title: Brief Rating of Aggression by Children and Adolescents (BRACHA): a reliability study.
abstract: The Brief Rating of Aggression by Children and Adolescents (BRACHA) is a 14-item instrument scored by emergency room staff members to assess aggression risk during an upcoming psychiatric hospitalization. In this study, we investigated the inter-rater reliability of the BRACHA 0.9, the latest version of the instrument. After receiving training based on the BRACHA 0.9 manual, 10 intake workers viewed 24 ten-minute videos in which child and adolescent actors portrayed pediatric emergency room patients with low, moderate, or high levels of risk for aggression during an upcoming hospitalization. We then evaluated inter-rater reliability for individual BRACHA items, using three measures of agreement, and reliability for total BRACHA 0.9 scores, using conventional (frequentist) methods and Bayesian techniques for calculating the intraclass correlation coefficient ICC (2,1). Inter-rater reliability for individual items ranged from good to almost perfect, with Kendall's W exceeding 0.75 for eight of 14 BRACHA items. The ICC (2,1) for the total BRACHA 0.9 score was 0.9099, with both conventional and Bayesian methods (95% credible interval 0.8530-0.9533), suggesting an excellent level of overall agreement. The BRACHA appears to be an accurate, highly reliable instrument for assessing the risk of aggression by children and adolescents who are about to undergo psychiatric hospitalization.
authors.affiliation: Child and Adolescent Forensic Psychiatry Service, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA. drew.barzman@cchmc.org
authors.forename: Drew
authors.initials: D
authors.lastname: Barzman
authors.forename: Douglas
authors.initials: D
authors.lastname: Mossman
authors.forename: Loretta
authors.initials: L
authors.lastname: Sonnier
authors.forename: Michael
authors.initials: M
authors.lastname: Sorter
mesh_terms: D000293:Adolescent; D000374:Aggression / Q000145:classification* / Q000523:psychology; D002648:Child; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D015588:Observer Variation; D009820:Ohio / Q000453:epidemiology; D011795:Surveys and Questionnaires / Q000592:standards*; D014743:Videotape Recording