Reliability, Validity and Usefulness InCrisis Reports

Reliability, Validity and Usefulness

Understanding the value and usefulness of any psychological or behavioral screening instrument is not a simple task. Ideally one should be an expert in statistics and research design in order to understand various graphs, values, quotients and ratings. Understanding calculation results and analysis procedures can be difficult even for licensed and trained health care professionals.

There are three ways to understand any questionnaire that is being used to evaluate and understand human behavior. The following are general definitions of the terms necessary to appreciate the value of any instrument.

Reliability

The reliability of any questionnaire is defined as the consistency with which the same results are achieved. Practically speaking that means a person completing the questionnaire would produce the same responses and results if he or she completed the questionnaire a second time. It also means that more than one person completing a questionnaire with the same knowledge and experience would have similar results. Of course, reliability assumes both people have similar knowledge and experience with the person being evaluated. Asking good questions is important. The reliability of any questionnaire is not necessarily constant. The person being evaluated can change over time. The person completing the questionnaire may be biased or change over time. The evaluators may have different experiences and levels of knowledge regarding the person being evaluated. For these reasons, the results can be different. Any questionnaire that provides significantly different results for no reason other than the evaluators' bias may not provide a valid result. The reliability of a questionnaire depends on the questionnaire and the person answering the questions.

Validity

The validity of a questionnaire is defined as its ability to measure and describe what it is supposed to measure and describe. In other words, if the questionnaire is supposed to measure depression, then the results should correctly identify actual depression. Ideally, it should identity depression and not other problems or problems that are like depression but not the same. The ability of a questionnaire to identify what it is supposed to identify depends asking and getting answers to questions that collectively identify the attribute, state or quality we want to identify.

There are 6 primary types of validity. Following is a brief description of each.

Face Validity. This form of validity is based on commonly accepted opinion or consensus of opinion. Face validity is normally established by qualified professional observation, investigation or experience with an instrument, test or a computer-based test interpretation system. Face validity is based on how the results look.
Content Validity. This form of validity is based on the content (actual questions) used in a survey or questionnaire. Content validity is established by a professional or professionals selecting appropriate content for questions and statements. The results of a questionnaire or survey are considered valid if the questions are appropriate and necessary to identify a specific attribute, state or quality.
Predictive Validity. This form of validity is based on a questionnaire's ability to predict what it is supposed to predict that its ability to predict some future state, result or event.
Concurrent Validity. This form of validity means a questionnaire or survey is capable of identifying a state, attribute, quality or result that is already known. An instrument is valid if it correctly identifies by some other means a state or result that is already known to exist.
Construct Validity. This form of validity is the most difficult to establish. It is normally based on demonstrating meaningful relationships among elements of states, attributes, results, problems or disorders. For example, there are different symptoms of depression. There are many other disorder that do not have the symptoms associated with depression. For instance, depression is in many ways the opposite of mania. A result of depression would have construct validity if results showed a positive relationship between low energy (depression) and no relationship between depression and the high energy in mania. The results would diverge.
Incremental Validity. This form of validity can help determine whether or not a particular instrument or method provides a significant improvement in addition to the use of another approach. For instance, does a screening instrument provide a significantly better result during an 50 minute interview than just using just the interview alone? An particular approach is said to have incremental validity if it actually helps more that not using it.

The StepOne Online web site has been reviewed by qualified professionals in order to insure the program meets ethical and professional standards for development and operation. A standardization and administration manual is available from the developers.

The initial normative sample for the general population consists of 211 families with an n equal to 432 children. The questionnaires can be used for all children age 11 to 17. The normative sample for the profile summary scales consisted of 8 separate stratified samples that were combined into a total normative sample with an n of 87. Diagnostic and agreement statistics were established based on 9 mental health criterion groups. StepOne for parents is a good predictor of mental health problems and high risk behaviors.

The StepOne for Parents Program was developed in a primary medical care and a private practice mental health care setting. The program can be used as a formative research tool in private practice mental health, primary medical care, foster care and education. Reliability was established based on a test-retest strategy with a kappa of r equal to 0.94. Validity has been established through convergence with other scales (other constructs) based on correlations that range from r= 0.54 to r=0.84. Validity has also been established based on significant agreement statistics for criterion groups covering categories of broad mental health concerns including risk factors. The validity of the clinical screening report should be good provided the prevalence of mental health and addictive disorders are not less that 10% or more than 50%.

Validity estimates are improved by gathering information from multiple informants such as two parents or more than one care givers. The use of StepOne by more than one parent appears to create interaction between parents and measures how well parents know their child. The system can provide parents with community specific results and guidance based on zip codes.

Usefulness

The usefulness of a questionnaire is often referred to as its utility. The utility of a questionnaire is defined as the value or cost of using the questionnaire to identify the attribute, state, quality or event we want to identify. There is more than one way to identify a state, event, attribute or quality. Some methods require less effort or fewer resources than others. The idea is to use surveys and questionnaires that are efficient, have a low risk of harm and are cost effective. A questionnaire with high utility is one where the cost of identifying an attribute or quality is low and the cost of being wrong is not high. Another term for utility is the "usefulness" of an instrument, although "usefulness" does not have the precise definition of "utility" within the field of statistics.

Parent and professional feedback has been gathered regarding the usefulness of StepOne. Parents and professionals reviewing this report may find a few inconsistencies. More than one problem or concern may be raised. In this case, parents and counselors should discuss these concerns and evaluate these issues further. Serious inconsistencies may indicate that a parent does not know their child very well. Inconsistencies can also surface because this is a screening report and NOT a psychological evaluation that provides a diagnosis. As such, only a qualified professional can perform an evaluation, resolve inconsistencies and make a diagnosis.

A given report may raise issues and questions for parents to discuss with professionals. No screening process or result is always correct. The results may raise potential problems that seem unlikely to parents and professionals. This occurs most often when eating disorders or the risk of violent, suicidal or self-injuring behavior is identified.

In some cases, the identified problems may be the result of other underlying problems that parents may not see or be aware of. More than one problem, concern or issue may be raised in the screening report. Discussing these results and further evaluation as indicated by a health or mental health care professional is always appropriate. In a sample of over 592 parents, no less than 97% felt StepOne for Parents was very well organized and useful. Approximately 99% felt they could share this report with a health care professional.

Parent reactions and response to screening reports may vary a great deal. The vast majority of parents find StepOne reports useful and helpful, and they feel the report reflects their concerns. In effect, reports are designed to help clarify what parents suspect, fear or are concerned about. Other parents will find that the report raises issues that they were not aware of. This is also very common because parents can know a great deal about their child but they do not always understand the significance or meaning of certain behaviors and patterns of behavior. As a result, some parents will experience a higher level of concern after completing their screening than before. Parents should remember that this is a screening - not an evaluation. As such, the results are not always correct. In some cases, the screening will reveal a problem that is the result of an underlying problem that a parent, family member or teachers could not see.

Preliminary research suggests that StepOne may reduce the number of appointments by three. StepOne appears to create a more efficient and effective use of time. StepOne is also altering the prescribing practices of physicians. StepOne appears to foster further physician-patient interactions and appears to change, reduce or stop certain medications. The developers believe that it would take between 3 and 6 hours for a person to screen and write an equivalent report.

Dated: June 27, 2009

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