Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study.

Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.

Informatics Research on Mental Health Functioning: Decision Support for the Social Security Administration Disability Program.

The disability determination process of the Social Security Administration's (SSA's) disability program requires assessing work-related functioning for individual claimants alleging disability due to mental impairment. This task is particularly challenging because the determination process involves the review of a large file of information, including objective medical evidence and self-reports from claimants, families, and former employers. To improve this decision-making process, SSA entered an interagency agreement with the Rehabilitation Medicine Department, Epidemiology and Biostatistics Section, in the Clinical Center of the National Institutes of Health, intending to use data science and informatics to develop decision support tools. This collaborative effort over the past decade has led to the development of the Work Disability-Functional Assessment Battery and has initiated an approach to applying natural language processing to the review of claimants' files for information on mental health functioning. This informatics research collaboration holds promise for improving the process of disability determination for individuals with mental impairments who make claims at the SSA.

Linking job duties, functioning, and employment status using the Work-Disability Functional Assessment Battery (WD-FAB): An expert coding and quantitative analysis.

BACKGROUND: An understanding of the link between specific occupational demands and individual worker functioning is limited, although such information could permit an assessment of the fit between the two in a manner that would inform national and state disability programs such as vocational rehabilitation and Social Security disability programs. OBJECTIVE: Our goal was to examine the utility of assessing physical and mental functioning relative to self-reported job duties to identify the domains of worker functioning most likely to create barriers to fulfilling an occupation's specific requirements. METHODS: Through primary survey data collection, 1770 participants completed the Work-Disability Functional Assessment Battery (WD-FAB) instrument after reporting details on their occupations (or most recent occupation if not working). Expert coders evaluated the level of function expected to successfully carry out each self-reported job duty with respect to six scales of physical and mental function. Quantitative analysis is used to examine the relationship between functioning and job duties. RESULTS: Those not working due to disability were more likely to fall short of the threshold of the physical and mental functioning requirements of their last job's three main job duties compared to those currently employed. Mental function scales were most likely to be the area experiencing a shortfall. CONCLUSIONS: Functional difficulties impede the ability to continue working in particular jobs that require that ability. This points to a need for specific accommodations to be implemented to bridge the gap between job requirements and functional capacity so that workers may remain engaged in their current work.

Information Extraction Framework for Disability Determination Using a Mental Functioning Use-Case.

Natural language processing (NLP) in health care enables transformation of complex narrative information into high value products such as clinical decision support and adverse event monitoring in real time via the electronic health record (EHR). However, information technologies for mental health have consistently lagged because of the complexity of measuring and modeling mental health and illness. The use of NLP to support management of mental health conditions is a viable topic that has not been explored in depth. This paper provides a framework for the advanced application of NLP methods to identify, extract, and organize information on mental health and functioning to inform the decision-making process applied to assessing mental health. We present a use-case related to work disability, guided by the disability determination process of the US Social Security Administration (SSA). From this perspective, the following questions must be addressed about each problem that leads to a disability benefits claim: When did the problem occur and how long has it existed? How severe is it? Does it affect the person's ability to work? and What is the source of the evidence about the problem? Our framework includes 4 dimensions of medical information that are central to assessing disability-temporal sequence and duration, severity, context, and information source. We describe key aspects of each dimension and promising approaches for application in mental functioning. For example, to address temporality, a complete functional timeline must be created with all relevant aspects of functioning such as intermittence, persistence, and recurrence. Severity of mental health symptoms can be successfully identified and extracted on a 4-level ordinal scale from absent to severe. Some NLP work has been reported on the extraction of context for specific cases of wheelchair use in clinical settings. We discuss the links between the task of information source assessment and work on source attribution, coreference resolution, event extraction, and rule-based methods. Gaps were identified in NLP applications that directly applied to the framework and in existing relevant annotated data sets. We highlighted NLP methods with the potential for advanced application in the field of mental functioning. Findings of this work will inform the development of instruments for supporting SSA adjudicators in their disability determination process. The 4 dimensions of medical information may have relevance for a broad array of individuals and organizations responsible for assessing mental health function and ability. Further, our framework with 4 specific dimensions presents significant opportunity for the application of NLP in the realm of mental health and functioning beyond the SSA setting, and it may support the development of robust tools and methods for decision-making related to clinical care, program implementation, and other outcomes.

Modulating Cognitive-Motor Multitasking with Commercial-off-the-Shelf Non-Invasive Brain Stimulation.

