Rater Reliability:Science and Practice

Nate Israel, PhD

Chapin Hall for Children at the University of Chicago

Goals

Understand what ‘Reliability’ means to participants

Review scientific literature on inter-rater reliability of common behavioral health concerns

Describe the difference between pre- and post- rating triangulation

Walk through scenarios for making sure our CANS / ANSA ratings are reliable

Reliability

When someone in our profession says that something is ‘reliable’ or not, what does that mean?

When we are using the CANS / ANSA, what kinds of reliability matter the most to us?

Are there times when we actually expect our data to be unreliable in some way?

Science, Psychometrics, and Reliability

Common types of reliability:Cross-time Cross-item Cross-rater

What does each of these tell us, clinically?

Science, Psychometrics, and Reliability

Research on inter-rater reliability of common behavioral health needsRaters commonly include:

Professional (often a psychiatrist if diagnoses are involved)

Parent Youth

…sometimes an additional party, such as a teacher

Reliability: The Data

Research findings are (generally) consistent across a variety of studies

What would you guess that inter-rater reliability of common behavioral health concerns would be? .9 is exceptionally reliable .8 is highly reliable .7 is often the minimum threshold for an

instrument’s reliability (for research purposes) .6 is seen as somewhat unreliable

Reliability: Variation by Rater

Reliability: Variation by Rater

Reliability: Variation by Rater

Reliability: AAAAAAAAhhhhhhhhhhh!!!!

Science agrees: raters disagree Disagreement is substantial. Disagreement is consistent What do we do with disagreement??

Reliability: A Pragmatic Approach

This disagreement is discovered with most behavioral health measures after the measure is filled out

The CANS and ANSA are designed to be completed differently

The goal of the collaborative process underlying the CANS and ANSA is to surface and address disagreement before a rating is made

Reliability: Building Collaboration

This approach is sometimes referred to as pre-rating triangulation

This means that you get important information from all relevant / available sources before making a rating

You make the rating in consultation with the client

Reliability: Moments of Truth

In making a rating this way you can surface differences of opinion and address them

This is the heart of therapy: building and acting on a common understanding

It’s probably part of why collaborative assessment processes are associated with both better engagement and a small TREATMENT effect

Reliability: The Tough Parts

True Collaboration often means dealing with initially strong differences of opinion about needs and strengths

The CANS is designed to help people get through the toughest, most stigmatizing part of disagreement: the Why

It does this by allowing you to build a sense of Why something is happening together with the client

Example: Different Perspectives

Johnny is a 16-year old male youth His Spanish teacher reports that he has been

skipping class and thinks that he is hanging out with ‘the wrong crowd’ and ‘probably getting into trouble’ and wants these issues addressed

Johnny reports that he sometimes misses Spanish class ‘because it’s right after lunch’ and denies being involved in any delinquent behavior

Example: Different Perspectives Jenna is a 36-year old female adult Her CPS caseworker reports that she

recently failed a drug screen (heroin), and that as long as she uses, her child’s permanency plan will not include her as the preferred placement outcome for the child

Jenna strongly denies using heroin and loudly protests being rated as needing to address Substance Use concerns. She wants her child back in her custody.

Example: Different Perspectives How can you make this about the What? What kind of treatment goal(s) would be

consistent with Jenna’s perspective and desire, and the case worker’s needs?

Reliability: A CANS/ANSA Perspective

Reliability is not separate from our process of relating to, and working with our child, family, and adult clients

The more we make the ratings about their action implications, the more useful, and reliable, they become

Professional-on-Professional Doubt

We may have questions about how a professional arrived at a CANS / ANSA rating

The CANS / ANSA are designed to be transparent

When there is a question about a rating, it should be asked

Professional-on-Professional Doubt

We have a dirty little secret in some places of our profession; we sometimes institutionalize unreliability

This may seem protective of clients, the system, etc

Yet with the CANS and ANSA accuracy is advocacy

For us to get better we have to be honest and collaborative with our clients, selves, supervisors, and managers

Additional Thoughts / Questions

Thanks for spending this morning together. If there’s any other way I can be helpful,

please let me know. I hope to see you at the CANS conference in

November!