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i. Chapter 1: Introduction1 Practical Problem Being Addressed2 Client Retention3 Client Satisfaction5 The Need for Qualitative Research on Client Satisfaction11 Contributions to Knowledge13 Chapter 2: Data and Methods15 Data15 Method16 Chapter 3: Results20 Theme # 1: Positive Caseworker Personality20 Theme # 2: Feeling Emotionally Supported23 Theme # 3: Positive Counseling Environment27 Theme # 4: Feeling Helped33 Chapter 4: Discussion42 Theme # 1: Positive Caseworker Personality42 Theme # 2: Feeling Emotionally Supported43 Theme # 3: Positive Counseling Environment44 Theme # 4: Feeling Helped45 Limitations and Key Assumptions47 Chapter 5: Recommendations49 Theme # 1: Positive Caseworker Personality49 iii Theme # 2: Feeling Emotionally Supported50 Theme # 3: Positive Counseling Environment51 Theme # 4: Feeling Helped52 Conclusion54 References56 Appendices61 Appendix A: Protocol & Interview Script61 Appendix B: Interview Transcripts66 Appendix C: Visual Representation of Emergent Themes242 1 Chapter 1: Introduction In the United States, of every 1,000 women giving birth between the ages of 1544, 52 pregnancies are unplanned. This rate is significantly higher compared to many other developed countries. Births resulting from unplanned or closely spaced pregnancies negatively affect individual women, their families, and society (Guttmacher Institute, 2011). For example, such births are associated with adverse maternal and child health outcomes, and social and economic challenges. Economically disadvantaged women are disproportionately affected by unplanned pregnancies and their consequences. The unintended pregnancy rate among women with incomes lower than the federal poverty level was more than five times higher than the rate among women with incomes greater than 200% of the federal poverty. If current trends continue, more than half of all women in the United States will experience an unplanned pregnancy by the time they reach age 45. Fifty percent of all pregnancies in Oregon (roughly 36,000) are unplanned (Guttmacher Institute, 2011). This rate is slightly higher than the national average of 49%. Of these 36,000 unplanned pregnancies in Oregon, 14% resulted in miscarriages, 55% in births, and 31% in abortions. Given the increasing rates and adverse consequences of women having unplanned pregnancies, it is critical that these women are provided with avenues of support, including at least information about parenting, adoption, and abortion, and at most skill training and tangible support. Perhaps more importantly, it is critical that these women utilize these services. All of the aforementioned services are provided by the non-profit 2 organization focused on in this thesis, that being Catholic Charities Pregnancy and Adoption Support (Hereafter CC). The following introduction begins by describing the practical problem being addressed. This introduction then reviews client retention, including its conceptualization, its importance, and its relationship to client satisfaction. This introduction then reviews client satisfaction, including its conceptualization, explanation, and relationship to communication. Finally, this introduction justifies the need for qualitative research on client satisfaction. The Practical Problem Being Addressed CC feel that they provide an invaluable service to the community, particularly to pregnant women who lack the resources (financial, educational, medical, social, etc.) needed to make informed decisions related to the life of their child. CC have internal data suggesting a practical organizational problem involving client retention. Specifically, clients’ usage of CC services radically declines, or halts, after thirty days. This is problematic not from a financial standpoint, because services are free. Rather, this is problematic in terms of CC’s mission statement and the types of problems CC hopes to address. Specifically, research has demonstrated that problematic issues raised by pregnancy and adoption during crisis frequently last longer than thirty days (Fraser, Nelson, & Rivard, 1997; Olds, 1997). In order to improve its services, CC desires to understand the aforementioned retention problem. The agency-wide standard is that 75% of clients who come in for a 3 first appointment successfully engage in services, as evidenced by regular attendance. Quarterly reports put together by the agency show that, while in 2008-2009 77% of those that attended an initial intake visit continued services for at least thirty days, this number fell to 48% in 2009-2010. Although 2010-2011 saw an increase in the percentage of clients engaging in services after their first meeting at 67.5%, this is still lower than the agency’s targeted retention rates.

Exploring Communicative Aspects of Client Satisfaction, Loyalty, and Retention in a Private, Non-profit Organization: A Qualitative, Interview-Based Study of Catholic Charities