A standardized assessment of the work behaviour of psychiatric patients.

This paper describes the development of a standardized report intended for the assess ment of the work behaviour of psychiatric patients in hospital workshops and clerical units. The report form was developed in the Rehabili tation Unit of the Maudsley Hospital, and primarily within the workshops and clerical section which are integral parts of the co ordinated unit. The work report was developed in an attempt to achieve a set of aims that would have an important bearing on the assessment of patient work behaviours. The first aim was to develop an instrument which would give a compre hensive picture of a patient's assets and diffi culties in a work situation. Such a picture would be useful both as a basis for modification and a guide to management and placement. For example, if slowness or difficulties with supervisors were indicated to be problems, assessment might be the first step in the treat ment of these problems, and might influence decisions about work placement in the com munity. A second aim was to develop a stan dardized measure so that individual assessors. would be required to take a uniform approach, and be less likely to miss specific but important areas. Such an instrument should also be such that it could be repeated over time and provide some indication of the kind and extent of change in behaviour. Ideally, the results of an assessment should be easily converted into a quantified form. Quantification would facilitate comparisons between individuals, and within individuals over time; it would also facilitate the use of the instrument for research purposes. Last of all, a report should be suitable for use with a wide range ofjobs including, for example, workshop assembly, clerical work and computer card punching. With these aims and criteria in mind, a standardized report has been developed which does appear to have a number of distinct advantages. The final form of the report is illustrated in Fig. i. The report was derived from a number of sources. Both the form and content owe much to assessment forms used originally in the IndustrialRehabilitationUnits ofthe MinistryofLabour, and more recentlyto modifications made by Cheadle, Cushing, Drew and Morgan (1967). In fact, the present report incorporates the revised work report described by Cheadle and his colleagues. There are, however, a number of differences between the two report forms. Both forms involve pairs of opposite state ments, and a five-point rating scale. But whereas the previous researchers decided to define the mid-point as †̃¿ about midway' (between the two extremes) and to discard the use of †̃¿ about average', since this involved reference to †̃¿ average'patient behaviour which was consi dered to be irrelevant, the present form has retained the term †̃¿ about average' to define the mid-point. However, in the present form the reference group for defining the †̃¿ average' was not a patient group: †̃¿ average' refers to the norm in industry outside the hospital context and among non-psychiatric work personnel. This use of †̃¿ about average' was selected for two reasons. One was that the main group or raters were industrial supervisors whose experience was primarily in the open community rather than within a psychiatric hospital. The second was that the workshops and clerical section involved in this study were the last step before the patient's discharge into the community. It was, there fore, especially useful to try to assess patients against norms appropriate in open industry. In addition to this difference, the work reports