Experience of Service Questionnaire (ESQ)

Abstract

The Experience of Service Questionnaire (ESQ) is a specialized psychological scale designed to systematically capture the views and experiences of service users within Child and Adolescent Mental Health Services (CAMHS). Developed primarily by the Commission for Health Improvement (CHI) and J. Attride-Stirling in 2002, the ESQ provides a crucial measure of user satisfaction regarding the quality of care, communication effectiveness, accessibility of services, and overall treatment received. The instrument is unique in that it offers three distinct versions tailored for different informants: parents/carers, young people aged 12–18, and children aged 9–11, ensuring feedback is developmentally appropriate and comprehensive across the service delivery spectrum.

Keywords

Experience of Service Questionnaire, ESQ, CAMHS, patient experience, user feedback, service quality, clinical governance, mental health services, user satisfaction

Authors

Commission for Health Improvement (CHI), J. Attride-Stirling, A. Brown, T. Ford, J. Deighton, M. Wolpert

Purpose

The primary purpose of the ESQ is to provide a standardized, robust methodology for capturing user feedback concerning mental health services delivered to children and adolescents. This feedback is essential for meeting requirements related to clinical governance and quality improvement within healthcare systems. The instrument allows service providers to benchmark their performance against national standards and identify specific areas for improvement, such as communication practices, appointment scheduling, and perceived staff competence. The ESQ’s multi-informant structure ensures that the perspective of the patient (child/young person) is balanced with that of the primary caregiver (parent/carer).

The ESQ was intended to be a practical tool for routine monitoring, allowing CAMHS units to translate qualitative user views into measurable quantitative data. This systematic approach facilitates better accountability and responsiveness to the needs of families accessing specialist mental health support.

Construct

The ESQ measures the construct of Patient and Carer Experience of Service Quality, which encompasses several key dimensions of care delivery. These dimensions typically fall under two broad categories: the quality of the therapeutic relationship and the operational quality of the service setting.

• Quality of Relationship and Communication: Items focus on whether staff listened, whether communication was easy, whether views and worries were taken seriously, and the perceived competence of the staff in addressing the problem.
• Accessibility and Environment: Items assess the convenience of appointment times, ease of access to the location, comfort of facilities (e.g., waiting areas), and clarity of explanations regarding available help.
• Overall Satisfaction and Recommendation: The final items provide a global measure of satisfaction and the likelihood of recommending the service to others, serving as an ultimate indicator of service success.

Validity

The initial development of the ESQ emphasized content validity, ensuring the items reflected the actual concerns and priorities of service users. The development process, led by Attride-Stirling (2002) for the Commission for Health Improvement, involved extensive consultation and qualitative research to ensure the questionnaire captured relevant dimensions of service experience in CAMHS.

Subsequent research, such as the work by Brown, Ford, Deighton, and Wolpert (2012), has affirmed the utility of the ESQ in translating user feedback into reliable measurement data suitable for administrative and policy contexts. While the instrument is primarily designed for service evaluation rather than clinical diagnosis, its widespread adoption across UK health services provides evidence of its face and ecological validity in measuring service quality metrics.

Reliability

While specific detailed psychometric reports on internal consistency (like Cronbach’s alpha) are typically found within the full academic literature, the design of the ESQ, which uses standardized, closed-ended questions alongside open-ended feedback, aims for high reliability in capturing consistent user perceptions across different service settings. The use of distinct, age-appropriate language in the child and young person versions also contributes to the reliability of the responses by ensuring clarity and comprehension suitable for each developmental stage.

Factor Analysis

The ESQ is often treated as a unidimensional measure of overall service satisfaction, with individual items contributing to a single, summative score reflecting the perceived quality of care. However, research examining the underlying structure of similar user feedback instruments often suggests potential sub-factors related to interpersonal care (e.g., listening, communication) versus logistical/environmental factors (e.g., appointments, facilities). Studies utilizing ESQ data often perform factor analysis to confirm whether the scale operates as a single global satisfaction measure or if distinct subscales should be scored separately to inform targeted service improvements.

Instrument

Test Type: Psychological Scale; User Experience and Service Satisfaction Questionnaire

Format: Self-report (for young people and children) and proxy-report (for parents/carers). Utilizes 3- or 4-point Likert-style response options, with an unscored “Don’t Know” option.

Language Available: English (Original)

Population Group: Users of Child and Adolescent Mental Health Services (CAMHS) and their primary caregivers.

Age Group: Children (9–11 years), Adolescents (12–18 years), and Parents/Carers of children accessing services.

Population Details: Developed for use within the UK National Health Service (NHS) and related healthcare settings for routine evaluation and clinical governance.

Test Methodology: The core instrument consists of 12 quantitative items. The parent/carer version also includes three mandatory open-ended questions designed to capture qualitative feedback on aspects that were good, areas needing improvement, and any other comments.

Keywords

Child mental health, service evaluation, health quality, experience measure, patient feedback, clinical audit, Commission for Health Improvement, healthcare policy

Authors

Author ORCID Identifier: Not specified in source content.

Affiliation Email addresses: Not specified in source content.

Correspondence Address: Correspondence is typically directed through the originating institutions, such as the Commission for Health Improvement (now defunct, succeeded by subsequent regulatory bodies) or the relevant academic institutions (e.g., Anna Freud Centre for M. Wolpert’s related work).

Permissions & Fee and Test Year

The ESQ was developed in 2002 under the direction of the Commission for Health Improvement (CHI), a UK public body. It is widely used in public service settings, often considered available for use by healthcare providers for quality assurance purposes, provided appropriate citation is given. The original instrument and related documentation are often publicly accessible.

The original PDF of the revised instrument can be downloaded here: https://kar.kent.ac.uk/30454/1/ESQ%20revision%202%20proofread.pdf

An additional PDF link for the parent ESQ is: http://s3-eu-west-1.amazonaws.com/files.royalfree.nhs.uk/Patient_resources/Paed_occ_therapy/CHI_parent_ESQ.pdf

Reference’s

The following references are key to the development and application of the ESQ:

• Attride-Stirling‚ J. (2002). Development of Methods to Capture Users’ Views of CAMHS in Clinical Governance Reviews. This foundational document is available as a PDF here: www.healthcarecommission.org.uk/_db/_documents/04017624.pdf.
• Brown A‚ Ford T‚ Deighton J‚ Wolpert M. (2012). Satisfaction in child and adolescent mental health services: translating users’ feedback into measurement. Administration and Policy in Mental Health; 41(4):434-46.
• Commission for Health Improvement (CHI). (2002). Experience of Service Questionnaire (ESQ) documentation.

Items of the Experience of Service Questionnaire (ESQ)

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

ESQ for parents /carers

Certainly True – Partly True – Not True – Don’t know (“don’t know” response option is not scored).

1. I feel that the people who have seen my child listened to me
2. It was easy to talk to the people who have seen my child
3. I was treated well by the people who have seen my child
4. My views and worries were taken seriously
5. I feel the people here know how to help with the problem I came for
6. I have been given enough explanation about the help available here
7. I feel that the people who have seen my child are working together to help with the problem(s)
8. The facilities here are comfortable (e.g. waiting area)
9. The appointments are usually at a convenient time (e.g. don’t interfere with work‚ school)
10. It is quite easy to get to the place where the appointments are
11. If a friend needed similar help‚ I would recommend that he or she come here
12. Overall‚ the help I have received here is good

What was really good about your care?

Was there anything you didn’t like or anything that needs improving?

Is there anything else you want to tell us about the service you received?

ESQ for young people aged 12-18

Certainly True – Partly True – Not True – Don’t know (“don’t know” response option is not scored).

1. I feel that the people who saw me listened to me
2. It was easy to talk to the people who saw me
3. I was treated well by the people who saw me
4. My views and worries were taken seriously
5. I feel the people here know how to help me
6. I have been given enough explanation about the help available here
7. I feel that the people who have seen me are working together to help me
8. The facilities here are comfortable (e.g. waiting area)
9. My appointments are usually at a convenient time (e.g. don’t interfere with school‚ clubs‚ college‚ work)
10. It is quite easy to get to the place where I have my appointments
11. If a friend needed this sort of help‚ I would suggest to them to come here
12. Overall‚ the help I have received here is good

ESQ for children aged 9 -11

1. Did the people who saw you listen to you? (Yes-Only a little-Not really-Don’t Know)
2. Was it easy to talk to the people who saw you? (Yes-Only a little-Not really-Don’t Know)
3. How were you treated by the people who saw you? (Very well-Ok-Not very well-Don’t Know)
4. Were your views and worries taken seriously? (Yes-Only a little-Not really-Don’t Know)
5. Do you feel that the people here know how to help you? (Yes-A little-Not really-Don’t Know)
6. Were you given enough explanation about the help available here? (Yes-Only a little-Not really-Don’t Know)
7. Do you feel that the people here are working together to help you? (Yes-Only a little-Not really-Don’t Know)
8. The facilities here (like the waiting area) are… (Comfortable-Ok-Uncomfortable-Don’t Know)
9. The time of my appointments was… (Convenient-Ok-Not convenient-Don’t Know)
10. The place where I had my appointments was… (Easy to get to-Ok to get to-Hard to get to-Don’t Know)
11. If a friend needed this sort of help‚ do you think they should come here? (Yes-Maybe-Not really-Don’t Know)
12. Has the help you got here been good? (Yes-Only a little-Not really-Don’t Know)