (federal, state, county, city) __ psychiatric service of general hospital other psychiatric inpatient facility private psychiatrist other outpatient psychiatric clinic __ psychiatric day care center private physician __ local health department -23- general hospital nursing home other medical or health agency __ private psychologist other psychological service social service agency (family service agency, settlement house, child placement agency, marriage counseling, public welfare agency, legal aid society) court, correctional institution, police, probation, parole school clergy alcoholics anonymous vocational rehabilitation employment service boarding care home other (SPECIFY) llllllll We appreciate the time and effort taken to answer this questionnaire. It is through your cooperation that we will be able to improve out services to the greater Flint Community. We would welcome any additional comments about agency services; please use the back of this page. Thank you. A PPENDIX I I Major Hypothesis 34 - 1 not continued continued 34-3&2 * 914-1 waiting . period less 33 12 45 then 2 weeks 14-2 waiting period more 4 2 6 then 2 weeks ' 37 If 51 34-3112 34-1 not continued continued 16-1 aware of waiting 31 8 39 period l6-2/‘aqi5are of waiting 9 8 17 period 40 16 56 34-3312 34-1 not continued continued 17-1 after 1st interview ? I ‘ . . did you feel 33 6 39 agency could be of service 17-2 didn't feel could be of 7 8 15 service 40 14 54 34-3812 34 - 1 not continued continued 18-1 atmosphere friendly 33 12 45 18-2 atmosphere not friendly 4 2 6 37 14 51 34-3812 34-1 not continued continued 20-1 worker courteous 36 14 50 20—2 worker I P not courteous 4 0 4 4O 14 54 34-3&2 34-.-1 not continued continue 21-2 worker ( 1 interested 34 12 46 21-1 worker bored ,6 3 9 40 15 55 34~3l¢2 34-1 not _ , . o . . 22-2 worker ‘ relaxed 34 14 48 22-1 worker tense 6 0 6 40 14 54 34-3&2 34-1 not continued continued, 23-2 worker concerned 32 10 42 23-1 worker unconcerned 8 4 12 40 14 54 34-3&2 34-1 not continued continued 24-2 worker ac ce pting 31 10 41 24-1 worker dominee ring 9 4 13 4o 14 P 54 34-3822 34-1 not c ontinue d c ontinue d 25-2 worker warm 31 9 40 25-1 worker P cold 9 5 14 40 14 54 I"The first number refers to the IBM column number; the second number refers to the coding of the response. 34 38:2 34-1 not continued g continued 26-1 worker understood 26 7 33 problem fl 26-2 worker didn't understand 12 7 19 problem 38 14 52 34-3&2 34-1 not continued continued 27-1 talk easily 24 11 35 27-2 talk not easily l6 3 19 40 14 54 34-3&2 ’ 34-1 not continued continued 28-1 indication agency I” 8' n could help 33 6 39 28-2 not indication agency could help 7 8 15 40 14 54 34-3&Z 34-1 not continued continued 33-2 I 24 10 34 33-1&3 I 16 6 22 40 16 56 Minor Hypothesis #1 Table l 34-3&2 34-1 not continued continued 8-1 Less 9 4 5 9 8-2 High 23 6 29 school “' ‘ 8-3 college 13 5 18 40 16 56 Table 2 34-3&2 34-1 not continued continued 9-1 laborer 7 4 11 9-2 semi- 9 3 12 skilled 9-3 skilled 2 2 4 9-4 pro 6 1 7 24 10 34 Table 3 34-3&2 34-1 not continued continued 10-1 less ' 1 3, 000 7 . 5 12 10-2 3,-6,000' 11 5 16 10-3 6, -9;_ 000 13 1 14 10-4 9, 000- 6 5 11 37 16 53 Combining Tables 1, 2 8: 3 low low high class middle mid 1e continued ‘ 4 14 6 24 not continued [3 \ 9 L8 \ 32 3 l4 l9 2 Minor Hypothesis #2 Table 1 36-2&3 36-1 continued elsewhere stOpped 12-1 self referred 10 17 27 12-2&3 other 10 19 29 referred ' v 20 36 56 Table 2 36-2&3 36-1 continued elsewhere stgnped 13-1 1 week under 9 10 19 13-2 over one 10 26 36 week 3 19 36 55 Table 3 36-2&3 36-1 continued elsewhere stapped 29-1 had expectations 10 19 29 29-2 no 9 16 25 expectations W 19 35 54 34-3&2 34-1 not continued continued 35-1 received all help 22 8 30 could 35-2 didn't receive all help could 16 8 24 +38 16 54 Combining Tables 1, 2 8: 3 34- 3 8:2 34 -1 not continued continued Low Agency initial 15 6 Stimulated motivation High initial 1 6 2 motivation Low initial Agency Didn't motivation 5 3 Stimulate High initial motivation 4 3 Minor Hypothesis #3 34 - 3 8: 2 34 -1 not continued continued 14-1 less ~ 1 6 2 8 14-2 1-2 17 5 W. 22 14-3 3—4 ~ 8 1 9 14-4 over 8 6 14 4 v. 39 14 53 34 - 3 8:2 34-1 not continued continued 30 -1 s imilar expe ctations 16 1 17 30- 2 not similar expectations 4 2 6 20 3 23 35-1 35-2 received not received help help 36-3 continued 11 T8 19 elsewhere 36-18:2 knot l9 16 35 continued elsewhere 30 24 54 "I11111111111118S (U) (u) S I I I1 A W ""__’ I o