Academic journal article Social Work

Instruments and Psychometrics: A Response to Mattaini and Kirk

Academic journal article Social Work

Instruments and Psychometrics: A Response to Mattaini and Kirk

Article excerpt

Social and mental phenomena are slippery creatures, rapidly mutating and subject to dynamics that make them hard to catch in our research nets. Mattaini and Kirk (1991) have provided an overview of several alternatives to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition--Revised (DSM-III-R) (American Psychiatric Association, 1987) for assessing the presence of disorders and measuring their severity, but they overlook the fact that assessment problems in social work are due more to the nature of the phenomena than to mechanical problems of unreliable instruments. They say the problems with DSM-III-R arise from its psychometric features. Although the DSM-III-R is not perfect, we do not agree that its problems stem primarily from its psychometric features. Moreover, there are several points on which their technologically optimistic view could mislead readers and a few on which we believe they have been misled themselves.

Structured interviews such as the Structured Clinical Interview for DSM-III-R (SCID) have produced reliable results with acceptable short-term test-retest reliability and concurrent validity (Skodol, Rosnick, Kellman, Oldham, & Hyler, 1988; Williams et al., 1992). This and the other structured instruments produce a research diagnosis and are not immediately treatment directed, as Mattaini and Kirk would wish.

They decry the system of the DSM-III-R as providing "flat, undimensional groups of otherwise diverse problems" (Mattaini & Kirk, 1991, p. 262). Categorizing disorders need not reduce them to "flatness," and when properly used the diagnostic system of DSM-III-R rests on five axes: I, clinical syndromes; II, developmental and personality disorders; III, physical disorders and conditions; IV, severity of psychosocial stressors; and V, global assessment of functioning. As they noted, axis IV is the direct predecessor of the person-in-environment (PIE) system of evaluation (Karls & Wandrei, 1992; Williams, Karls, & Wandrei, 1989). Moreover, axis V measures role functioning, an important dimension for the determination of proper intervention.

The categorical PIE system uses notation familiar to social workers on the first two of its four factors (factor I, social role problems, and factor II, environmental problems). Both factors prominently feature coding intervals indicating duration of the problem and its severity, as do the corresponding axes of the DSM-III-R. In this respect the PIE and DSM-III-R are scalar instruments of the sort Mattaini and Kirk desire.

Multidimensional approaches in assessment have been the focus of psychiatric epidemiology for some time now. A major contribution has been to develop assessments in which the purpose determines the method: Screening and research purposes would call for standardized, structured interviews, but clinical or evaluation purposes would call for less structured interviews. Those involved in the interdisciplinary training of new social workers would do well to examine the literature of this field and to apply its findings to their practice with individuals and families. Just a few of the topics for which epidemiological approaches regarding measurement might be useful are examining the comorbidity of disorders, detecting familial patterns, and exploring cultural variants of specific disorders.

We do not disagree that there are good and poor assessment instruments and procedures, but the value of each one depends closely on the purpose of the interview and the data gathering. If the goal is to match an individual's social diagnosis and an appropriate intervention, perhaps greater (or at least equal) efforts should concentrate on evaluation of the interventions. If the goal is completion of a particular task in a community and the assessment is of obstacles impeding progress, an entirely different approach is required. At this point, however, defining one special approach as "prescriptive" seems premature; what social workers face is a handful of available interventions and a panoply of diagnosed problems for both individuals and groups (such as people with mental disorders). …

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