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Joseph M. Rey, MD, FRANZCP; Michelle Singh, MPsychol(Clin); Se-fong Hung, FHKAM(Psychiatry), MRCPsych; David R. Dossetor, MD, MRCPsych; Louise Newman, MD, FRANZCP; Jon M. Plapp, PhD; Kevin D. Bird, PhD

Arch Gen Psychiatry. 1997;54(9):817-822.

Abstract
Background
Simple, reliable measures of the quality of the environment in which a child was reared that can be used in clinical research and practice are lacking.

Method
The reliability and validity of a global scale to retrospectively appraise the quality of that environment were examined. Fifty-three clinicians from 4 centers in Australia and 1 in Hong Kong, People's Republic of China, used the scale to rate 7 case vignettes; 4 clinicians rated 20 medical records, and 49 rated 211 subjects after clinical interviews.

Results
Interrater reliability (intraclass correlation coefficient) was 0.82 (time 1) and 0.84 (time 2) for case vignettes, 0.90 for medical records, and 0.89 for clinical interviews. Consistency in time was high (r=0.91). Lower ratings, indicative of a less adequate environment, were associated with a clinical diagnosis of oppositional defiant or conduct disorder.

Conclusions
Our simple-to-use scale appears to measure reliably a relevant clinical construct and fills a gap among the instruments available. Ratings may be useful as a cost-effective index to consider in outcome studies, when examining response to treatment, or in other clinical research.

Author Affiliations
From the Department of Psychological Medicine, University of Sydney (Drs Rey, Dossetor, and Plapp), Rivendell Child, Adolescent and Family Services (Drs Rey and Plapp), Wentworth Area Health Service, Child and Adolescent Mental Health Team (Ms Singh), the Department of Psychological Medicine, Royal Alexandra Hospital for Children (Dr Dossetor); Liverpool Pediatric Mental Health (Dr Newman), and the School of Psychology, University of New South Wales (Dr Bird), Sydney, New South Wales; and the Yaumatei Child Psychiatric Center, Hong Kong, People's Republic of China (Dr Hung).

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