An ethnographic study of the meaning of continuity of care in mental health services.

OBJECTIVE: As a step toward developing a standardized measure of continuity of care for mental health services research, the study sought to identify the interpersonal processes of giving and receiving day-to-day services through which individual providers create experiences of continuity for consumers.
METHODS: Ethnographic methods of field observation and open-ended interviewing were used to investigate the meaning of continuity of care. Observations were carried out at two community mental health centers and a psychiatric emergency evaluation unit in Boston. Sixteen recipients and 16 providers of services at these sites were interviewed.
RESULTS: Six mechanisms of continuity were identified, labeled, defined, and described through analysis of field notes and interview transcripts: pinch hitting, trouble shooting, smoothing transitions, creating flexibility, speeding the system up, and contextualizing. The mechanisms elaborate dimensions and principles of continuity cited by other observers and also suggest new formulations.
CONCLUSIONS: The mechanisms identified in this study facilitate operationalization of the concept of continuity of care by specifying its meaning through empirically derived indicators. Ethnography promises to be a valuable methodological tool in constructing valid and reliable measures for use in mental health services research.