Development and Testing of a Measure to Assess Coercion in Mental Health Treatment

Beth Angell
School of Social Service Administration
University of Chicago
969 E. 60th St.
Chicago IL 60637
Phone: 773-702-1421
FAX: 773-702-0874
Email: angell@uchicago.edu
 
Purpose: Although there is much debate and concern about the problem of coercion in mental health services, there has been little empirical study of this phenomenon, in part because of the lack of appropriate measurement instruments for assessing coercive practices.  This presentation will report the development and testing of a measure to assess the extent to which assertive community treatment providers working with adults with serious mental illness utilize coercive clinical strategies with their clients.

Method: A preliminary conceptualization was identified from the research literature and from qualitative observations of and informant interviews with mental health providers.  A 16-item pool measuring strategies for addressing medication non-adherence with a particular client was administered via written questionnaire to 280 providers of assertive community treatment.
Exploratory factor analysis of the measure indicated a single dimension.  Rasch analysis was then used to calibrate the items along the dimension of coercion and to assess item fit, yielding a unidimensional 15-item measure.

Results: The exploratory factor analysis and Rasch measurement modeling indicate that items indicating varying degrees of coercion can be calibrated to yield a conceptually coherent and internally consistent unidimensional measure.  Subsequent analyses to assess concurent validity showed that coercion measure scores behaved in an expected manner with related constructs.  That is, coercion scores were positively associated with perceived negativity in the client-provider relationship and negatively associated with the provider’s assessment of the client’s cooperativeness in treatment.

Implications for Practice: Development of measures that meaningfully represent processes occurring in intensive mental health treatment will enable researchers to better examine quality of care and mediating factors in the success of various treatments.  Identifying ways to assess the phenomenon of coercive practices in particular will highlight priority areas for training sensitive and competent professionals to work with people with serious mental illness.