A Computer Adaptive Test to Measure Community Reintegration
Linda J Resnik PhD MS
VA Medical Center, Providence
Providence, RI
Funding Period: January 2008 - May 2011

BACKGROUND/RATIONALE:
The early identification of problems in community re-integration and the promotion of greater function in the community is an important mandate for the VA. Successful achievement of this mandate hinges upon accurate assessment and monitoring of community re-integration. At this time, the VA does not assess community re-integration in an organized or standardized way, in part, because there is no consensus on the appropriate measure to use. Although numerous instruments that measure community re-integration exist, they lack proven content validity for use with veterans. To address this gap, we propose further development of a new measure, the Community Re-integration of Service Members (CRIS). The CRIS was recently developed through formative research on OIF/OEF veterans, caregivers and clinical experts, and a comprehensive review of concepts and content of existing measures. The CRIS is based upon the conceptual framework of the WHO's International Classification of Function (ICF), measures 9 domains of participation and 3 dimensions: objective and subjective aspects of participation as well as satisfaction with participation. We propose to use contemporary measurement techniques to develop a computer adaptive test version of the CRIS, the CRIS-CAT. Because CAT methodology uses a computer interface to tailor questions to the ability level of the patient, it will enable an assessment that is sufficiently sensitive to detect meaningful change while avoiding the administration of a long, fixed form instrument.

OBJECTIVE(S):
The objectives of this proposal are to: 1) develop the CRIS into a computer adaptive test (the CRIS-CAT) that will facilitate efficient yet comprehensive collection of community re-integration data; 2) assess psychometric characteristics of the CRIS-CAT including concurrent, discriminant and predictive validity, and to 3 )use the new measure to compare and contrast community re-integration outcomes in the 3 groups of veterans whose outcomes are expected to span the spectrum.

METHODS:
Development of the CAT will be achieved through a field study of 400 veterans, a) 100 veterans under the age of 60 who are observed to have good community reintegration, i.e. those with housing stability, steady employment, who are in long term relationships, and who screen negative for depression, PTSD, and substance abuse, b) 100 veterans under the age of 60 who are observed to have poor community reintegration, i.e., who are homeless, and/or chronically unemployed, and c) 200 OIF/OEF veterans, with community reintegration hypothesized as spanning the full range of the scale. Concurrent validity will be evaluated by examining correlation of the CRIS-CAT with existing measures that assess community re-integration dimensions. Discriminant validity will be evaluated by examining correlations with measures assessing differing constructs. Cross-sectional discriminant validity will be examined by comparing CRIS-CAT scores for the three groups. Predictive validity will be examined via a follow-up of the OIF/OEF veteran group to assess key outcomes. including: employment, income, and housing stability, as well as hospitalization due to mental health or substance abuse. Descriptive analysis, and multivariate modeling will identify factors associated with community reintegration.

FINDINGS/RESULTS:
No results at this time.

IMPACT:
The CRIS-CAT is a veteran-centric measure of community re-integration applicable for clinical practice and research. Its use will allow efficient assessment and tracking of global functional outcomes and need characteristics of OEF/OIF veterans, facilitate earlier identification, prevention and treatment of social disengagement, and enable more sensitive and valid assessment of treatment effectiveness.

PUBLICATIONS:

Journal Articles

1. Allen SM, Wieland S, Griffin J. The importance of healthcare provider continuity to the receipt of preventative services in an adult Medicaid population with physical disabilities. Journal of Prosthodontics : Official Journal of The American College of Prosthodontists. 2008.
2. Resnik L, Plow M. Review of Measures of Community Reintegration as defined by the Participation domain of the International Classification of Functioning, Disability and Health (ICF). Archives of Physical Medicine and Rehabilitation. 2008.
3. Berg K, Finne-Soveri H, Gray L, Harwood JC, Henrard J, Hirdes J, Ikegami N, Ljunggren G, Morris P, Paquay L, Resnik L, Teare G. Relationship between interRAI HC and the ICF: Opportunity for operationalizing the ICF. BMC Health Services Research [Electronic Resource]. 2008.

DRA: Health Services and Systems, Military and Environmental Exposures, Special (Underserved, High Risk) Populations
DRE: Rehabilitation, Technology Development and Assessment
Keywords: Deployment, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none