Development and Initial Validation of the Homelessness Severity Index

描述(由申请人提供)： 项目背景：目前，数十万退伍军人通过几个退伍军人无家可归计划获得住房和相关服务(心理健康治疗、工作培训)。这些方案提供的住房支持类型各不相同(例如，过渡性、住宅性、永久性)以及它们提供的相关服务。令人惊讶的是，退伍军人管理局项目中没有常规使用的评估来检查退伍军人的历史和当前功能状态的特征，提供可解释的结果来优化结果。多年来，退伍军人事务部无家可归者方案收集了方案评估问卷数据。这些数据(例如，名为表格X的标准化摄入量评估表)确实捕获了似乎与干预决定相关的信息(例如，无住所、健康和精神健康问题的时间长短)，但没有转换为可靠、有效的指数，供决策使用。例如，表格X要求摄入量临床医生询问五个关于酒精使用的问题，但这些信息随后不会转换为一个指数，作为使用/滥用严重程度的估计、预测结果或推动关于治疗的决定。项目目标：这项拟议研究的总体目标是开发一个多尺度的结构化访谈(无家可归严重程度指数，HSI)，以提供对首次接触护理提供者时无家可归者状况的全面、翔实的评估。我们的具体目标是：1)细化一组影响无家可归发生和长期无家可归的领域或因素(例如，心理社会特征、共病状况)，2)扩展和细化利用每个已识别领域的要素的项目，以及3)创建将提供每个领域严重程度估计的指数子量表。这项工作是以McLellan等人开发的成瘾严重程度指数(ASI)为模型的。(1980、1992)。ASI是一种结构化的访谈，提供了对七个领域(例如，毒品问题、医疗问题)的成瘾严重程度的估计。ASI主要是在VA项目中开发的，是药物滥用领域最广泛使用的工具之一，已被用于许多治疗结果的研究。在这项拟议的研究中，量表的编制和初步效度研究将使用与建立ASI时使用的类似的方法。拟议的研究由于可获得大量潜在的无家可归老兵参与者(PI是最大的退伍军人计划--赠款和每日饮食计划的全国主任)和先前在量表开发方面的经验(联合调查员在量表开发和验证方面具有丰富的经验)而得到加强。项目方法：将使用理性-经验的规模开发方法来开发HSI。该方法将需要以下顺序步骤：1)创建利用在无家可归风险研究中确定的相关领域(例如，工作/财务、饮酒)的访谈项目库，2)通过专家评审团(在无家可归领域有经验的临床医生)的评审来改进项目库，以创建阿尔法版本，3)对申请无家可归计划的退伍军人实施阿尔法版本的HSI(根据批准的VA/IRB方案)，4)使用Mokken比例分析方法进行项目分析和量表改进，以及检查传统的多种心理测量标准(例如，项目-总量表和跨量表相关性)，5)建立内部信度和检查因素结构，6)制定个别量表和总指数的评分算法，以及7)检查对比组的表现和与人口统计学变量的收敛/判别相关性，以建立初始效度。随后将要求提供资金，以完善和验证HSI，以便在无家可归者方案和亚群中使用。

DESCRIPTION (provided by applicant): Project Background: Currently, hundreds of thousands of veterans receive housing and associated services (mental health treatment, job training) through several VA homeless programs. These programs vary in the type of housing support they provide (e.g., transitional, domiciliary, permanent) and in associated services they offer. Surprisingly, there is no assessment that is routinely used in VA programs that examines characteristics of veteran history and current functional status, providing interpretable results to optimize outcomes. For many years the VA homeless programs have collected program evaluation questionnaire data. These data (e.g., the standardized intake evaluation form titled Form X) do capture information that would appear to be relevant to intervention decisions (e.g., length of time without residence, health and mental health problems), but are not transformed into reliable, valid indices for use in decision-making. For example, Form X requires the intake clinician to ask five questions about alcohol use, but this information is not then transformed into an index that would serve as an estimate of severity of use/abuse, predict outcomes, or drive decisions about treatment. Project Objectives: The overall objective of the proposed study is to develop a multiscale structured interview (the Homelessness Severity Index, HSI) that will provide a comprehensive, informative evaluation of homeless status at the point of first contact with care providers. Our specific objectives are to: 1) refine the set of domains or factors influencing the occurrence and chronicity of homelessness (e.g., psychosocial characteristics, comorbid conditions), 2) expand and refine the items tapping elements of each of the identified domains, and 3) create index subscales that will provide estimates of severity for each of the domains. This work is modeled on the Addiction Severity Index (ASI), developed by McLellan et al. (1980, 1992). The ASI is a structured interview that provides estimates of addiction severity in seven domains (e.g., drug problems, medical problems). Developed largely in VA programs, the ASI is one of the most widely used instruments in the field of substance abuse and has been used in numerous studies of treatment outcome. In this proposed study, scale development and initial validity research will use a similar methodological approach as that used in establishing the ASI. The proposed research is enhanced by the availability of substantial numbers of potential homeless veteran participants (the PI is national director of the largest VA homeless program, the Grant and Per Diem program) and by prior experience in scale development (the co-Investigator has extensive experience in scale development and validation). Project methods: A rational-empirical method of scale development will be used to develop the HSI. The method will require the following sequential steps: 1) creation of pool of interview items tapping relevant domains identified in homelessness risk research (e.g., work/finances, alcohol use), 2) refinement of the item pool via review by a panel of expert judges (clinicians experienced in the field of homelessness) to create an alpha version, 3) administration of the alpha version of the HSI to veterans applying to homeless programs (under an approved VA/IRB protocol), 4) item analyses and scale refinement using Mokken scaling analysis methods as well as examination of traditional multiple psychometric criteria (e.g., item-total scale and cross- scale correlations, squared multiple correlations, conditional alpha on item deletion), 5) establishment of internal reliability and examination of factor structure, 6) development of scoring algorithms for individual scales and the total index, and 7) examination of contrasted groups performance and convergent/discriminant correlations with demographic variables to establish initial validity. Subsequent funding will be requested to refine and validate the HSI for use across homeless programs and subpopulations.