Ward Climate? Research Shows: Still No Operationalized Definition

Ward climate is often used to refer to the material, social, and emotional conditions of a unit that influence the mood, behavior, and self-concept of the individuals involved. This study sought to examine the psychometric properties of the EssenCES and the GCI-r, two self-report questionnaires that assess ward climate, and the overlap between these two instruments in three high security forensic psychiatric facilities. Good internal consistency was found for all subscales of both instruments, and analyses indicated that the instruments measure related concepts. This is the bottom line of a recently published article in The International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health| 2018, Vol. 17, No. 3, 247-255

Ward Climate in a High-Secure Forensic Psychiatric Setting: Comparing Two Instruments

Authors

Meike Godelieve de Vries, Division Diagnostics Research and Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands
Inti Angelo Brazil, Division Diagnostics Research and Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands; Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, Antwerp, Belgium; Centre for Psychology, Behaviour, & Achievement, Faculty of Health and Life Sciences, Coventry University, UK
Peer van der Helm, Hogeschool Leiden, Youth Expert Centre, Leiden University of Profressional Sciences, Leiden, The Netherlands
Robbert-Jan Verkes, Division Diagnostics Research and Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands; Department of Criminal Law, Law School, Radboud University, Nijmegen, The Netherlands; Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
Berend Hendrik Bulten, Division Diagnostics Research and Education, Forensic Psychiatric Centre Pompestichting, Nijmegen, The Netherlands; Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands

Abstract

The psychometric properties and associations between the Essen Climate Evaluation Schema (EssenCES) and the Group Climate Instrument-revised (GCI-r) were examined. These self-report questionnaires assessing ward climate were filled out by 123 male patients, residing in 3 high-secure forensic psychiatric facilities. Good internal consistency was found for all subscales of both instruments. The original factor structure was confirmed for the EssenCES, but not for the GCI-r. Bivariate correlation analyses indicated that the instruments measure related concepts. The results of this study call for further development and validation and for finding common grounds in the definition and operationalization of ward climate.

Keywords

EssenCES, GCI-r, ward climate, self-report measures, psychometric properties

Summary of the Research

“it has long been recognized that ward climate or atmosphere plays an important role in the efficacy of treatment in psychiatric hospitals…Ward climate or social climate is often used as a term to refer to the material, social, and emotional conditions of a particular unit and the interaction between such factors, which may influence the mood, behavior and self-concept of the people involved…Having an optimal ward climate has been described as a prerequisite for fostering program responsivity and enhancing treatment readiness. There is a growing body of research on ward climate, demonstrating that positive ward climate often co-occurs with positive organizational and therapeutic outcomes in inpatient forensic psychiatric care. For instance, the quality of ward climate is found to be related to motivation to engage in treatment, coping, and therapeutic alliance, staff and patient satisfaction, self-reported aggression and aggressive incidents, and recidivism…” (p.247).

“…Nowadays, relatively short questionnaires are preferred and used to monitor and compare ward climate and to guide clinical practice. One example of this type of instrument is the Essen Climate Evaluation Schema (EssenCES)…The EssenCES was developed for use in forensic psychiatric units. The EssenCES is also available for correctional and prison settings…The psychometric quality of the EssenCES in correctional settings and forensic psychiatric hospitals has been studied and supported several times. However, additional research on its suitability is required for specialized settings such as female units, facilities for juvenile offenders, and forensic facilities for individuals with learning disabilities. The EssenCES measures three aspects of ward climate, namely ‘Therapeutic Hold,’ referring to the extent to which the unit is perceived as supportive of patients’ therapeutic needs; ‘Experienced Safety,’ representing freedom from the threat of aggression and violence; and ‘Patient Cohesion and Mutual Support…,’ indicating the extent to which characteristics of a therapeutic community are approximated on a unit” (p.248).

