title: The reliability of the community version of the MRC Needs for Care Assessment.
abstract: One hundred and nine adults were screened in the community using the abridged version of the CIDI (CIDIS). The subjects comprised DSM-III-R current cases (N = 48), lifetime cases (N = 31) and non-cases (N = 30). The interviews with the 109 subjects were conducted by one of two pairs of clinicians and videotaped. Each interviewer-pair included a psychiatrist and a clinical psychologist. They rated the community version of the Needs for Care (NFCAS-C) by consensus. The other pair of judges then viewed the video and rated the NFCAS-C independently. The agreement on overall needs was excellent (kappa = 0.75), and very good for four of the seven specific sections (from kappa = 0.61 to 0.81). One section could not be rated because of low prevalence, and agreement was less good for the remaining two sections. Agreement was good on specific interventions (medication, kappa = 0.60; specific psychotherapy, kappa = 0.55), but poor on non-specific interventions. The majority of disagreements were due to differences in clinical judgement rather than to technical errors. A new instruction manual has been produced and should help training as well as stabilizing reliability. In devising reliable and valid instruments based on clinical judgement, a balance must be achieved between enhancing reliability with more precise rules and constraining clinical judgement so tightly that validity is lost.
authors.affiliation: Centre de recherche Fernand-Seguin, Louis-H. Lafontaine Hospital, Institut Philippe-Pinel, Montreal, Quebec, Canada.
authors.forename: A D
authors.initials: AD
authors.lastname: Lesage
authors.forename: L
authors.initials: L
authors.lastname: Fournier
authors.forename: M
authors.initials: M
authors.lastname: Cyr
authors.forename: J
authors.initials: J
authors.lastname: Toupin
authors.forename: J
authors.initials: J
authors.lastname: Fabian
authors.forename: G
authors.initials: G
authors.lastname: Gaudette
authors.forename: C
authors.initials: C
authors.lastname: Vanier
authors.forename: P E
authors.initials: PE
authors.lastname: Bebbington
authors.forename: C R
authors.initials: CR
authors.lastname: Brewin
mesh_terms: D000328:Adult; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D008875:Middle Aged; D015588:Observer Variation; D010348:Patient Care Team / Q000706:statistics & numerical data; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics; D011792:Quebec / Q000453:epidemiology; D015203:Reproducibility of Results