One growing area of multitasking research involves a focus on performing cognitive and motor tasks in tandem. In these situations, increasing either cognitive or motor demands has implications for performance in both tasks, an effect which is thought to be due to competing neural resources. Separate research suggests that non-invasive brain stimulation may offer a means to mitigate performance decrements experienced during multitasking. In the present study, we investigated the degree to which a commercially available non-invasive brain stimulation device (Halo Sport) alters balance performance in the presence of different types of cognitive demands. Specifically, we tested if performing a secondary cognitive task impacts postural sway in healthy young adults and if we could mitigate this impact using transcranial direct current stimulation (tDCS) applied over the primary motor cortex. Furthermore, we included conditions of unstable and stable surfaces and found that lower surface stability increased postural sway. In addition, we found that cognitive load impacted postural sway but in the opposite pattern we had anticipated, with higher sway found in the single-task control condition compared to executive function conditions. Finally, we found a small but significant effect of tDCS on balance with decreased sway for active (compared to sham) tDCS.

Correlation and Crosswalks Between Patient-Reported Functional Outcomes and PROMIS Physical Function Among Medically Ill Patients.

OBJECTIVES: To develop scoring crosswalks between a new multidomain patient-reported outcome measure, the Functional Assessment in Acute Care (FAMCAT), with a Patient-Reported Outcomes Measurement (PROMIS) measure of physical function, and examine correlations with existing legacy instruments. DESIGN: Cross-sectional, single-group design study. SETTING: Large, Midwestern academic teaching hospital. PARTICIPANTS: A sample of patients (N=1885; 53% men; average age, 62±16y) hospitalized on the general medical services between May 2016 and June 2017. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Scores from the FAMCAT administered via computerized adaptive testing were compared with scores on the 8-item PROMIS Physical Function (PROMIS PF) short form. RESULTS: Correlations with the FAMCAT and the PROMIS PF were strong for initial scores (MCAT_Mobilty: r=0.78, P<.0001; MCAT_DailyAct: r=0.81, P<.0001). The Applied Cognition scale did not demonstrate adequate correlations and thus was not a candidate for crosswalk scores. Although the MCAT_Mobility scale could be initially linked, subsequent analysis did not support a valid crosswalk. Linking criteria were applied with the Daily Activity scale to developing a final concordance table. CONCLUSIONS: The FAMCAT Daily Activity scale yielded robust correlations to develop crosswalk scores with the PROMIS PF. The resulting crosswalk conversion metric may be useful to compare outcomes across these constructs for assessing functional abilities among patients on general medical services. The Applied Cognition and Basic Mobility scales did not meet the criteria; therefore, alternate legacy instruments are needed to develop additional crosswalks.

Identifying Clinically Relevant Functional Strata to Direct Mobility Preservation Among Patients Hospitalized With Medical Conditions.

OBJECTIVE: To develop a system to guide interpretation of scores generated from the newly developed item response theory (IRT)-based Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT), which assesses 3 important domains of function: Mobility, Daily Activities, and Applied Cognition. DESIGN: Cross-sectional data was used to inform a modified Delphi approach to establish FAMCAT cutpoints delineating various functional ability levels. SETTING: Large midwestern academic teaching hospital. PARTICIPANTS: Patients hospitalized to an inpatient medical service (N=2049). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FAMCAT Basic Mobility, Daily Activity, and Applied Cognition scores. RESULTS: IRT-based score estimation data was successfully integrated with expert clinical feedback using a modified Delphi process to arrive at consensus yielding 4 functional level strata (ranging from bed-based mobility to independent mobility) for both the FAMCAT Mobility and Daily Activity scales; 1 cutpoint was supported to delineate 2 functional strata for Applied Cognition. CONCLUSIONS: Meaningful cutpoints were established for each FAMCAT domain using a data-informed, modified Delphi process for achieving consensus. The resulting FAMCAT interpretation guide may be used to develop an ability-matched mobility preservation program and identify patients who may require a higher level of supervision based on the resulting FAMCAT scores.

Improving the Delivery of Function-Directed Care During Acute Hospitalizations: Methods to Develop and Validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT).

