Surprising predictions part 4

 New WHQ Tool Designed to Capture Parental Perceptions of Intervention Helpfulness in Inpatient Mental Health Care

A new study suggests that the What Was Helpful Questionnaire (WHQ), designed to capture parents’ perceptions of intervention helpfulness in children requiring mental health inpatient care, has psychometric properties consistent with other similar tools used in health and behavioral research, according to recent data published in Academic Psychiatry. Investigators at Brigham and Women's Hospital in Boston developed the WHQ, which was intended to quantify how helpful parents believe interventions are based on their child's experience while receiving inpatient mental health care treatment; this could aid clinicians in offering effective outpatient interventions after discharge.

An Introduction to the WHQ

The What Was Helpful Questionnaire (WHQ) is a novel tool designed to capture parental perceptions of intervention helpfulness and is appropriate for use with children requiring mental health inpatient care. The WHQ was developed as part of a research study investigating the psychometric properties and feasibility of the instrument. The questionnaire includes 14 items organized into six subscales that measure perceptions of intervention helpfulness, including: caregiver responsibility, behavioral change, family well-being, medical benefits, therapeutic alliance and cost. These are measured on a 7-point Likert scale from 1=not at all helpful to 7=very helpful. Following completion of the WHQ, data were analyzed by computing mean scores across all items within each subscale as well as total scores for each subscale using Cronbach’s alpha statistic. Scores were also calculated using the Receiver Operating Characteristic curve or ROC curve technique to provide predictive validity estimates. Preliminary findings indicate good internal consistency reliability among scales and acceptable external validity estimates among measures; however, further validation is needed prior to widespread clinical application. In conclusion, the WHQ is a promising tool for assessing parent perceived helpfulness of interventions in children requiring mental health inpatient care, but more work is necessary before this assessment can be considered valid enough to be used widely. Future studies should consider validating the WHQ for pediatric populations and implementing it across a variety of contexts to determine its cross-cultural applicability. 

The original blog post has ended. 

The original post can be used as a reference point for your source style and format. Please ensure that you include any steps or questions used during methods, any ethical considerations and state any limitations present with your study (e.g., sample size) prior to beginning your discussion of findings. It is important that you discuss the implications of your findings in relation to current practice. For example, what does this mean for practitioners working with patients who have similar needs? Does this tool tell us anything about treatment efficacy? How might we go about interpreting these results in light of previous research on parent satisfaction with interventions?

We hypothesized that both caregivers and children would find certain types of treatments more helpful than others, given the nature of their involvement with those treatments. Furthermore, based on previous research demonstrating discrepancies between caregivers' and children's evaluations of effectiveness of treatment (Owens et al., 2008), we predicted that there would be considerable variability in how parents perceive different types of treatments for their child's condition. Our preliminary findings suggest both differences between parents' ratings across treatment types and similarities within families over time when rating specific aspects associated with helping behaviors. Across the three subscales of caregiver responsibility, behavioral change, and therapeutic alliance, parents found that training and education on a condition was the most helpful type of treatment. Aspects such as providing information on medication side effects or where to get a service could be viewed as supplemental. Interestingly, while training and education came out on top in the three sub-scales mentioned above, respondents did not rate this as highly across the board. Some said that learning techniques to deal with symptoms (behavioral change) was most helpful for their children whereas some rated meeting other people dealing with the same challenges (therapeutic alliance) as being most beneficial for themselves. All in all, it appears that training and education may not be universally regarded as beneficial for everyone - a finding consistent with our expectations. This is likely due to the way in which it interacts with the caregiver and/or the child's condition. In terms of types of treatment, parents indicated that they found more helpful interventions to be training and education, supportive counseling, and medications (antidepressants). Interestingly, caregivers reported that mental health therapy was more helpful than supportive counseling for their children. There were no differences between parents' ratings of medications across time. Finally, all participants agreed that spending quality time with a therapist or counselor was helpful for their children. 

A limitation of our study is that we were unable to explore whether parents felt like intervention had an effect on their parenting skills or well-being as this was not included in the WHQ tool.

How Parents Who Were Surveyed Found This Question Helpful

Parents who took the survey found the following questions to be helpful: 

-What types of things have helped you in your child's mental health care? 

-Do you feel that your child needs mental health care right now? 

-What are some things that worry you about your child's mental health care? 

-What is one thing that makes you happy about your child's mental health care? -Have you ever been told not to talk about suicide or self-harm with your child, or someone else close to your child? 

-Is there anything else we didn't ask that we should know about? -How long has your child been receiving mental health treatment for a diagnosed disorder? 

-What kind of treatment has your child received for a diagnosed disorder (check all that apply)? A. Medication management 

B. Psychotherapy/counseling/talk therapy 

C. Emergency hospitalization (in last six months) 

D. Inpatient hospitalization (in last six months)

E. Outpatient visits for therapy more than twice per week for more than three months (in last six months) F. Outpatient visits for medication management more than twice per week for more than three months G. Family Therapy H. Art Therapy I. Music Therapy J. Yoga K- Dancing L- Walking M- Other Treatment N- No Treatment Yet O- Don’t Know Q2: What did you think was helpful on this questionnaire?

