ChGK in the Prairie

Chapter 8: Angry Protocol

The next day at work, Patricia comes to a grim realization. The bosses of the hospital consulted with the patients and their families because the medical staff didn't agree with the logistics of implementing the protocol. Mostly on how it should be triggered, and what steps to take. Some people wanted nothing to do with it because they feel it's not a matter of mental health. Others didn't agree on who should be exempt, even if they mostly agreed on the criteria, namely that screening for educational issues shouldn't take place until the patients recovered sufficient mental health. The deadline for test providers to submit bids is fast approaching and we need one last member on the selection committee. Quick! I'll circulate a memo about who should be on it! Patricia muses, while reviewing the criteria.

The primary criterion is, of course, that the final committee member should have a working knowledge of psychometric testing and continuing education. On which she admits her knowledge is a little shallow.

Because the main criteria of the request for proposal was that the test would test for functional literacy and numeracy, use computerized adaptive technology, have a high level of reliability, can be partially administered and be billed on a per-administration basis. Beyond that, she wanted the process to be done in good faith, but couldn't tell which test would be more appropriate for the pursuit of continuing education.

At lunch, one of the inpatient rehab counselors running the financial literacy training workshop approaches her:

"Hi Patricia. My name is Deepak, and, although I personally believe this protocol of yours to be deeply flawed..."

"What makes it flawed to you?" Patricia asks Deepak, a little defensively.

"It's as if you were clueless about how people worked. If you knew people better, you would know how to pick out the sort of weaknesses you're looking for without having to administer that kind of screening tests" Deepak retorts to her.

"I get it, Deepak; however, not everyone in the medical staff can do so at the same extent as you do. And I found that too subjective as well. For instance, all I can make out of the trauma aspect is that understanding the personal circumstances of the patient is key to resolve it. Beyond that, I am of no use" Patricia retorts, knowing that she would not be a good counselor or therapist.

What Patricia referred to as "too subjective" is called, in the world of psychometrics, low inter-rater reliability. IRR is about how much the results of a test will be consistent when administered by different people. As for computerized adaptive testing, it promises high IRR while, at the same time, allow for higher sensitivity and specificity. It also makes the difficulty of the next set of test questions go up or down based on the results of the previous set.

"I help run the financial literacy workshop believing it would help my career somehow. In the past, these kinds of issues flew under the radar and then some families filed complaints. But what makes you think that..." Deepak pauses and he catches his breath. "Directing patients to specific continuing education resources would be in the patients' best interests?"

"The initial protocol called for exemption from screening based on some educational attainment benchmarks. Then the patients and their families forced our hands, and so the final version calls for medical personnel to notify the patient and family first, and later ask the patient's approval prior to testing" Patricia rambles on the changes made. "What's in their best interest is ensuring they have adequate education: we have all seen what challenges patients face once rehab ends. So I'll ask this once: is there anyone else you know who would know better about continuing education?"

To this, Deepak draws a blank. He seems a little skeptical not of continuing education per se, or even of whether it can help recovering addicts, but of something else surrounding the aims of continuing education. Ainslee? She's too close to Patricia, because she's also part of the Congressional debate club. Preferably staff who deals with the later stages of rehab; they historically played had more of a hand in addicts' continuing education. Who's left that has a working knowledge of such? Deepak reflects on who he could ask to serve on this committee in his stead.