OBJECTIVE: To (1) develop a patient-reported, multidomain functional assessment tool focused on medically ill patients in acute care settings; (2) characterize the measure's psychometric performance; and (3) establish clinically actionable score strata that link to easily implemented mobility preservation plans. DESIGN: This article describes the approach that our team pursued to develop and characterize this tool, the Functional Assessment in Acute Care Multidimensional Computer Adaptive Test (FAMCAT). Development involved a multistep process that included (1) expanding and refining existing item banks to optimize their salience for hospitalized patients; (2) administering candidate items to a calibration cohort; (3) estimating multidimensional item response theory models; (4) calibrating the item banks; (5) evaluating potential multidimensional computerized adaptive testing (MCAT) enhancements; (6) parameterizing the MCAT; (7) administering it to patients in a validation cohort; and (8) estimating its predictive and psychometric characteristics. SETTING: A large (2000-bed) Midwestern Medical Center. PARTICIPANTS: The overall sample included 4495 adults (2341 in a calibration cohort, 2154 in a validation cohort) who were admitted either to medical services with at least 1 chronic condition or to surgical/medical services if they required readmission after a hospitalization for surgery (N=4495). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The FAMCAT is an instrument designed to permit the efficient, precise, low-burden, multidomain functional assessment of hospitalized patients. We tried to optimize the FAMCAT's efficiency and precision, as well as its ability to perform multiple assessments during a hospital stay, by applying cutting edge methods such as the adaptive measure of change (AMC), differential item functioning computerized adaptive testing, and integration of collateral test-taking information, particularly item response times. Evaluation of these candidate methods suggested that all may enhance MCAT performance, but none were integrated into initial MCAT parameterization. CONCLUSIONS: The FAMCAT has the potential to address a longstanding need for structured, frequent, and accurate functional assessment among patients hospitalized with medical diagnoses and complications of surgery.

Driver Rehabilitation Utilization and Need Among Community-Dwelling Older Adults.

IMPORTANCE: Driving is one of the most important instrumental activities of daily living. As adults age, many face challenges with maintaining independent driving, leading to risk for decreased occupational engagement and quality of life. The extent to which occupational therapy services meet the driver rehabilitation needs of older adults is unknown. OBJECTIVE: To characterize driver rehabilitation service utilization among a nationally representative sample of community-dwelling older adults. DESIGN: Exploratory, descriptive cross-sectional study using the National Health and Aging Trends Study 2016 wave. PARTICIPANTS: Community-dwelling adults age 65 and older who received rehabilitation services in the past year (N = 1,173). OUTCOMES AND MEASURES: Sociodemographic information, comorbidities, rehabilitation use, community mobility, and participation restrictions were collected using self-report and performance-based measures. RESULTS: Of this sample of older adults, 63.0% reported driving as their primary mode of transportation, 25.8% reported limitations in community participation related to transportation, and 9.2% reported having received rehabilitation focused on driving or other transportation goals in the past year. Findings from this study suggest a discrepancy between utilization of driver rehabilitation and self-reported need. CONCLUSIONS AND RELEVANCE: Many older adults reported limitations in community participation for transportation-related reasons, yet driver rehabilitation represented only a small proportion of services used. As experts in driver rehabilitation, occupational therapy practitioners should lead the way in advocating for increased utilization of driver rehabilitation and development of innovative, accessible transportation options to promote community mobility and participation among older adults. WHAT THIS ARTICLE ADDS: The results of this study illustrate an important discrepancy between self-reported need for and utilization of driver rehabilitation services. Occupational therapy practitioners can play an important role in meeting older adults' driving and transportation needs to enable them to fully participate in their community and daily routines.

The Specificity of Cognitive-Motor Dual-Task Interference on Balance in Young and Older Adults.

Standing upright on stable and unstable surfaces requires postural control. Postural control declines as humans age, presenting greater risk of fall-related injury and other negative health outcomes. Secondary cognitive tasks can further impact balance, which highlights the importance of coordination between cognitive and motor processes. Past research indicates that this coordination relies on executive function (EF; the ability to control, maintain, and flexibly direct attention to achieve goals), which coincidentally declines as humans age. This suggests that secondary cognitive tasks requiring EF may exert a greater influence on balance compared to non-EF secondary tasks, and this interaction could be exaggerated among older adults. In the current study, we had younger and older adults complete two Surface Stability conditions (standing upright on stable vs. unstable surfaces) under varying Cognitive Load; participants completed EF (Shifting, Inhibiting, Updating) and non-EF (Processing Speed) secondary cognitive tasks on tablets, as well as a single task control scenario with no secondary cognitive task. Our primary balance measure of interest was sway area, which was measured with an array of wearable inertial measurement unit sensors. Replicating prior work, we found a main effect of Surface Stability with less sway on stable surfaces compared to unstable surfaces, and we found an interaction between Age and Surface Stability with older adults exhibiting significantly greater sway selectively on unstable surfaces compared to younger adults. New findings revealed a main effect of Cognitive Load on sway, with the single task condition having significantly less sway than two of the EF conditions (Updating and Shifting) and the non-EF condition (Processing Speed). We also found an interaction of Cognitive Load and Surface Stability on postural control, where Surface Stability impacted sway the most for the single task and two of the executive function conditions (Inhibition and Shifting). Interestingly, Age did not interact with Cognitive Load, suggesting that both age groups were equally impacted by secondary cognitive tasks, regardless the presence or type of secondary cognitive task. Taken together, these patterns suggest that cognitive demands vary in their impact on posture control across stable vs. unstable surfaces, and that EF involvement may not be the driving mechanism explaining cognitive-motor dual-task interference on balance.

