The disablements (impairments, disabilities and handicaps) which result from alcohol and drug use and mental (ADM) disorders are a major public health problem. They are of increasing concern because of their impact on health services. Diagnosis alone does not provide sufficient understanding of the need for mental health care. Assessment and classification of disablements provides an important additional dimension for understanding the health care needs, provision and outcomes. At present researchers and policy-makers are hampered in their ability to make accurate assessments of the form and frequency of such disablements, to develop projections of future health care needs and costs, and to evaluate and monitor management, treatment and outcomes. These difficulties stem from the absence of standardized methods for the assessment and classification of these disablements. The primary purpose of this proposal is to develop a comprehensive system for assessment of disablements resulting from ADM disorders. This proposal is a continuation of the WHO/NIH Joint project which has provided an international common language for psychiatric diagnosis and developed diagnostic instruments for ADM disorders in accordance with international classifications. The current term will focus on the disablements resulting from ADM disorders. The current proposal will also complete work and continue the coordination of research for international diagnostic instruments.
Specific aim 1 is to develop two instruments for the assessment of disablements, one for use in clinical settings and one for use in health care research. Cross-cultural definitions and methods of assessing disablements will be reviewed and will be used as the basis for developing instruments. The instruments will be reviewed and pilot tested at international collaborating centres and the revised instruments will be tested in focused field tests. Two pilot studies will be designed for health services research utilizing the disablement assessment instruments. The first study will focus on the ability of the instruments to predict service need. The second study will examine the ability of the disablement assessment instruments to predict health service utilization and cost.
Specific aim 2 is continue work related to the diagnostic instruments, including further analysis and publication of the reliability and validity study data for alcohol and drug use disorders, and prepare a critical review of the diagnostic instruments produced by the Joint Project to develop a research strategy addressing assessment of severity, course and comorbidity.