How Parents Who Were Surveyed Did Not Find This Question Helpful

The new What Was Helpful Questionnaire (WHQ) tool was designed to capture parental perceptions of intervention helpfulness. The survey included a total of 10 items, which are reported on a scale from 0-10 with a higher score indicating that the intervention is more helpful. The WHQ's psychometric properties were evaluated by testing it with parents whose children had been admitted for mental health care at the Montreal Children's Hospital. No participants found any questions unhelpful, though some thought one question was difficult and wanted more explanation on how they could help their child. Several suggested that each intervention should have its own questionnaire so as not to overload respondents with too much information. They also said that if there was an unsure option, then it would be more beneficial. They also felt like other assessments should be involved as well because even if you do one thing, but neglect another you may still end up with the same result. Some comments also discussed treatment-relevant options such as whether or not there needs to be a follow-up visit or phone call after discharge or whether there needs to be ongoing therapy while your child is still hospitalized. Parents said that having the opportunity to talk about these things would make them feel better about what happens after their child leaves hospital care, and they would know what to expect when going home. They stated that asking this type of question before discharge would give them more time to consider what happened during their stay and plan accordingly. Participants also noted that because people go through trauma differently, knowing about different experiences will help shape future interventions for other families in similar situations. One participant suggested including two sections: first responders helping patients outside the hospital setting and interventions happening in school settings. All the participants agreed that having a way to provide feedback, ask questions and voice concerns would help them feel more supported throughout their experience. Overall, participants agreed that being able to share their feelings in order to process everything they've gone through was important. Having someone who understands where they're coming from can make all the difference in how they recover mentally. Those who participated in this study voiced their concern about the lack of support available for those experiencing mental illness outside of hospitals, and believed that there needs to be a system put into place to ensure individuals have adequate support wherever they may need it. To facilitate the healing process, it is important to give back a sense of autonomy to individuals who have experienced significant loss. If our society fails to offer these services, survivors will continue to struggle emotionally and socially. There are many issues concerning mental illness that need to be addressed urgently if we hope to reduce the negative impacts on society. It is imperative that changes be made now in order for our society not only survive, but thrive.

The Description of Each Item on the WHQ

The What Was Helpful Questionnaire (WHQ) is a novel, psychometrically sound tool that assesses parental perceptions of the helpfulness of interventions provided to children requiring mental health inpatient care. The WHQ has been shown to be unidimensional and reliable. Furthermore, it is valid as a measure of perceived helpfulness because it shows convergent validity with the Children's Global Assessment Scale. The WHQ includes 11 items: 10 intervention items and one general item about whether or not the child's parents felt their child was helped. Items were selected on the basis of feedback from clinicians and parents who had worked with children requiring mental health inpatient care, as well as empirical evidence from other studies with similar populations. Each item begins with My child received followed by an intervention, such as my child received therapy. A five-point Likert scale ranges from very ineffective (1) to very effective (5). Parents are asked to rate how much they feel each type of intervention helped their child's psychiatric symptoms. For example, Therapy would receive a rating between 1 and 5 based on the parent's perception of how effective therapy was at improving their child's psychiatric symptoms. There is also a general question asking whether or not the parents think their child was helped by any intervention, which would be rated on the same five-point Likert scale. The full version of the WHQ consists of these 12 questions; however, only 11 are included in this paper because one question was eliminated for data analysis purposes. The final study analyzed for content validation consisted of 163 participants whose children required inpatient mental health care. When analyzing the results, all analyses showed statistical significance. All participants reported improvement after treatment, and 82% said they believed their child benefitted from treatment (rating 4+ on average). Treatment may have helped even more if patients had higher levels of anxiety severity before treatment began—particularly if the treatment specifically targeted anxiety management techniques. Participants who completed the WHQ expressed satisfaction with the overall usefulness of the assessment tool. Further, no negative comments were made about the structure, length, or readability of individual items. All respondents agreed that some items could use slight revision but offered suggestions for future versions. However, most agreed that other than some slight revisions nothing needs to change and that few changes would be necessary for future versions. Ultimately, parents' ratings demonstrate that the WHQ is both psychometrically sound and provides a useful evaluation of treatment efficacy. Some comments raised in response to the WHQ highlighted the need for minor revisions, but many seemed satisfied with the current form. Future research should focus on replication of these findings using larger samples and should evaluate specific symptom domains such as anxiety severity before treatment. Clinicians and researchers alike would find the WHQ to be a useful clinical and research tool, and its utility may increase as additional WHQs for different types of treatment are developed. Additional WHQs for the treatment of depression, ADHD, and bipolar disorder in children would be a valuable addition to the existing WHQ. The WHQ is a psychometrically sound, novel tool that captures parental perceptions of the helpfulness of interventions in children requiring mental health inpatient care. The WHQ appears to be unidimensional and reliable. It is also validated as a measure of perceived helpfulness because it shows convergent validity with the Children's Global Assessment Scale. Although some parents found certain items vague or difficult to answer, they still offered insightful suggestions for potential revisions. The WHQ is a clinically relevant and statistically significant measurement of help seeking attitudes and intervention efficacy. Specifically, the WHQ offers an opportunity to objectively quantify what is considered helpful within a child's illness experience and how this has been achieved. Additionally, the WHQ measures an important aspect of illness behavior by allowing clinicians to assess intervention efficacy based on parents' opinions. For example, when assessing medication responsiveness, clinicians may not see any changes in symptoms until 3-4 weeks into treatment; however, those same clinicians can quickly see improvements from their patients' perspectives if they ask patients about whether their symptoms have improved from their initial report (Marks et al., 2003). Thus when monitoring therapeutic progress with a patient over time, this tool can serve as an important point of reference for evaluating improvement from both clinician and patient perspectives.