Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis-A Brief Summary

Over the last 10 years, behavioral health systems and organizations have increasingly adopted the Adult Needs and Strengths Assessment (ANSA) to support planning, to monitor progress, and for quality improvement initiatives. However, research related to the ANSA remained scarce. This gap was recently been addressed through a publication by Betty Walton, PhD, and Hea-Won Kim, PhD, from the Indiana University School of Social Work.  “Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis”, published online in the Journal of Social Service Research in March 2018, examined the psychometric properties of the ANSA.

Routine statewide use of the ANSA to identify behavioral health symptoms, related functional challenges, risks, and strengths provided the opportunity to validate the instrument with adults received community-based behavioral health treatment. About two years after statewide implementation, an early study explored the psychometric properties and outcomes for adults with serious mental illness (Walton, Kim, & Park, 2014). We found internal consistency reliability adequate-good for all but the Risk Behavior Domain. Following modifications for the risk domain, reliability issues remained. Recognizing that the ANSA structure mirrors the CANS, we decided to explore the underlying structure of the instrument in community-based behavioral health practice before completing other research.

An exploratory factor analysis was conducted with routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N=46,013). Five factors with adequate to good internal consistency (α = 0.733 – 0.880) emerged:

• Personal recovery factor included purpose, social and community connections, optimism, and positive recreational activities (α = 0.880)
• Trauma and stress related problems factor combined depression, adjustment to trauma, anxiety, sleep, danger to self and others, social functioning, and eating disorders (α = 0.818)
• Substance use risks factor consisted of legal, criminal behavior, substance use, antisocial behavior, other self- harm, impulse control, parental role, involvement in recovery, and residential stability (α = 0.733)
• Self-sufficiency factor included a combination of living skills, self-care, psychosis, intellectual disability, medication involvement, transportation, decision-making, employment (α = 0.795)
• Cultural-linguistic considerations factor included cultural identity, stress, rituals, and language (α = 0.752)

Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of the factor structure requires additional research.

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Walton, B. A. & Kim, H. (2018). Validating a behavioral health instrument for adults: Exploratory factor analysis. Journal of Social Services Review, 0, 1-17. doi.10.1080/01488376.2018.1442897 Available at https://www.tandfonline.com/eprint/N7DIeH8xyzRaHP9f65kI/full

Walton and Kim have completed a a series of psychometric analyses of statewide ANSA data. They developed  new ANSA recovery outcome measure, Community Integration, which the state has used for the last six years as a performance outcome measure. As  part of this work, our recently published exploration factor analysis provides evidence of the ANSA’s reliability and support for a holistic, recovery-oriented approach to behavioral health practice and to measuring progress.

Dr. Betty Walton, Assistant Research Professor, Indiana University School of Social Work, Indianapolis, conducts translational research to support the effective implementation of behavioral health services for children, youth, and adults.  Since 2010, Dr. Walton has provided training and technical assistance to support the implementation of common assessment tools for children, youth, and adults across public service systems. She also works with a team to provide evaluation and research services for child behavioral health services.

Hea-Won Kim, MSSW, Ph.D., is an Associate Professor in the School of Social Work at Indiana University (Indianapolis). Dr. Kim received her doctorate in social work from the University of Wisconsin-Madison.  She has conducted statewide needs assessments with mental health professionals serving people with severe mental illness and with families of consumers.  Currently, she is evaluating a provider training program to develop a partnership between consumers, families, and providers.  Her research and practice interest focus on evidence-based practices and family’s role in the recovery process for people with severe mental illness.

To learn more about Dr. Walton and Kim’s work, respond in the comments below or reach out directly! email: beawalto@iupui.edu; heakim@iupui.edu

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