Effects of Cognitive Over Postural Demands on Upright Standing Among Young Adults.

A growing body of research has shown that static stance control (e.g., body sway) is influenced by cognitive demands (CD), an effect that may be related to competition for limited central resources. Measures of stance control have also been impacted by postural demands (PD) (e.g., stable vs. unstable stances). However, less is known of any possible interactions between PD and CD on static stance control in populations with intact balance control and ample cognitive resources, like young healthy adults. In this study, among the same participants, we factorially compared the impact of PD with and without CD on static stance control. Thirty-four healthy young adults wore inertial measurement units (IMU) while completing static stance tasks for 30 seconds in three different PD positions: feet apart, feet together, and tandem feet. After completing these tasks alone, participants performed these tasks with CD by concurrently completing verbal serial seven subtractions from a randomly selected three-digit number. For two dependent measures, path length and jerk, there were main effects of CD and PD but no interaction effect between these factors. For all other stance control parameters, there was only a PD main effect. Thus, adding a cognitive demand to postural demands, while standing upright, may have an independent impact on stance control, but CD does not seem to interact with PD. These results suggest that young healthy adults may be less sensitive to simple PD and CD due to their greater inherent balance control and available cognitive resources. Future work might explore more complex PD and CD combinations to determine the boundaries under which young adults' resources are taxed.

The Supporting Older Americans Act of 2020: How Policy Connects With Occupational Therapy Principles and Practice.

The U.S. population is aging at an unprecedented rate, creating both opportunities and challenges for the overall health of the nation. Occupational therapy practitioners can inform important health policies by developing an understanding of the basis for relevant laws and programs and how occupational therapy principles relate to policy goals. This column discusses the Older Americans Act of 1965 (reauthorized as the Supporting Older Americans Act of 2020) and describes ways in which the objectives of this legislation align with the principles and practice of occupational therapy. Recommendations are provided for how the field of occupational therapy can enhance current policy development and debate, thus leading to expanded opportunities for the profession.

Meditation-Based Interventions for Adults With Dementia: A Scoping Review.

IMPORTANCE: With the high prevalence and cost of dementia care worldwide, a need exists to develop cost-effective and evidence-based treatment for people with dementia. Meditation, which has been demonstrated to have positive effects on brain health, may be a viable intervention option. OBJECTIVE: To investigate how meditation-based interventions affect health and quality-of-life (QOL) outcomes for adults with dementia. DATA SOURCES: Articles were located by using the keywords meditation, mindfulness, mind-body, dementia, and Alzheimer's to search the following electronic databases: PubMed, CINAHL, Embase, Cochrane, and JumboSearch at Tufts University. STUDY SELECTION AND DATA COLLECTION: Using Arksey and O'Malley's methodology, a scoping review was conducted to examine scientific and gray literature published between 1997 and 2018. Data were abstracted and assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Only articles that included a meditation-based intervention and at least 1 participant with dementia were included. FINDINGS: Nineteen articles met inclusion criteria. The four main outcomes that emerged from the literature were improvement in QOL, mental health, cognition, and functional abilities after participation in a meditation-based intervention. The outcome with the strongest support was the effectiveness of meditation-based interventions in maintaining cognitive function in people living with dementia. Significant gaps in the research were identified, including weak research design, inconsistency in measurement of outcomes, small sample sizes, and a lack of standardized meditation protocols for people with dementia. CONCLUSIONS AND RELEVANCE: Our findings suggest that incorporating meditation into interventions for clients with dementia can have beneficial results. Opportunities exist for occupational therapy practitioners to advocate for the continuation of research in this field. Notable gaps in the literature highlight the need for randomized controlled trials and the development of standardized meditation protocols for people with dementia. WHAT THIS ARTICLE ADDS: Meditation-based interventions for people with dementia are associated with improved quality of life and cognition and may be viable treatment options for occupational therapists to implement in their practice.

Older Adult Productive Activity Participation Using the National Health and Aging Trends Study.

This study aims to characterize factors related to productive activity participation among community-dwelling older adults. Cross-sectional analyses using data from the National Health and Aging Trends Study were used to calculate weighted frequencies representative of the U.S. population of older adults. Multivariate logistic regression was used to explore factors related to participation outcomes (paid work, volunteering, caregiving). We found that 21% of community-dwelling older adults in the United States reported currently working. Older adults reported working in a wide range of occupations. Driving emerged as one of the most important factors related to increased odds of productive activity participation. Age, gender, and health factors were also significantly associated with increased odds of productive activity participation. By understanding the current profile of participation in activities including employment, caregiving, and volunteering among a national sample of community-dwelling older adults, we can effectively inform intervention programs and resource allocation to support productive aging.

Measuring Activity Limitations Within the National Health and Aging Trends Study (NHATS).

BACKGROUND AND OBJECTIVES: To better understand the disablement process among older adults, improved measures of activity limitations are needed. Traditional population-level measures lack the ability to distinguish precise gradations of activity limitation and are unable to detect degrees of differences over a wide range of ability levels. Therefore, we used contemporary measurement methods to improve upon current methodologies for characterizing activity limitations within the National Health and Aging Trends Study (NHATS) . RESEARCH DESIGN AND METHODS: We used the NHATS Round 1 cohort to assess the feasibility of constructing an Activity Limitations scale using Rasch item response theory methods. Factor analysis was used to develop the scale from a set of existing items in the NHATS Mobility, Self-Care, and Household Activity domains. Psychometric properties of the scale were evaluated and the scale was used to examine change in activity limitations among the sample from 2011 to 2015. RESULTS: Results supported an 18-item scale (N = 7,609). Rasch infit and outfit statistics were within acceptable range for all items (Cronbach's alpha = 0.95; sample score reliability = 0.83). From 2011 to 2015, 5.88% older adults demonstrated increase in function, 15% showed decrease in function, and 78% of the sample showed no change (did not exceed ± MDC90). DISCUSSION AND IMPLICATIONS: Findings demonstrate that a unidimensional, interval scale of activity limitations can be constructed using traditional survey measures nested within the NHATS. Results revealed concerns regarding ceiling effects within the current self-report items of activity limitations suggesting future work is needed to expand the range of ability currently represented in the NHATS Activity Limitation items.

The Work Disability Functional Assessment Battery (WD-FAB).

Accuracy in measuring function related to one's ability to work is central to public confidence in a work disability benefits system. In the United States, national disability programs are challenged to adjudicate millions of work disability claims each year in a timely and accurate manner. The Work Disability Functional Assessment Battery (WD-FAB) was developed to provide work disability agencies and other interested parties a comprehensive and efficient approach to profiling a person's function related to their ability to work. The WD-FAB is grounded by the International Classification of Functioning, Disability, and Health conceptual framework.

Psychometric Evaluation of the Improved Work-Disability Functional Assessment Battery.

OBJECTIVE: To assess psychometric properties of the improved Work Disability Functional Assessment Battery (WD-FAB 2.0). DESIGN: Longitudinal study. SETTING: Community. PARTICIPANTS: Three samples of working-age (21-66) adults (N=1006): (1) unable to work because of a physical condition (n=375); (2) unable to work because of a mental health condition (n=296); (3) general United States working age sample (n=335). INTERVENTION: NA. MAIN OUTCOME MEASURES: All samples completed the WD-FAB 2.0; the second administration came 5 days after the first. Construct validity was examined by convergent and divergent correlational analysis using legacy measures. Test-retest reliability was assessed by intraclass correlation coefficients (ICC3,1). Standard error of the mean (SEM) and minimal detectable change (MDC90) were calculated to measure scale precision and sensitivity. RESULTS: Physical function ICCs ranged from 0.69 to 0.77 in the general sample, and 0.66 to 0.86 in the disability sample. Mental health function scales ICCs ranged from 0.62 to 0.73 in the general sample, and 0.74 to 0.76 in the disability sample. SEMs for all scales indicated good discrimination; those for the physical function scales were generally lower than those for the mental health scales. MDC90 values ranged from 3.41 to 10.55. Correlations between all WD-FAB 2.0 scales and legacy measures were in the expected direction. CONCLUSIONS: The study provides substantial support for the reliability and construct validity of the WD-FAB 2.0 among 3 diverse samples. Although initially developed for use within the Social Security Administration (SSA), these results suggest that the WD-FAB 2.0 could be used for assessment and measurement of work-related physical and mental health function in other contexts as well.

