Principle 4. Consider culture and development of the individual prior to establishing the level of measurement.
by: Dr. John S. Lyons
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Concept: In training we often conceptualize a communimetric measure as a strategy for measuring the person’s (or family’s) story. The background of communimetrics has more in common with qualitative research methods, like grounded theory, than with more quantitative approaches. With either qualitative or quantitative methods you end up with a number but the routes to that number can be quite varied. A major goal in all human serving enterprises is to individualize decisions about care. However, a competing pressure is to create accountable environments that allow comparisons across people and programs and over time. To achieve this second goal you must have common metrics. Communimetrics is designed to find the compromise between these two competing pressures. The fourth key principle is critical to successfully achieving this compromise.
Background: The two aspects of contextualizing the individual story—culture and development–have separate histories. The first contextualizing consideration to impact this measurement approach was development. The key experience that informed this principle was a project evaluating residential treatment that I worked on. The outcome measures were the CFARS for symptoms and the Ansell-Casey as a functional assessment. The Ansell-Casey is a sophisticated measure of whether or not youth have achieved mastery of key skills. This measure is designed from a developmental perspective so there are different relevant skills for different age groups. This design makes enormous sense. However, when we were trying to analyze the results, it was a major barrier to have different measures for each age cohort since there was a new set of skills used every two years across adolescent development. So the question became “How do you recognize that developmental processes impact functioning expectations without needing to have a separate measure for each developmental stage?” The answer is obvious: understand development first and then decide whether action is necessary. This is what all good clinicians do as a standard part of treatment planning.
The contextualization of culture occurred in parallel. In all honesty, as a white, monolingual Midwesterner growing up in the 1960s and ‘70s, I had very limited exposure to multiculturalism. I remember seeing the BITCH test in graduate school—the Black Intelligence Test to Counteract Honkies. That was the first time I remember being painfully aware that different people thought about things from different cultural worldviews. But, I had never even been on an airplane until I had my Ph.D. at 25 years of age. So I really knew little to nothing regarding the real impact of culture. And then the world began to change for me. Perhaps the key personal experience was the work I did with the European Consultation Liaison Workgroup and Frits Huyse, MD, Ph.D. in Amsterdam. The regular travel and work in Europe and the close relationships I formed with people from very different backgrounds than mine was eye opening for me in recognizing the importance of culture on understanding. After contextualizing the CANS based on development it was a short journey to realize that the same must be done for culture and for essentially the same reason—finding a balance between individualization and a common framework. It is this common purpose that leads us to combining these two contextualizing factors into the same key principle.
Proof of Concept: The mostly widely used communimetric measure, the Child and Adolescent Needs and Strengths (CANS) is used around the world and has been adapted to all age groups and a variety of very different cultural contexts on every continent (except Antarctica). Despite these broad cultural and developmental differences, published and presented research demonstrates that the approach functions with consistency as a reliable and valid decision support and outcome tool.
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Want to learn more about the 6 key principles and Communimetrics? Attend our 13th Annual TCOM Conference to meet Dr. Lyons and the TCOM Team in person!