Scales and Indices
Abstract and Keywords
This entry reviews the uses of scales and instruments in social work practice, including scales and instruments for diagnosis and evidencing treatment necessity, as methods for monitoring client progress, and as outcomes measures of clinical significance. A resource list for locating scales and instruments is provided.
Standardized instruments have been part of social work practice since its beginning. The very notion of “scientific charity,” characteristic of the Charity Organization Society in the late 1870s, had an “emphasis on the need for hard data” (Trattner, 1999, p. 95), an emphasis furthered with Mary Richmond's advocacy for “social research” (Zimbalist, 1977, p. 21). Significant advancement in the use of measurements resulted from the call for accountability (Briar, 1973), the introduction of behavioral interventions (Fischer & Gochros, 1975), and the need to demonstrate treatment effectiveness (Bloom, Fischer, & Orme, 2006).
The routine use of instruments and scales by practitioners, however, had to wait until a sufficient number were developed on a wide range of client conditions. The first major effort was Hudson's Clinical Measurement Package (1982). Subsequently, Corcoran and Fischer (1987) published the first compendium with over 125 rapid assessment tools for couple, family, children, and adult conditions. After 20 years the number of scales and instruments has grown exponentially, with thousands available with a simple Google search and over 500 reprinted in Fischer and Corcoran (2007a, 2007b). The number of compendiums providing reprinted instruments has also flourished (Fischer & Corcoran, 2007a).
Just as the number of instruments and scales have increased, so too has their use in social work practice. Although once chiefly the domain of problem identification and diagnosis, instruments and scales are also useful for evidencing the need for treatment in managed care settings (Corcoran & Boyer-Quick, 2009; Corcoran & Vandiver, 1996), monitoring the treatment effectiveness throughout clinical services (Bloom, Fischer, & Orme 2006), and establishing clinical significance (Jacobson & Truax, 1991). This entry will review these uses of instruments and scales.
Essential Features of Instruments and Scales
Instruments and scales are designed to quantitatively ascertain some “thing.” In social work practice, this “thing” is likely a client's behaviors, thoughts, and feelings, and the interaction of clients with others in the social environment. The “thing” may be considered in terms of the problem presented for clinical attention or the goal of the intervention.
As standardized measurements, instruments and scales assign a number to the different attributes of the thing being assessed. The attributes are ascertained in terms of their magnitude, frequency, or duration. As a consequence of having numbers as referent points for the attributes, scores may be compared by using the arithmetic operations of addition, subtraction, multiplication, and division—an advantage not afford by qualitative accounts.
The data from instruments and scales also provide information that is designed to be consistent and accurate. Consistency is estimated with reliability procedures and accuracy is estimated with validity procedures; both enable the social worker to estimate how much error is actually involved in the scores (Corcoran, 1995).
In summary, the essential features of instruments and scales are that the scores provide quantitative referent points of the attributes of some topic of interest. The numeric referents are intended to tap magnitudes, frequency, or duration of that topic with consistency and accuracy. Moreover, scores may be compared with addition, subtraction, multiplication, and division. As such, there are four major ways social workers can use instruments and scales in practice.
Instruments and Scales for Problem Identification and Diagnosis
Instruments and scales have traditionally been used to identify clinical problems and for diagnostic purposes. Instruments and scales allow the clinician to narrow the wide range of client concerns and complaints into a formulated case description with a diagnostic summary. The outcome of this use is that the social worker narrows the focus and purpose which guides the selection of the intervention.
A major advantage of an instrument and scale is that the score not only helps determine the clinical condition, for example, depression, but also affords an assessment of the severity of the condition, typically in terms of its magnitude. The practitioner is thus able to understand the severity level of a client's condition and then compare this severity with other scores, particularly clinical norms and the general population.
Instruments and Scales to Establish Treatment Necessity
By comparing a client's score with normative data, the social worker is able to use instruments and scales to establish treatment necessity. This is a frequent prerequisite to services in managed care setting. By comparing the client's score with a clinical sample, one is able to determine how similar the client is with individuals already receiving services. Such a situation would persuasively suggest that services are warranted. Similarly, treatment necessity may be shown by determining how different a client's score is from the general population. Being distinguishable from the typical or average person evidences a need for services. In addition, simple procedures are available to calculate the percentage of others who are more and less severe in the symptoms (Corcoran & Boyer-Quick, 2009).
