Citation

Green RS. Eval. Program Plann. 1993; 16(4): 365-376.

Copyright

(Copyright © 1993, Elsevier Publishing)

DOI

10.1016/0149-7189(93)90050-I

PMID

unavailable

Abstract

Ratings of the level of functioning of severely disabled clients collected from staff of mental health agencies, while attractive as outcome measures, lack specificity and, at times, consistency. Three multidimensional scaling (MDS) studies were conducted to identify the dimensions staff emphasize when they compare clients as to their level of functioning. Analogues of clients were created to serve as stimuli, dissimilarity judgments of pairs of stimuli were collected, and an individual differences MDS model was applied in each study to distinguish client variance from the judges' perspectives. Ratings along specified dimensions also were collected and compared to the MDS solutions. One dimension emerged as pre-eminent, but it corresponded to many of the pre-selected dimensions, such as competence with daily living tasks, clarity of thinking, appearance and manner, and overall functioning. The other two dimensions were belligerence and openness to psychological intervention or distress with one's problems. Differences among judges were sizable; nevertheless, considerable support for emphasizing these three dimensions was found upon reviewing the contents of other assessments of functioning. Concentrating on these three dimensions of functioning may promote greater agreement among raters, highlight where functional improvements occur, and expand the coverage of functional differences without markedly increasing the costs of assessment.