Measuring Work Related Physical and Mental Health Function: Updating the Work Disability Functional Assessment Battery (WD-FAB) Using Item Response Theory.

OBJECTIVE: To further improve measurement of work-related physical and mental health by updating the Work Disability Assessment Battery (WD-FAB). METHODS: Cross-sectional study with 1024 disability claimants and 1000 working age (21 to 66 years) adults in the United States. Developed new items to replenish the WD-FAB and analyzed using factor analysis and item response theory (IRT). Computer adaptive testing (CAT) simulations evaluated the psychometric properties of the original versus updated WD-FAB. RESULTS: Analyses confirmed the structure of the WD-FAB. Twenty-three new items were added (basic mobility: 7, upper body function: 4, fine motor: 6, self-regulation: 1, resilience & sociability: 5 items). CONCLUSIONS: Findings support the WD-FAB as a robust, psychometrically sound assessment of work-related function. Extensive content coverage (331 items) represents eight physical and mental health domains. IRT/CAT methods allow administration in under 15 minutes. The WD-FAB may prove valuable for efficiently characterizing work-related function across work rehabilitation settings.

Concordance of assessments of clients' mental and behavioral health with in vivo assessment of work performance.

BACKGROUND: Assessing functioning and disability among individuals with mental and behavioral health disorders has historically relied on deriving accurate psychiatric diagnoses and assessing symptoms. However, growing empirical evidence suggests that this approach is inadequate to determine real world performance, particularly with respect to work. OBJECTIVE: We examined a performance-based approach to the assessment of work functioning and its relationship to mental and behavioral health status. METHODS: A cross-sectional study was conducted at two mental health programs. Trained employment providers conducted performance-based assessments of work function and ratings of mental and behavioral health while study participants self-reported their mental/behavioral health functioning. We hypothesized that participant and provider ratings of mental/behavioral health would be moderately correlated with performance-based assessments of work function. RESULTS: We found no significant correlation between participants' self-report of their mental and behavioral health and performance-based assessments of work. Employment providers' ratings of participants' mental/behavioral health were moderately correlated with performance-based measures of work. Finally, we found low concordance between employment providers and study participants' with respect to ratings of their mental/behavioral health. CONCLUSIONS: Contrary to our hypotheses, ratings of mental/behavioral health were only moderately correlated with performance-based measures of work. Results confirm earlier research suggesting that it is difficult to predict work performance from participants' self-reports of their mental/behavioral health alone. Performance-based assessments of work capacity as well as ratings of mental and behavioral health may both be needed for a more complete and complimentary picture of the ability of individuals with mental and behavioral health disorders to function in the work place.

Improving Assessment of Work Related Mental Health Function Using the Work Disability Functional Assessment Battery (WD-FAB).

Purpose To improve the mental health component of the Work Disability Functional Assessment Battery (WD-FAB), developed for the US Social Security Administration's (SSA) disability determination process. Specifically our goal was to expand the WD-FAB scales of mood & emotions, resilience, social interactions, and behavioral control to improve the depth and breadth of the current scales and expand the content coverage to include aspects of cognition & communication function. Methods Data were collected from a random, stratified sample of 1695 claimants applying for the SSA work disability benefits, and a general population sample of 2025 working age adults. 169 new items were developed to replenish the WD-FAB scales and analyzed using factor analysis and item response theory (IRT) analysis to construct unidimensional scales. We conducted computer adaptive test (CAT) simulations to examine the psychometric properties of the WD-FAB. Results Analyses supported the inclusion of four mental health subdomains: Cognition & Communication (68 items), Self-Regulation (34 items), Resilience & Sociability (29 items) and Mood & Emotions (34 items). All scales yielded acceptable psychometric properties. Conclusions IRT methods were effective in expanding the WD-FAB to assess mental health function. The WD-FAB has the potential to enhance work disability assessment both within the context of the SSA disability programs as well as other clinical and vocational rehabilitation settings.