Tuesday, 23 October 2012

MEASURES OF OUTCOME AND PROCESS

Measure of Processes of Care (MPOC)
(Available to download free from Internet)

Rony Schenker make the following stimulating Comment to Conductive World's recent posting on developments in Norway:

There are some measurements of processes of practice available which are standardized and therefore valid, not less than outcome measures, e.g. MPOC56 and the MPOC-SP to measure processes of care and family-centered service.

http://www.canchild.ca/en/measures/mpoc56_mpoc20.asp

Thanks, Rony, for introducing me to the MPOC materials. I am afraid that I could not find them in the Mental Measurement Yearbooks so I had to make my own very quick analysis based only upon the URL that you sent me. Here are some brief thoughts on the actual instrument.
  • The report that I read seems comprehensive – and honest. I could really see the process of test-construction
  • This is a rating scale of parents' views rather than a direct sample of the behaviours in question
  • I would regard these views as outcomes rather than direct insight into the processes involved in creating them
  • Psychometric detail looks impressive but I wonder about proposing a reliability amongst indications of validity I also question inclusion of face validity in a psychometric discussion of this nature, as it really means no more than plausibility within a given reference group
  • The items from which these instruments were derived come from the experiences of people experienced in services as presently exist in their given social context – they will inevitably therefore have a bias or some sort, omitting possible considerations or emphases of different kinds of service manifest in othersocial contexts.
I am afraid that to do this report justice would take far more time (and a far better memory of psychometrics!) that I can offe. Further, I have no time to follow up on literature on MPOC's actual use and/or validation studies in the field. I leave such essential tasks to those who may consider using this instrument in practice.
 
As for the present context, it is unlikely that in any knowable future CE will have the resources, personal or financial, to create such instruments of its own and will be therefore obliged to 'borrow' already developed ones like these. Such borrowings might serve useful purposes in service-evaluation, for comparisons across time, across age-groups, between different kinds of provision etc. Given your interest here I presume that you are already testing them in such a way and I look forward to seeing eventually how it goes. I do wonder about my above caveat on item selection (and perhaps a subtler point about the desired conductor-client relationship underpinning this, that I cannot quite concretise in my mind), and about possible cultural differences.

None of this, though, is really what I was struggling to express in my posting. MPOC is a 'self-report measure of parents' perceptions of the extent to which the health services they and their child(ren) receive are family-centred.' As noted above, I regard such parental ratings of how they regard such matters of service-oucome rather than process itself. By 'the actual processes of practice'. I myself had in mind direct sampling of what actually happens within the dynamic transactions of upbringing and intervention, as it happens, in real time and in vivo, with particular interest in identifying which forces (more likely combination of forces) lead learning and development in this direction or that. This is of course related not so much to 'what is' or 'what has been' as to 'what might be', and includes the upbringer/intervener in the process, actively, as an essential part of the process. Sorry to express this awkwardly. I am not the only one to find difficulty in recounting the dynamics of transaction concisely!

Of course, developing formal means to achieve this, or even just formal description, has been so far beyond the world of CE, though informal articulation is not – and this is perhaps an essential step along the way.
 
Of more immediate concern, the current events in Stockholm may well have been a context in which use of MPOC or something similar might have helped illuminate the discussion, and this ought to be born in mind by bidders for future contracts, in that country and elsewhere. But in future, if competition between systems is to become a feature of  contested tendering, then 'conductive' bidders should look very cautiously at the appropriateness of items making up such instruments for the outcomes that conductive interventions might hope to demonstrate.
 
By the way, a final point, you wrote 'standardized and therefore valid'. I saw no standardisation of MPOC in the report that I read, if by that is meant the creation of norms (though there may of course be such in later published literature). Even if there are, the long, sad history of psychometrics would suggest that standardisation can hardly serve as reassurance on validity, in any context!
 
I shall try and respond to your second Comment as soon as I can find time. Thanks for being such a wonderful foil.
 
References
 
King, S., Rosenbaum, P., King, G. (1995) The Measure of Processes of Care (MPOC); a means to assess family centres behaviours of health-care providers, McMaster University
Sutton, A. (2012) Evidence is not enough: Stockholm as paradigm example? Conductive World, 22 October





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