Ontario Perception of Care Tool for Mental Health and Addictions (OPOC-MHA)

Abstract

The Ontario Perception of Care Tool for Mental Health and Addictions (OPOC‐MHA) is a standardized, psychometrically sound instrument designed to measure the client experience and perception of care quality within publicly funded mental health and addiction services across Ontario, Canada. Developed in 2013 by Rush and colleagues, this tool was commissioned to provide consistent data on service quality, accessibility, and client outcomes. It is crucial for informing system planning, quality improvement initiatives, and ensuring accountability within the provincial healthcare system. The scale is administered to both service recipients (clients) and their family members or significant others, recognizing the importance of diverse perspectives on care delivery.

Keywords

Client perception, quality of care, mental health services, addictions treatment, psychometric evaluation, Ontario, client satisfaction, service accessibility, psychometrics

Authors

Brian Rush, Emily Hansson, Dr. Yanka Cvetanova, Dr. Nooshin Rotondi, April Furlong, Renéé Behrooz

Purpose

The primary purpose of the OPOC-MHA is to provide a reliable and consistent measure of clients’ and their supporters’ experiences with mental health and addiction services. Prior to its development, there was a lack of standardized tools across Ontario’s diverse network of providers, making system-wide quality comparisons and improvements challenging. This tool addresses that gap by offering a uniform instrument.

The scale serves as a mechanism for gathering feedback across critical domains of service delivery, including physical environment, staff conduct, access to services, and involvement in treatment planning. The resulting data enables organizations and the Ministry of Health and Long-Term Care to identify strengths, address systemic weaknesses, and drive evidence-based improvements in care quality.

Construct

The OPOC-MHA measures the multidimensional construct of Perception of Care Quality. This construct is defined by the client’s subjective evaluation of the processes and environment surrounding their treatment for mental health and/or addiction issues. It is structured around several core domains that reflect key indicators of high-quality service provision, moving beyond simple satisfaction to evaluate specific elements of the therapeutic relationship and operational efficiency.

The scale is structured to capture aspects of recovery orientation, rights protection, and culturally sensitive care, ensuring a comprehensive assessment that aligns with modern best practices in behavioral health services.

Validity

The development of the OPOC-MHA involved rigorous qualitative and quantitative validation processes, as detailed in the final report. Initial development utilized extensive qualitative input from clients, family members, and service providers to ensure strong content validity—meaning the items accurately reflect the critical aspects of care experienced by users.

Subsequent quantitative testing, including factor analysis and statistical modeling, was conducted to confirm the tool’s structure and construct validity, demonstrating that the scale measures the intended underlying dimensions of perceived care quality.

Reliability

The OPOC-MHA exhibits strong internal consistency across its various domains, indicating high reliability. Internal consistency was measured using Cronbach’s Alpha, with most subscales achieving alpha values well above the acceptable threshold of 0.70, demonstrating that items within each domain are highly correlated and measure the same underlying dimension.

The reported Cronbach’s Alpha values for the client version (Section A) domains are generally excellent:

• Access/Entry: Alpha 0.87
• Services Provided: Alpha 0.89
• Participation/Rights: Alpha 0.87
• Therapists/Support/Workers/Staff: Alpha 0.92
• Environment: Alpha 0.89
• Discharge/Leaving the Program: Alpha 0.91
• Overall Experience/Recovery/Outcome: Alpha 0.91 (depending on the specific version)

Factor Analysis

The psychometric analysis performed during the OPOC-MHA development identified several distinct factors or domains of care perception. These factors structure the instrument into coherent subscales, reflecting the key areas of service quality that clients evaluate. The factor structure ensures that the tool is not measuring a single monolithic concept but rather distinct aspects of the service experience, such as accessibility versus staff competency.

The identified factors include areas related to administrative efficiency (Access/Entry), clinical interaction (Services Provided, Therapists/Staff), patient empowerment (Participation/Rights), and physical setting (Environment), confirming a robust, multi-factor model for assessing client experience.

Instrument

Test Type: Self-report questionnaire / Client perception survey

Format: Multi-item scale using a 4-point Likert scale response format, supplemented by a “Not Applicable” (N/A) option and open-ended comment sections for qualitative feedback.

Language Available: Primarily English (developed for use in Ontario, Canada).

Population Group: Individuals receiving mental health and addictions services (clients/consumers) and their family members/significant others/supporters.

Age Group: Adults (or individuals capable of self-reporting their perception of services).

Population Details: Applicable across various settings, including community-based, residential, and inpatient mental health and addictions programs funded by the Ontario Ministry of Health and Long-Term Care.

Test Methodology: The scale uses the following response anchors: 1 – Strongly Disagree, 2 – Disagree, 3 – Agree, 4 – Strongly Agree, and N/A – Not Applicable.

Keywords

Service quality, client experience, psychometric tool, outcome measurement, healthcare evaluation, treatment accessibility, confidentiality, patient rights, Canadian mental health system

Authors

Author ORCID Identifier: Not specified in the source content.

Affiliation Email addresses: Not specified in the source content (Authors were affiliated with the Centre for Addiction and Mental Health, Health Systems and Health Equity Research in 2013).

Correspondence Address: Not specified in the source content.

Permissions & Fee and Test Year

The OPOC-MHA was developed in 2013 under a final report for the Ministry of Health and Long-Term Care. Given its purpose as a mandated tool for quality improvement within the publicly funded Ontario system, the instrument is widely accessible for non-commercial use by service providers in the region. The full final report, including the instrument, is publicly available. The original PDF can be downloaded here: http://eenet.ca/wp-content/uploads/2013/08/OPOC-Final-Report-2013.pdf. Further information is also available at: http://halton.cmha.ca/about-us/ontario-perception-care-tool-mental-health-addictions-opoc-mha/#.VlAw7NIrK70.

Reference’s

Rush, B., Hansson, E., Cvetanova, Y., Rotondi, N., Furlong, A., & Behrooz, R. (2013). Development of a client perception of care tool for mental health and addictions: qualitative, quantitative, and psychometric analysis: final report for the Ministry of Health and Long-Term Care. Centre for Addiction and Mental Health, Health Systems and Health Equity Research. The final report is available at: http://eenet.ca/wp-content/uploads/2013/08/OPOC-Final-Report-2013.pdf.

Items of the Ontario Perception of Care Tool for Mental Health and Addictions (OPOC‐MHA)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The OPOC-MHA is divided into two main sections: Section A (Client/Consumer) and Section B (Family member/significant other/supporter). The following items reflect the structure outlined in the final report (August 13, 2013).

Section A (Client/Consumer)

Access/Entry to Services

1. The wait time for services was reasonable for me.
2. Services were available at times that were good for me.
3. The location of services was convenient for me.
4. When I had appointments I was seen on time.
5. From the start I felt welcome.
6. I received enough information about the programs and services available to me.

Services Provided

7. I had a good understanding of my treatment and support plan.
8. Staff and I agreed on my treatment and support plan.
9. Responses to my crises or urgent needs were provided when needed.
10. I received clear information about my medication (i.e.‚ side effects‚ purpose‚ etc.)
11. I was referred or had access to other services when needed (including alternative approaches).

Participation/Rights

12. I was involved as much as I wanted to be in decisions about my treatment and support.
13. I understand how to make a formal complaint to this organization.
14. I understood that I could decline treatment activities if I wanted to.
15. I was assured my personal information was kept confidential.
16. I felt comfortable asking questions about my treatment and support‚ including medication.

Therapists/Support Workers/Staff

17. I found staff knowledgeable and competent.
18. I was treated with respect by program staff.
19. Staff were sensitive to my cultural needs (e.g.‚ language‚ ethnic background‚ race).
20. Staff believed I could change and grow.
21. Staff understood and responded to my needs and concerns.

Environment

22. Overall‚ I found the facility welcoming‚ inclusive‚ and comfortable (e.g.‚ entrance‚ waiting room‚ décor‚ posters‚ your room if applicable).
23. Overall‚ I found the program space clean and well maintained (e.g.‚ meeting space‚ bathroom‚ and your room if applicable).
24. I was given private space when discussing personal issues with staff.
25. I felt safe in the facility at all times.
26. The program accommodated my disability-related needs.

Discharge/Leaving the Program

27. Staff helped me develop a plan for when I leave the program.
28. I have a plan that will meet my needs after I leave the program.
29. Staff helped me identify where to get support after I leave the program.

Recovery/Outcome

30. The services I have received have helped me better understand my personal strengths and challenges.
31. The services I have received have helped me deal more effectively with my life’s challenges.

Service Quality (General)

32. I think the services provided here are high quality.
33. If a friend were in need of similar help I would recommend this service.

Residential/Inpatient Specific Items (Included in Service Quality Section of Final Report)

34. There were enough activities of interest to me during free time.
35. Rules or guidelines concerning contact by my family and friends were appropriate to my needs.
36. The layout of the facility was suitable for visits by my family and friends (e.g.‚ privacy‚ comfort level).
37. The area in and around my room was quiet at night.
38. The quality of the food met my needs.
39. My special dietary needs were met (e.g.‚ diabetic‚ halal‚ vegetarian‚ kosher).

Section B (Family member/significant other/supporter)

Access/Entry to Services

1. Services were available at times that were good for me.
2. The location of services was convenient for me.
3. From the start I felt welcome.
4. I received enough information about the programs and services available to me.

Services Provided

5. Responses to my crises or urgent needs were provided when needed.
6. I was referred or had access to other services when needed (including alternative approaches).

Participation/Rights

7. I understand how to make a formal complaint to this organization.

Therapists/Support Workers/Staff

8. I found staff knowledgeable and competent.
9. I was treated with respect by program staff.
10. Staff were sensitive to my cultural needs (e.g.‚ language‚ ethnic background‚ race).
11. Staff understood and responded to my needs and concerns.

Environment

12. Overall‚ I found the facility welcoming‚ inclusive‚ and comfortable (e.g.‚ entrance‚ waiting room‚ décor‚ posters‚ your room if applicable).
13. Overall‚ I found the program space clean and well maintained (e.g.‚ meeting space‚ bathroom‚ your room if applicable).
14. I was given private space when discussing personal issues with staff.
15. I felt safe in the facility at all times.
16. The program accommodated my disability related needs.

Service Quality

17. I think the services provided here are high quality.
18. If a friend were in need of similar help I would recommend this service.