Individual problem rating: A proposed scale
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INDIVIDUAL PROBLEM RATING: A Proposed Scale David F. Gillespie and James R. Seaberg
ABSTRACT: A procedure for Individual Problem Rating (IPR) in the evaluation of community mental heahh and other types of service programs is presented. The instrument is based on client reports of problems, and it uses problem severity and relative importance as criteria for rating. The issues of client self-rating, variation in levels of abstraction among listed problems, interaction between problems, reliability, and validity are discussed in relation to the need for empirical studies prior to IPR's adoption in clinical practice and treatment evaluations. Social scientists, especially psychometricians, have p r o d u c e d a massive literature a r o u n d the c o n c e p t o f " m e n t a l health." T h e bulk o f this w o r k has f o c u s e d on p r o b l e m s o f definition (Senn 1950; M a y m a n 1955) o r criteria o f m e a s u r e m e n t ( L o r r 1954; R o g e r s a n d D y m o n d 1954; J a h o d a 1958; K e l m a n a n d P a r l o f f 1957; P a r l o f f 1961; L u b o r s k y 1972). T h e s e efforts have a s s u m e d implicitly o r explicitly a n d w i t h o u t exception that ùmental health" can be reasonably c o n c e p t u a l i z e d in t e r m s o f a single d i m e n s i o n . T h e r e c e n t w o r k by L u b o r s k y (1972), for e x a m p l e , p r o d u c e d a "health-sickness" 100-point rating scale r a n g i n g f r o m "an ideal state o f c o m p l e t e f u n c t i o n i n g i n t e g r a t i o n . . , to c o m p l e t e l y r e p r e s s e d schizophrenics." T h e p r o b l e m with this a n d o t h e r such scales is that they oversimplify a c o m p l e x a n d not-weil u n d e r s t o o d p h e n o m e n o n . Mental h e a l t h is a m u l t i d i m e n s i o n a l process, a process that r e n d e r s u n i d i m e n s i o n a l conceptualization a n d overall s t a n d a r d i z a t i o n f a t u o u s a n d unreliable. T h e c o n c e p t o f m e n t a l h e a l t h resists s t a n d a r d i z a t i o n p r e cisely because it is a process. As B e r g e r (1963) a n d o t h e r p h e n o m e n o l o g i cally inclined sociologists have suggested, p e r s o n s continually rewrite t h e i r biographies in light o f a l t e r n a t i n g situational contingencies. Behaviors that facilitate f u n c t i o n a l i n t e g r a t i o n in o n e setting create conflict o r stress in a n o t h e r (Gross 1970:56). M o r e o v e r , m e c h a n i s m s o f stress o r d i s c o m f o r t i m p a c t differentially o n d i f f e r e n t p e o p l e at the same time a n d David F. Gillespieis affiliatedwith the Schoolof SocialWork, MichiganState University.James R. Seabergis with the Center for SocialWelfareResearch,Universityof Washington.This research was supported by a grant 90-C-430, from the National Center on Child Abuse and Neglect,Children's Bureau, OCD, HEW. 21
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Administration in Mental Health
on the same people at different times. Symptoms such as personality disorganization, discomfort, or d
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