Abt Associates, Cambridge, Massachusetts (McClellan, Hunt), and Seattle (Olsho); NORC at the University of Chicago, Boston (Sirkin); Mercy College School of Health and Natural Sciences, Dobbs Ferry, New York (Pfefferle).
Psychiatr Serv. 2020 Feb 1;71(2):158-164. doi: 10.1176/appi.ps.201900072. Epub 2019 Sep 25.
The objective was to assess the number of new clients accepted by licensed mental health clinicians in Massachusetts and clinician characteristics associated with new clients accepted.
Surveys about client access to outpatient mental health care were sent to a stratified random sample of 2,250 licensed mental health clinicians (psychiatrists, psychologists, licensed certified social workers, licensed independent clinical social workers, licensed mental health counselors, and licensed marriage and family therapists) practicing in Massachusetts. The survey was administered from September 2016 to March 2017 by using a mail survey with a push-to-Web design and telephone follow-up. The final adjusted response rate was 28% (N=413). Results were weighted to reflect the sampling design and for nonresponse and are representative of all licensed mental health clinicians in Massachusetts.
On average, clinicians accepted seven new clients per month. Although most clinicians reported accepting one or more new clients per month, half reported accepting four or fewer new clients per month. After adjustment for other factors, the analysis showed that clinicians in practices owned by hospitals or health systems reported accepting eight more new clients per month, on average, than clinicians in solo private practices (p<0.05). Clinicians in private group practices reported accepting two more new clients per month on average than clinicians in solo private practices (p<0.05). Working fewer than 30 hours per week and tenure of more than 1 year in one's current position were negatively associated with acceptance of new clients.
New client acceptance varied by practice setting but not by type of clinician. These findings can inform mental health system and workforce planning to improve access to mental health services.
评估马萨诸塞州持照心理健康临床医生新接纳的客户数量，以及与新接纳客户相关的临床医生特征。
对马萨诸塞州执业的（精神科医生、心理学家、持牌认证社会工作者、持牌独立临床社会工作者、持牌心理健康顾问和持牌婚姻和家庭治疗师）持照心理健康临床医生进行了一项关于获得门诊精神卫生保健机会的调查，采用分层随机抽样方法抽取了 2250 名持照心理健康临床医生。调查于 2016 年 9 月至 2017 年 3 月通过邮件调查和网络推送设计以及电话跟进的方式进行。最终调整后的响应率为 28%（N=413）。结果进行了加权处理，以反映抽样设计和无应答情况，结果代表了马萨诸塞州所有持照心理健康临床医生。
平均而言，每位临床医生每月接纳 7 名新客户。尽管大多数临床医生报告每月接纳一名或多名新客户，但有一半的临床医生每月接纳的新客户少于 4 名。在调整了其他因素后，分析表明，与在私人执业的临床医生相比，在医院或医疗系统所有的医疗机构执业的临床医生平均每月多接纳 8 名新客户（p<0.05）。在私人团体执业的临床医生平均每月比私人执业的临床医生多接纳 2 名新客户（p<0.05）。每周工作时间少于 30 小时和在目前职位上工作时间超过 1 年与新客户的接纳呈负相关。
新客户的接纳因执业环境而异，但与临床医生的类型无关。这些发现可以为精神卫生系统和劳动力规划提供信息，以改善精神卫生服务的可及性。