Instruments and Scales to Monitor Client Progress
One of the more common uses of instruments and scales is to monitor a client's condition before, during, and after services (Bloom, Fischer, & Orme 2006). Instruments and scales may be used to monitor a client by observing the decrease in the problem, clinical condition, or symptoms, and by assessing the obtainment of treatment goals. A more informative use of instruments and scales is to collect observation of both the problem and the obtainment of the goals.
The practical values of these data are greatly enhanced by plotting the scores on a graph to form a simple, single system design. This allows the social worker to visually determine whether the problems decreased and whether the goals were obtained.
Instrument and Scales to Establish Clinical Significance
Another use of instruments and scales is to establish a definition of “clinical significance,” the obtainment of which is itself a treatment goal (Jacobson & Truax, 1991). Clinical significance is defined as an accurate score on an instrument or scale, which at the end of treatment, is similar to the general population and distinguishable from the clinical sample. Clinical significance is, in fact, the mirror opposite of the use of scores for establishing treatment necessity based on having scores similar to a clinical sample but distinguishable from the general population.
In essence, by comparing a client's scores to norms after treatment the social worker has another indication of treatment outcomes. Moreover, by being able to say that the client is no longer similar to those in treatment and is now like the “average,” “typical,” or “normal” individual is probative evidence of treatment effectiveness, which is afforded only by the use of instruments and scales in social work practice.
In conclusion, the short history of using scales and instruments in social work practice has accompanied the advancement in the field. From a humble beginning or assessing client progress with a limited number of instruments, the field had witnessed huge growth in the number and variety of available instruments. Moreover, the use of scales and instruments has expanded to include diagnostic purposes, evidencing treatment necessity and even illustrating clinical significance. One can only hope that the future witnesses similar growth in the effort to help clients change.
Bloom, M., Fischer, J., & Orme, J. (2006). Evaluating practice: Guidelines for the accountable professional. Boston: Allyn & Bacon.Find this resource:
Briar, S. (1973). Effective social work intervention in direct practice: Implications for education. In S. Briar et al. (Eds.), Facing the challenge. Plenary session papers from the 19th Annual Program Meeting. Alexandria, VA: Counsel on Social Work Education.Find this resource:
Corcoran, K. (1995). Psychometrics in social work. In R. Edwards et al. (Eds.), Encyclopedia of social work (19th ed., pp. 1942–1947). Silver Spring, MD: NASW Press.Find this resource:
Corcoran, K., & Boyer-Quick, J. (2009). How clinicians can effectively use assessment tools to evidence medical necessity and throughout the treatment process. In A. R. Roberts & G. J. Greene (Eds.), Social work desk reference. New York: Oxford University Press.Find this resource:
Corcoran, K., & Fischer, J. (1987). Measures for clinical practice: A sourcebook. New York: Free Press.Find this resource:
Corcoran, K., & Vandiver, V. (1996). Maneuvering the maze of managed care. New York: Free Press.Find this resource:
Fischer, J., & Corcoran, K. (2007a). Measures for clinical practice and research: A sourcebook, Vol. 1: Couples, families and children. New York: Oxford University Press.Find this resource:
Fischer, J., & Corcoran, K. (2007b). Measures for clinical practice and research: A sourcebook, Vol. 2: Adults. New York: Oxford University Press.Find this resource:
Fischer J., & Gochros, H. (1975). Planned Behavior Change: Behavior Modification in Social Work. NY: Free Press.Find this resource:
Hudson, W. W. (1982). The clinical measurement package: A field manual. Chicago: Dorsey Press.Find this resource:
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Find this resource:
Trattner, W. I. (1999). From poor laws to welfare state: A history of social welfare in America. New York: Free Press.Find this resource:
Zimbalist, S. E. (1977). Historic themes and landmarks in social welfare research. New York: Harper.Find this resource: