Capacity Evaluation Screen – Social Work (CES-SW): Development of a Screening Instrument for Community Based Programs

Background & Purpose: Social service usage is founded upon informed consent of clients. Valid consent can only be given when the client has the capacity to make meaningful decisions on the basis of disclosed information about services. As a result, social workers are needed to make judgments regarding a potential client’s capacity prior to initiating service delivery. The purpose of this study was to develop and validate an assessment tool to screen whether an individual is able to provide consent for involvement in social work programs. The Capacity Evaluation Screen – Social Work (CES-SW) was developed to be a valid and reliable instrument for brief administration within community-based programs. Theoretically, the CES – SW includes the four domains of capacity to consent which are evidencing a choice, understanding, reasoning, and appreciation.

Method: A research team of social work professors and veteran service providers evaluated existing instruments on capacity which were specific to health/mental health services.  The goal of this research was to construct an instrument that could be used within more general practice contexts. Data were obtained from 264 potential (wait list) clients from six community welfare centers in a metropolitan city in South Korea. Due to the nature of the study, a double consent form was provided and both the potential participants and an authorized person who signed in case the participant was deemed unable to provide consent. For data collection, face-to-face interviews with the research participants were conducted by six midlevel social workers who had at least seven years of working experience in the centers. Reliability and validity were tested through a series of statistical analyses such as item analysis, Pearson’s correlation and confirmatory factor analysis.

Results: An analysis revealed that the CES-SW differentiated between decision-making within the sample. Of the 264 research participants, 221 (83.7%) answered all the four items to demonstrate capacity to consent. However, 43 persons (16.3%) failed to demonstrate the capacity to consent as they did not provide an acceptable answer to at least one of the questions. The CES-SW demonstrates very good psychometric properties. Reliability analysis resulted in a Cronbach’s alpha coefficient of .83 with all of the item-total correlations greater than .50. Convergent validity was supported through significant correlations with cognitive abilities and a significant correlation with the Aid to Capacity Evaluation (ACE) scale (Etchells et al., 1999). Construct validity indicated that the four items constituted a one model factor.

Conclusions: The CES-SW is a valid and reliable instrument to screen potential clients for their capacity to consent to social work services. Using the CES-SW in community-based social welfare programs, staff can easily be trained to administer and interpret the screening data. Based upon these data, staff can determine whether clients have adequate understanding to participate in service programs in a voluntary way.

References

Etchells, E., Darzins, P., Silberfeld, M., Singer, P. A., Mckenny, J., Naglie, G., Katz, M., Guyatt, G. H., Molloy, W., & Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14, 27-34.