Academic journal article Journal of Nursing Measurement

The CCH Consumer Outcome Scales: A Brief Instrument to Assess the Multiple Problems of Homelessness

Academic journal article Journal of Nursing Measurement

The CCH Consumer Outcome Scales: A Brief Instrument to Assess the Multiple Problems of Homelessness

Article excerpt

Homeless persons are underresearched; existing instruments do not adequately address this population. Clinical experts developed a brief instrument to assess housing, employment, benefits, physical health, mental health, and substance use that was tested for its psychometric properties. The instrument demonstrated content validity based on expert consensus, adequate interrater reliability (average r = .58), convergent and divergent validity with established measures, freedom from social desirability bias (average r = .00 with the Marlowe-Crowne scale), criterion-related validity for housing (85% accurate) and employment (83% accurate) items, and no floor effects. The benefits item had poorer psychometrics. The Colorado Coalition for the Homeless (CCH) Consumer Outcome Scales are recommended for assessment and service planning with homeless individuals. Further research is needed on the instrument's sensitivity to change over time and applicability to diverse cultural groups.

Keywords: homeless; functioning; measurement; reliability; validity

Homeless individuals are underresearched (Gelberg, 1993). Despite the need for data on this population, at least three recent reviews concluded that services for the homeless are not adequately evaluated (Crook, Mullis, Cornille, & Mullis, 2005; Frankish, Hwang, & Quantz, 2005; Post, 2005). Barriers to measurement in communitybased services for the homeless include difficulty collecting follow-up information over time (Crook et al., 2005), difficulty aggregating disparate information across different service types (Frankish et al., 2005), and a lack of measures that match service programs' objectives (Crook et al.; Frankish et al.). Although these evaluation challenges are common to many human service settings (Grembowski, 2001), agencies that serve the homeless are further hampered by a lack of instruments that have been validated with a homeless population, and that adequately obtain data on the multiple, interconnected difficulties associated with homelessness (Crook et al.; Post). The current study's goal was to fill these gaps with a brief, comprehensive assessment of homeless clients' functioning in multiple domains connected to homelessness through the development of the Colorado Coalition for the Homeless (CCH) Consumer Outcome Scales.

BACKGROUND AND CONCEPTUAL FRAMEWORK

Current Status of Measurement in Research on Homelessness

Current research on homeless persons is still at a rudimentary level, with gaps in the literature about the number and characteristics of homeless persons, the pathways to poor health outcomes in this population, and the effectiveness of interventions for homeless persons (Frankish et al., 2005). Studies of homeless individuals have tended to focus on single areas of impaired functioning (e.g., physical health or mental health), but homeless persons actually face a range of interrelated problems, with higher rates of poverty, unemployment, physical health problems, mental health problems, and domestic violence than their housed counterparts (National Coalition for the Homeless, 2002). Therefore, service programs for the homeless target a broad array of problem areas, which may focus on basic shelter, employment, and financial needs in addition to clinical "presenting problems" such as medical, mental health, and/or substance use issues.

Prior studies have rarely included information on the reliability and validity of instruments for a homeless population (Crook et al., 2005). Researchers have often relied on very brief measures with limited evidence of validity and a lack of normative data, such as single-item yes/no measures of service use, problem types, or need for assistance (Toro & Wall, 1991). A 1992 review on homeless persons with serious and persistent mental illness (SPMI) illustrated measurement limitations with this population (Lovell, Barrow, & Streuning, 1992). Of 21 studies reviewed, only six used instruments that had been validated with a homeless population, and none used measures developed specifically for a homeless population. …

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