We sat down with Andrew Molodynski, one of the authors of the newly-translated and validated (UK) Mini-ICF-APP Social Functioning Scale, and spoke with him about his involvement in the assessment and the ways in which it can help clinicians dealing with the growing global issue of mental illness.
The International Classification of Functioning (ICF), as per its name, seeks to classify functioning and disability. It's also a complex and detailed document. How does the Mini-ICF-APP Social Functioning Scale simplify this?
Simply put: by the design. It brings what is a massive and complex issue down to 13 day-to-day things - this makes it much more understandable and identifiable.
You translated and validated the Mini-ICF-APP in the UK. Can you describe how you got involved with this?
Well, our team at Oxford University was approached by (German author) Professor Linden - the author of the original German version of the Mini-ICF-APP - and his colleagues. They asked if we would look at doing the validation and translation since it had been quite well received, and they felt it could be quite useful in the English market.
Can you explain how you went about validating the data in the UK?
Working from the original data, we worked out that we would have similar properties and roughed out how many people we would need to make a suitable sample size. For instance, something like an effective antibiotic or vaccine you might need a smaller sample size because it has such a huge effect - something with an extremely small and discrete effect would need a much larger sample size to discern what could be minute differences. The Mini-ICF-APP falls between these extremes so we needed just over one hundred people to take part. We used the scale alongside other established measurements such as an individual's symptoms, whether or not they were employed - things like that. It took us about a year to fully validate the data.
You recently filmed a training video with Hogrefe, to take clinicians through the steps in using the Mini-ICF-APP Social Functioning Scale. Can you explain in brief for our readers how the scale works?
Ideally, this will be used in day-to-day patient care. These types of questions should be included in any good assessment anyway, and it simply defines, measures and assigns scores to help the clinician afterwards. The scale employs standard questions - about a patient's relationships, employment, the sorts of things that are instinctively important in people's lives - and it takes just 10 to 15 minutes to administer.
How is it different from other assessments being used?
Previously there have (broadly speaking) been two different kinds of assessments: one type that is extremely brief - just 2 to 3 minutes - and without much detail; sort of an 'on-the-go' assessment. And the other is extremely detailed but may take much much longer to complete; time that most clinicians simply don't have. The Mini-ICF-APP falls in the middle of these two - enough detail to get a good idea of how the patient's doing, but without overwhelming the busy clinician.
Mental health is often a hot topic, but it's recently been in the headlines in regards to people falling out of work and the toll that's taking on the economy. Do you think tools like the Mini-ICF-APP Social Functioning Scale are particularly useful in the current climate?
Mental health issues are a massive problem. The issues surrounding them are sky-high and the financial problem is just one of many. The WHO Global Burden of Disease estimates that depression will be the number one most costly disease by 2030 - in fact, it's already number two. Measurement of the impairment resulting from mental health problems is absolutely crucial in helping to deal with the problem - we need to intervene, and to do it effectively. We need to be more sophisticated about how we get help to the people who need it, and certainly the Mini-ICF-APP is a great tool to assist with this kind of intervention.
Can you tell us what the reaction to the Mini-ICF-APP Social Functioning Scale has been so far?
When we were validating and testing it, we used it a fair bit in a clinical setting. The feedback has been good - clinicians really appreciated that it is both quick and thorough, and patients didn't feel it was too intrusive or difficult to answer. It was acceptable to everyone. It also proved very useful; it truly recognised deficits and gave clinicians valuable information.
Andrew Molodynski is the consultant psychiatrist and team leader of a Community Mental Health Team in Oxfordshire and has also been part of theSocial Psychiatry Groupat the Oxford University Department of Psychiatry for a number of years. His research interests include the organisation of psychiatric services and the social functioning of those with severe mental health problems.