“A second example of a relatively short questionnaire developed to monitor ward climate is the Group Climate Instrument revised (CGI-r) derived from the Prison Group Climate Inventory (PGCI)…The PGCI was developed to measure group climate in youth prisons and secure residential treatment facilities…The GCI-r assesses four dimensions of ward climate, namely ‘Support…;’’ ‘Growth,’ reflecting facilitation of learning and preparation for a meaningful life both within and outside the closed facility; ‘Atmosphere…;’ and ‘Repression,’ which measures a negative side of ward climate encompassing perceptions of strictness and control, unfair rules and boredom, and lack of flexibility on the ward…it has yet to be determined whether and to what extent these two instruments diverge or overlap in the aspects of ward climate that they intend to measure. The main goal of the present study was to examine the psychometric properties of the EssenCES and the CGI-r, and the overlap between the instruments, in a Dutch high-secure forensic psychiatric setting” (p.248).

“A strong positive relationship was expected between the Therapeutic Hold scale of the EssenCES and the Support scale of the GCI-r, because both factors represent the quality of the relationship between patients and staff members in terms of responsiveness to patients’ needs. The Atmosphere scale of the GCI-r seems to assess elements of both the Experienced Safety and Patient Cohesion scale of the EssenCES, therefore a positive association between these scales was expected. A negative relationship was expected between the Repression scale of the GCI-r and the Therapeutic Hold scale of the EssenCES, as repression measures among other things unfair, repressive behavior by staff members. Because repression is the only aspect aimed at a negative side of ward climate, negative relationships between the Repression scale of the GCI-r and all other scales…were expected” (p.248-249).

“Bivariate correlation analyses showed that the GCI-r and the EssenCES were strongly related. As expected, a strong positive relationship was found between the Support scale of the GCI-r and the EssenCES’ Therapeutic Hold scale. Also, a strong positive relationship between the Atmosphere scale of the GCI-r and the Experienced Safety and Patient Cohesion scales of the EssenCES was found. However, it should be noted that strong correlations were found between the Atmosphere scale of the GCI-r and all the other scales (both of the EssenCES and GCI-r)…In line with our expectations, the Repression scale of the CGI-r showed strong negative relationships with all other scales (both of the EssenCES and CGI-r). The highest correlation was with the Therapeutic Hold scale of the EssenCES and the lowest with the Patient Cohesion scale of the EssenCES. This finding supports the notion that the Repression scale measures a concept reflecting the negative transactional processes (structure, power, coercion) between staff members and patients in a closed setting” (p.252).

“Our expectation that the Growth scale of the GCI-r would show relatively low correlations with the sub-scales of the EssenCES was not supported. The Growth scale of the GCI-r was strongly related to the Therapeutic Hold scale of the EssenCES. It is plausible that focusing on facilitation of learning and preparation for a meaningful life both within and outside the closed facility is an important element of therapeutic holding” (p.252)

Translating Research into Practice

“Our findings illustrate the importance of considering how instruments may differ in the definition and operationalization of ward climate. Hence, instruments used in clinical practice seem to differ in the aspects of ward climate they aim to measure and the amount of empirical support that they do so in a valid way. Nursing staff and management within the high-secure forensic setting could use the knowledge derived from this and other studies in their choices related to monitoring ward climate…The EssenCES will invite individuals to evaluate topics like safety, support, and cohesion on a group level (while taking other group members into account in their evaluation). Furthermore, the EssenCES can be used to measure how ward climate is perceived by both staff members and patients. Taking the perception of both staff and patients into account when monitoring ward climate is important, as their general perception of ward climate may differ” (p.253).

Other Interesting Tidbits for Researchers and Clinicians

“A critical note is that although both the EssenCES and the CGI-r are relatively easy to use in clinical practice, both instruments draw a simplified picture of ward climate. There are studies advocating a more in-depth definition and operationalization of ward climate. Alongside routine monitoring using short self-report measures, it has been recommended that more detailed information should be gathered by using more lengthy questionnaires, by means of focus groups, or through individual interviews with patients and staff” (p.253).

Join the Discussion

As always, please join the discussion below if you have thoughts or comments to add!

Authored by Amber Lin

Amber Lin is a volunteer in Dr. Zapf’s research lab at John Jay College of Criminal Justice. She graduated from New York University in 2013 with a B.A. (honors) and is a second year Masters student at Fairleigh Dickinson University. Her research interests include forensic assessment, competency to stand trial, and the refinement of instruments used to assess the psychological states of criminal defendants.

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