CAHPS Mental Health Care Surveys

Many organizations are interested in assessing and improving patient experience with behavioral health, mental health, and/or substance abuse services. To address this need, the CAHPS Consortium developed a survey focused on the experiences of health plan enrollees: the CAHPS Experience of Care and Health Outcomes (ECHO) Survey, which was released in 2003 and updated periodically.

In response to changes in the way behavioral health services are provided, the CAHPS Consortium has been developing and testing a revamped survey, the CAHPS Mental Health Care Survey. This instrument will enable users at various levels of the health care system to collect information on patients' experiences with different kinds of mental and behavioral health care services.

Below is information about the ECHO Survey and the new CAHPS Mental Health Care Survey.

Experience of Care & Health Outcomes (ECHO) Survey

The CAHPS® Experience of Care and Health Outcomes (ECHO) Survey asks health plan enrollees about their experiences with behavioral health care and services. It is appropriate for patients with a range of service needs, including those with severe mental illness, but does not include questions about inpatient stays or self-help groups.

The ECHO Survey can be used for multiple purposes:

  • To improve the quality of mental health and substance abuse services.
  • To evaluate and monitor the quality of behavioral health care organizations.
  • To hold providers accountable through public reporting.

Users of the ECHO Survey have included State Medicaid agencies, State mental health agencies, managed behavioral health organizations (MBHOs), and managed care organizations (MCOs).

Get the ECHO Survey

The current version of the ECHO Survey is 3.0. There are standardized instruments and optional supplemental items for adults and children who received mental health or substance abuse services in the previous 12 months through a managed care organization or managed behavioral health care organization. Supplemental items that can be used to customize the questionnaire are available for adults only.

Download the Managed Care Organization (MCO) Survey and Instructions (ZIP, 3.76 MB)—The MCO Survey asks enrollees about treatment, counseling, and administrative services, such as experiences filling out paperwork or finding information in written materials. The Adult version is available in English and Spanish; the Child version is available in English only.

Download the Managed Behavioral Health Care Organization (MBHO) Survey and Instructions (ZIP, 3.62 MB)—The MBHO Survey asks enrollees primarily about treatment and services; only a few questions focus on administrative services. The Adult version is available in English and Spanish; the Child version is available in English only.

Note: Information in the guidance documents is based on the survey developers' extensive research into best practices in survey design and administration as well as analyses of data collected during the field testing of each instrument. AHRQ does not require the use of a specific methodology for sampling or survey administration.

Also, the documentation available for the ECHO Survey does not reflect recent changes (e.g., changes in administrative codes) or refinements in the sampling guidance provided for newer CAHPS surveys. If you have questions about the ECHO Survey, please contact the CAHPS Help Line at

Users of this survey may also want to consult the following guidance:

Quality Measures From the ECHO Survey

Measures for adults: The ECHO Survey for adults produces the following measures of patient experience:

  • Getting treatment quickly.
  • How well clinicians communicate.
  • Getting treatment and information from the plan (or MBHO).
  • Perceived improvement.
  • Information about treatment options.
  • Overall rating of counseling and treatment (MCO and MBHO).
  • Overall rating of the health plan (MCO only).

The first three composite measures are like measures in the CAHPS Health Plan Survey. The other two composite measures are unique to the ECHO Survey.

Ten questions that do not group well with other items can be reported as single-item measures:

  • Having to wait in the office.
  • Being told about medication side effects.
  • Including family and friends in treatment.
  • Getting enough information to manage the condition.
  • Getting information about patient rights.
  • Whether the patient feels that he or she can refuse treatment.
  • Privacy of information.
  • Cultural competency.
  • Helpfulness of counseling or treatment.
  • Getting treatment after benefits are used up.

Review measures from the CAHPS ECHO Survey 3.0.

Measures for children. The CAHPS team did not develop and test a set of measures from the child version of the surveys.

Brief History

The ECHO Survey is the result of a collaborative effort to evaluate and merge the original Consumer Assessment of Behavioral Health Survey (CAHBS) and the Mental Health Statistics Improvement Program (MHSIP) survey. The survey has been tested with a wide range of behavioral health consumers to ensure that the items are easily understood.

Learn about the development of the CAHPS ECHO Survey.

CAHPS Mental Health Care Survey

The purpose of the new CAHPS Mental Health Care Survey is to ask patients about their experiences with care for mental or behavioral health problems. Because of the complexity of this kind of care, which patients may receive from multiple health care professionals over a short period of time, the research team is designing the survey to be adaptable to a variety of settings.

Work on this survey began with cognitive testing of items in the original ECHO instrument. Like all CAHPS surveys, this new instrument is undergoing a rigorous development and testing process that includes:

  • multiple focus groups with patients with public and private insurance (including some with people living with substance abuse disorders),
  • input from health care professionals and other experts in mental health care,
  • additional cognitive testing of new and revised survey items,
  • pilot testing, and
  • field testing.

When this process is complete, the survey will be carefully reviewed before AHRQ approves it as a CAHPS survey.

Page last reviewed February 2019
Page originally created June 2013
Internet Citation: CAHPS Mental Health Care Surveys. Content last reviewed February 2019. Agency for Healthcare Research and Quality, Rockville, MD.
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