AGPA and IBCGP Survey
Abstract
A survey of small, medium and large mental health agencies was taken (n=40, representing services provided to over 160,000 clients in inpatient and outpatient services), focusing on the role of group therapy in treatment. Agencies included, but were not limited to, inpatient, PHP/IOP and outpatient in hospital settings, university counseling centers, addictions units and child/adolescent agencies. Questions were asked about a range of topics, including, but not limited to, the competence of group therapy delivery, leadership qualifications, types of groups offered, and training needs.
A survey of small, medium and large mental health agencies was taken (n=40, representing services provided to over 160,000 clients in inpatient and outpatient services), focusing on the role of group therapy in treatment. Agencies included, but were not limited to, inpatient, PHP/IOP and outpatient in hospital settings, university counseling centers, addictions units and child/adolescent agencies. Questions were asked about a range of topics, including, but not limited to, the competence of group therapy delivery, leadership qualifications, types of groups offered, and training needs.
Overall, group was at a high level of utilization by agencies. On aggregate, group was used as at least 50% of all treatment type 42.6% of the time. There were differences in group utilization by level of care. PHP/IOP had the highest rates, utilizing group treatment for between 50-75%+ of its services 100% of the time. Inpatient utilized group at variable rates (<25% - >75%), suggesting considerable differences in treatment philosophy at each agency. Outpatient utilized group at the lowest frequencies, with the modal score being <25%. However, figures overall show that group accounts for a considerable amount of treatment in agency settings.
In terms of type of groups, psychotherapy process groups are well utilized in PHP/IOP and outpatient, but less frequently in inpatient, albeit with some notable exceptions. Manualized group treatments are heavily utilized but seldom required at most agencies. Although some agencies expressed a preference for evidence-based treatment, use of manuals in a required, consistent, agency-wide way was seldom endorsed. More often, agencies leave treatment theory selection up to therapists. Support groups are highly utilized in outpatient with little usage in inpatient. Recreation groups are used at higher rates in inpatient than PHP/IOP and outpatient.
Group leadership qualifications ranged from BA level to MS and above. However, BA level practitioners may either have been certified (for example, in addictions counseling) or running recreation and psychoeducational groups. Competency and quality assurance was highly variable in this survey, with few agencies reporting either requiring certification in group therapy or measuring outcomes, and the most endorsed answer being an assumption that basic qualifications (such as a social work license) were a guarantee of proficiency in group. Supervision was the next most endorsed category, suggesting attention is being paid to quality of group leadership. However, more details are needed on this to determine how well trained the supervisors are in group. Equally, some open-ended answers suggested that group supervision was limited to trainees and that there was little quality control over groups run by licensed therapists. The assumption of competence in group for experienced therapists may need exploring, particularly given a lack of corroborating outcome assessment.
Findings also included: 1) preference for curricula focused on core skills in group therapy rather than specific symptomology or population-based texts; 2) an interest in training in a range of group topics using a variety of delivery methods; and 3) that evaluation of effectiveness of groups was generally poorly performed, with few sites utilizing outcome measures but with many requesting training and support in conducting evaluation.
Certification in group was not seen as desirable, yet assurance of basic competence in group was desired. Possible explanations for this are that certification may be seen as either a mastery qualification or too intensive or expensive a process. More education of agencies may be necessary as to the role of certification in core competency.
Methodology
This survey was conducted in several phases. First, a group of experts was formed on agency mental health, drawing from AGPA’s membership. Their backgrounds included extensive experience in some of the largest and most prestigious agency settings in the country. From this group, and in collaboration with the Science to Service Task Force, a comprehensive list of possible content areas and questions was compiled. Questions were then refined by the first author and sent back to the Task Force. Questions were then reduced to make the questionnaire briefer and more compelling to agencies to complete.
The questionnaire was then tested on three agencies for content and format, as well as time to complete. It was then refined again and sent out in a large-scale first phase, targeting mental health agencies from a list of the largest mental health agencies in the country. It was anticipated that were would be a low response rate to the first phase, since administrators are typically very busy and have little time for unsolicited work. Agencies were guaranteed a curriculum from AGPA as a reward for completion of the survey. The response from phase 1 were 2 surveys.
To increase the n, a second phase was conducted, involving the Task Force members utilizing their professional connections to contact agency directors and program coordinators across the country. It was anticipated that response rates would be far higher for this phase due to the personal connections involved and the ability to obtain a free curriculum. In the second phase, another 38 surveys were collected, giving a grand total of 40 surveys. This second phase involved numerous follow up calls from Task Force members to ensure data was collected. To increase the sample size, a range of agencies of different types and sizes were sought.