Measurement of social climate within neurobehavioural rehabilitation services using the EssenCES

In forensic mental health settings, quality of social climates is associated with a range of therapeutic assets. An essential characteristic of neurobehavioural rehabilitation services is provision of an enriched environment which reverses contingencies that maintain challenging behaviour. The concept of social climate is therefore equally important to these services. Criticisms of existing measures of social climate led to development of the EssenCES. This was initially validated in German forensic mental hospitals, and subsequently an English translation in equivalent UK services. To determine if EssenCES can be used to measure social climate in neurobehavioural rehabilitation units, responses from 114 staff and patients were analysed using statistical methods from classical test theory. Results were similar to those obtained previously. Rasch analysis was also used to test the assumption that EssenCES comprises a true interval-scale measurement tool. Item-person misfit, erratic responding, redundant response categories and disordered thresholds undermined this assumption. Rating scale recalibration, item reduction, and removing respondents who continued to demonstrate poor fit resulted in a measure with good internal construct validity but questionable external construct validity. Relative merits of modifying EssenCES for use with patients with cognitive impairment versus designing a measure conceptualised for use in neurobehavioural rehabilitation services are discussed.