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S66 S. Penka et al. / European Psychiatry 27 (2012) / supplement n°2 / S63-S69
one or two experts, e.g. 27 had been rated by only one expert
as “less important” and 11 by only one expert as “not at all
important” (Md=10).
After two rounds of expert- based Delphi process 127 items
have been confi rmed and are therefore part of the revised fi nal
assessment tool which was created. None of the original 17 main
topics missed the defi ned consensus. Only subordinated items
failed consensus and therefore had to be deleted (e.g. form and
length of supervision, ethnical background of clients/patients,
rates of drop out).
But contrary to the result of the Delphi process we decided to
keep some items in the assessment tool, which should have been
taken out. This concerned issues important for the structure of
the tool other questions were based on, e.g. the question for job
advertisement in the previous four years seemed important to
us as the following question, if positions could have been fi lled
with persons with migration background, based on it. As well we
decided to resume the question about the ethnic background of
patients/clients with migration background in the assessment
tool. The question seemed imperative to us as the upcoming
assessment of the current status of “intercultural opening”
is aiming to check whether or not every group of migrants is
reached by the mental health care system.
In the end, the assessment tool piloted by the Delphi process
still comprised 15.5 pages and 147 items.
3.3. Pilot- survey using the developed
preliminary assessment tool
Our intention is to assess each institution in the community
mental health care system in one Berlin district using the same
instrument for each kind of institution, which therefore had to be
applicable to all of them. For this reason, we piloted our revised
assessment tool in every relevant type of institution to verify
applicability and to possibly make further revisions. The focus
in this process was on missing response categories, as well as on
possible misunderstandings or lack of pertinence. A manual was
developed containing instructions and notes for interviewers.
Three members of our study group had been trained in advance
in doing the interviews.
In the pilot assessment, 14 facilities of the community mental
health care system, three different types of psychosomatic
services and one migrant- specifi c offer, later also be assessed
in Berlin’s district Mitte, were included (Fig. 2). Private practice
psychiatrists and psychotherapists were excluded as the concept
of “intercultural opening” applies to institutional structures,
which do not usually exist in these services. A list was made of
institutions not located in the later assessed district but in other
Berlin districts, representing each relevant type of institution.
We chose three institutions of each type randomly distributed
over Berlin. The goal was to conduct at least one interview with
representatives from each type of institution. In the end, 17
representatives, mainly project managers, of 15 different types of
institutions were interviewed. The course of each interview was
documented to identify relevant items not covered by our assessment
tool, as well as less feasible questions and reactions of the
interviewees. We analysed these protocols and incorporated the
results into the revised questionnaire.
Assisted forms in the fi eld of living
- Assisted living (1)
- Therapeutic living communities in one fl at (2)
- Therapeutic living communities of separate 1- person fl ats (3)
- Transitional residence (4)
Contact and Counselling Centre (5)
Additional income project (6)
Psychiatric Clinical services
- inpatient offer (7)
- outpatient offer (8)
- outpatient day clinic (9)
Day Care Centre (10)
Berlin Crisis Service (11)
The Sociopsychiatric Service (12)
Sociotherapy (13)
(Drug) Addiction Counselling Centre (14)
Migrant- specifi c offer (15)
Psychosomatic clinical services
- inpatient clinic (16)
- outpatient clinic (17)
- outpatient day clinic (18)
Fig. 2. Institutions included into the pilot study.
3.3.1. Preliminary results from the pilot survey
In general, the pilot study confi rmed the applicability of the
tool. Response categories had to be added as they were deemed
necessary to represent the day- to- day practices of some types of
institutions. With regard to the question for access routes to facilities
of clients/patients “counselling center” and “administration
offi ce” had to be complemented in the assessment tool. Concerning
criteria on which the number of clients/patients of an institution
are based, additional response categories, e.g. “persons”, “appointments”
and “hospital admissions” were included as they were
missing before. One item eliminated in the Delphi process had to
be included again, regarding the use of freelance professionals in
an institution. The pilot assessment showed the importance of the
item, as freelancers appeared to play an important part in some
institutions because the institutions tend to employ freelance staff
with an immigration background. Some additions had to be done
with regard to information about facilities working inter- regionally
(e.g. percentage of clients/patients from the later assessed district).
Other questions were split into two. Only the question for the differentiation
of employees by gender had to be eliminated as it proved
too time- consuming for interviewees of larger working units.
Furthermore we received important information for improving
data collection in the upcoming assessment of one Berlin
district. As some interviewees did not have details available for
answering questions about numbers of e.g. clients or employees,
we decided to send in advance an excerpt of every question
concerning statistical data. Concerning the status of interviewees
clinic directors seemed not to be involved in the everyday practice
of each service of their institution and therefore are excluded
from participation. Project managers are also excluded from the
upcoming assessment if they are not involved into the actual
treatment/care. Each respondent must have been employed the
entire year in question in the facility.
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