Construction of the Structured Assessment of Functioning and Effectiveness-Revised (SAFE-R) : Validation Against the Million Adolescent Clinical Inventory (MACI) and Against Other Clinical Measures in an Adolescent Residential Setting
Date of Submission
Doctor of Psychology (PsyD)
Robert A. DiTomasso, Ph.D., ABPP
Stuart Badner, Psy.D., Chairperson
George McCloskey, Ph.D.
Robert G. Chupella, Ph.D.
Adolescents present with various emotional and mental health problems when admitted to residential settings. Such problems increase the probability that these clients represent a safety risk to themselves, to peers and to treatment staff. Psychometric devices can best meet the complex needs for assessment when such instruments are easily administered, well constructed, and diagnostically accurate. However, the usage of psychological assessment instruments labors under growing restrictions by time limited health care delivery systems. With a concerted effort, the field of psychology must respond with a sense of advocacy and a realistic explanation for the value and utility of assessments devices. Such an initiative is required if the testing and assessment capacity of psychological services, as supplied by practitioners is to continue. Time-limited health care providers have claimed that psychological assessments are time consuming, costly and of limited usefulness in the general framework of health care. In the past, indiscriminate usage of expensive evaluation materials may have enhanced such a bias. Over utilization of assessment instruments has been highlighted by time-limited health care as a major factor that initiates rising provider costs to members. Time limited health care has constrained various applications of testing instruments by an increased resistance to reimbursement of assessment instruments and procedures. Unfortunately, psychology as a field has demonstrated a lack of advocacy regarding the ongoing need to promote and initiate innovative research that could underscore the efficacy and utility of assessment instruments. Because this has been the case, this constrained reimbursement process has become extended in the direction of severely monitoring and truncating psychological assessments (Eisman et aI, 2000). This study responds to the continued need for applied research regarding safety and risk assessments as applied to adolescents in a residential setting by providing a description of the construction and validation of the Structured Assessment of Functioning and Effectiveness-Revised (SAFE-R). The SAFE-R, 110 item instrument, is scored on a Likert scale ranging from 1 = Strongly Disagree to 5 = Strongly Agree. The SAFE-R purports to measure 10 clinically relevant domains and scales including: Critical Risk and Safety Items, Anxiety/Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Tendencies, Conduct Problems, Depressiveness, Mania, Posttraumatic Stress, Psychosis, Substance Abuse and Effectiveness. The validation of the SAFE-R is conduced by comparisons against scores on select scales of the MACI and against current clinical diagnoses. Research indicates that in spite of a restrictive atmosphere of time-limited heath care reimbursements, the Millon Adolescent Clinical Inventory (MACI) continues to be a popular psychometric instrument among psychologists who are required to provide assessments of adolescents (Cashel, 2002). Archival data was obtained for 126 clients from an adolescent residential population. Demographic statistics included Means and Standard Deviations regarding such factors as Ethnicity, Gender, Age and levels of intellectual functioning (Full Scale Intelligence Quotients). Pearson correlations were then conducted between elevations of the clinical scales of the SAFE-R when compared with elevations of select scales of the MACI. Such SAFE-R and such MACI scales are believed to assess similar, yet not necessarily identical traits. Then, Pearson point biserial correlations were generated between elevated scores of the SAFE-R scales, elevated scores of select MACI scales and available diagnoses. Point Biserial correlations are utilized when one set of data is continuous, such as scale scores and when another set of data is dichotomous. Specifically, the pairing of having been diagnosed with a disorder and not having been diagnosed represented a dichotomous pairing. Pearson point biserial correlations were then generated between items of the SAFE-R scales and available psychiatric and psychological diagnoses. Specifically, the procedure of pairing SAFE-R item Specificity in terms of being diagnosed with a disorder versus SAFE-R item Sensitivity in terms of being diagnosed with a disorder represented a dichotomous pairing. Finally, Pearson point biserial correlations were generated between item endorsements of Safety and Risk Critical Items of the SAFE-R with endorsements of items of select Noteworthy Reponses categories on the MACI. Specifically, the procedure of comparing item Specificity versus item Sensitivity represented a dichotomous pairing.
Kuna, John Girard, "Construction of the Structured Assessment of Functioning and Effectiveness-Revised (SAFE-R) : Validation Against the Million Adolescent Clinical Inventory (MACI) and Against Other Clinical Measures in an Adolescent Residential Setting" (2008). PCOM Psychology Dissertations. 76.