Coordinated Care Attitudes Interview Measure

Abstract

The Coordinated Care Attitudes Interview Measure (CCAIM), developed by Hugunin et al. in 2023, is a specialized research instrument designed to elicit and evaluate the perspectives of healthcare and mental healthcare providers regarding coordinated care for the population of emerging adults. The instrument was initially utilized in a qualitative study involving a sample of Massachusetts-based pediatricians and child/adolescent psychiatrists who treat patients with serious mental health conditions (SMHCs).

The CCAIM operates as a semi-structured interview guide, employing six primary, open-ended questions supplemented by numerous probing items to ensure depth and thematic saturation of responses. As this instrument was developed for a specific qualitative research effort, the original publication did not report formal quantitative data pertaining to reliability or validity results for the items.

Keywords

Coordinated Care, Emerging Adults, Health Care Provider Attitudes, Mental Health Care Provider Attitudes, Serious Mental Health Conditions, Health Personnel Attitudes, Integrated Services, Therapeutic Processes, Emerging Adulthood, Treatment Process and Outcome Measures, Health Care Personnel Measures, Serious Mental Illness, Transition Planning, Pediatric-to-Adult Care.

Authors

Hugunin, Julie, Khan, Sara, McPhillips, Emily, Davis, Maryann, Larkin, Celine, Skehan, Brian, Lapane, Kate L.

Purpose

The primary purpose of the CCAIM interview guide is to gather detailed qualitative data concerning provider attitudes toward, and experiences with, coordinated care. Specifically, it focuses on how healthcare professionals perceive their role in managing the complex needs of emerging adults who suffer from serious mental health conditions (SMHCs).

A key objective is exploring the challenges and perceived necessities of transitional planning, particularly as these young patients move from specialized pediatric care structures into often fragmented adult care systems. The instrument aims to identify systemic barriers and facilitators to effective coordination during this critical life stage.

Construct

The CCAIM is designed to measure the latent construct of Provider Attitudes and Perspectives toward Coordinated Mental Healthcare for Emerging Adults. This construct encompasses various dimensions of professional viewpoint, organizational challenges, and clinical practice related to integrated care models.

Key dimensions explored through the interview questions include:

• Role Clarity and Responsibility: Providers’ self-perceived roles in managing SMHCs and their expectations regarding the roles of other specialists (PCPs vs. psychiatrists).
• Inter-Provider Communication: Current practices, effectiveness, barriers, and facilitators of communication necessary for effective care coordination.
• Transition Planning: Experiences with, and perceived gaps in, the formal and informal processes of transitioning patients from pediatric to adult care.
• Systemic Barriers: Identification of institutional, financial, or logistical obstacles (e.g., insurance, provider availability, time constraints) that impede coordinated care efforts.

Validity

Formal quantitative validity data, such as criterion or construct validity coefficients, were not reported in the initial publication (Hugunin et al., 2023). Given the instrument’s design as an open-ended interview guide utilizing qualitative methodology, validation efforts focused primarily on content alignment and thematic saturation.

The interview questions and probing items were systematically developed based on established literature related to coordinated care and transitional care models, suggesting strong face and content validity for assessing provider experiences within the intended population and setting.

Reliability

No formal quantitative reliability data, such as internal consistency metrics or test-retest reliability, were reported for the CCAIM items. As a structured interview guide designed for qualitative data collection, reliability would typically be assessed through inter-rater reliability applied to the coding of the interview transcripts.

The study employed a rigorous thematic analysis process guided by the Care Coordination Measurement Framework (AHRQ), ensuring a systematic and consistent approach to interpreting open-ended responses, thereby contributing to the trustworthiness of the qualitative findings.

Factor Analysis

Factor analysis is not applicable to the Coordinated Care Attitudes Interview Measure. This instrument is a qualitative interview guide consisting of six open-ended thematic questions, not a psychometrically validated scale composed of quantifiable items intended for statistical factor extraction.

Instrument

Test Type: Original research instrument (Qualitative Interview Guide)

Format: This instrument is an interview guide consisting of six main topics supported by multiple probing questions. All participant responses are open-ended and designed for subsequent thematic coding and analysis.

Language Available: English

Population Group: Human (Male and Female healthcare providers)

Age Group: Adulthood (18 years and older)

Population Details: The original administration was conducted in the United States (Massachusetts), targeting experienced healthcare providers, specifically Pediatricians and Child/Adolescent Psychiatrists.

Test Methodology: Interview Schedule/Guide utilizing semi-structured, open-ended questioning.

Keywords

Coordinated Care, Emerging Adulthood, Health Care Transition, Serious Mental Health Conditions (SMHCs), Provider Perspectives, Interview Guide, Pediatrician Attitudes, Child/Adolescent Psychiatry, Care Coordination Measurement Framework.

Authors

Author ORCID Identifier:

• Hugunin, Julie: http://orcid.org/0000-0002-5906-8910

• Larkin, Celine: http://orcid.org/0000-0003-2961-0585

Affiliation Email addresses:

• Hugunin, Julie: University of Massachusetts Chan Medical School Department of Population and Quantitative Health Sciences ([email protected])

• Khan, Sara: University of Massachusetts Chan Medical School Department of Population and Quantitative Health Sciences

• McPhillips, Emily: University of Massachusetts Chan Medical School Department of Population and Quantitative Health Sciences

• Davis, Maryann: University of Massachusetts Chan Medical School Department of Psychiatry

• Larkin, Celine: University of Massachusetts Chan Medical School Department of Psychiatry

• Skehan, Brian: University of Massachusetts Chan Medical School Department of Psychiatry

• Lapane, Kate L.: University of Massachusetts Chan Medical School Department of Population and Quantitative Health Sciences

Correspondence Address:

• Hugunin, Julie: [email protected]

Permissions & Fee and Test Year

Permissions: The instrument may be used for Research and Teaching purposes.

Commercial Use: No commercial use is permitted.

Fee: No fee is required for use.

Test Year: 2023

References

Hugunin, J., Khan, S., McPhillips, E., Davis, M., Larkin, C., Skehan, B., & Lapane, K. L. (2023). Pediatrician and child adolescent psychiatrist perspectives of coordinated care for emerging adults. Journal of Adolescent Health, 72(5), 770–778. DOI: https://doi.org/10.1016/j.jadohealth.2022.12.002

The detailed interview items and coding structure are available in the supplemental materials of the original publication (Supplemental Material 3, Pages 6-7, and Supplemental Material 4, Pages 8-13).

Items of the Coordinated Care Attitudes Interview Measure

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

This instrument consists of six main items with multiple probing questions. Test items are available in Supplemental Material 3, Pages 6-7, and Supplemental Material 4, Pages 8-13 of the source reference.

Items

Interview script

1. In your practice, do you see many youths with serious mental health conditions?

   1. What age range do you see?

   2. What types of conditions do you see?

   3. What do you see as your role in caring for youth with SMHCs?

2. Can you think of a particular case example of caring for a youth with a serious mental health condition and could you briefly tell me a little bit about it?

   1. Did you manage this patient on your own?

   2. Who did you work with to manage their care?

   3. What informed your decision making?

   4. What role did age of the patient play?

3. How do you coordinate with other providers on the youth’s care? [integrate with case example]

   1. Does this differ with age?

   2. To PCPs:

      1. Who are the providers you coordinate with?

      2. Tell me more about how you communicate with these providers?

      3. What role do they typically play?

      4. What role do you think they should play?

      5. We see in private insurance data that about 72% of youth with serious mental health conditions in MA don’t have a mental health outpatient visit with a psychiatrist, do you know/ask if your patients have a regular psychiatrist?

         1. About 6% don’t have any kind of outpatient mental health visit, do you know/ask if your patients receive additional outpatient mental health care?

   3. To psychiatrists:

      1. What providers do you coordinate with?

      2. Tell me more about how you communicate with these providers?

      3. What role do primary care providers typically play?

      4. What role do you think they should play?

      5. We see in private insurance data that about 32% of youth with serious mental health conditions in MA don’t have a primary care visit, do you know or ask if your patients have a regular PCP?

   4. In your experience, what makes care coordination easier?

      1. What are barriers to coordination?

   5. Have any issues come up that have affected the patient’s experience?

4. Who typically creates and manages the care plan?

   1. What role does the youth have in the care they are getting?

      1. At what age does the youth’s voice start to matter more?

   2. Who typically does the prescribing?

      1. For PCPs:

         1. How comfortable do you feel with prescribing?

         2. Does prescribing differ for class of medication?

         3. Which ones (anti-depressants, mood stabilizers, anti-psychotics, stimulants) do you feel comfortable prescribing?

      2. Does this differ with age?

   3. Who monitors for side effects?

      1. How often do you screen for metabolic markers?

      2. Do you share this information with other members of the youth’s care team?

      3. Does this differ with age?

   4. What about talk therapy?

      1. How do you engage with these mental health providers?

      2. Does this differ with age?

      3. If no, what are the barriers to talking to mental health providers?

      4. If yes, what facilitates this discussion?

      5. Do you feel engaging with these mental health providers benefits the patient?

5. I want to switch gears and think about patients in your practice as they age out of pediatric care and into adult care. Tell me about your experiences, if any, providing transitional planning to youth (PCPs: in general).

   1. PCPs: Is this any different in those with serious mental health conditions?

   2. PCPs: In our data, we’ve seen the transition to pediatric to adult care occurring at around 16-17 years. At what age do they typically leave your practice?

   3. Do you have any kind of organized process for this handoff?

   4. Are you notified that they’ve left?

   5. What guidelines or tools do you use for transitional planning?

   6. Do you have a network of adult primary care and mental health providers that you are able to refer your transition age youth to?

   7. Do providers reach out for transfer records?

   8. Are there particular populations within this group for whom you have difficulty finding either adult primary care or mental health for mental health care for?

   9. Do you feel you’ve had training in transitional planning for youth with serious mental health conditions?

   10. If you could re-design healthcare, what do you think would be the ideal transition?

   11. How do you think transitional planning could be improved?

   12. Why do you think transitional planning is important for this population?

6. How can the healthcare system be improved to help providers care for youth and young adults with serious mental health conditions?