Development of a local function assessment tool: A field-based example from the peter c alderman foundation psycho-trauma clinics in northern Uganda

Background: PCAF's mission is to heal the emotional wounds of victims of terrorism and mass violence in post-conflict countries. In 2005, PCAF and the Ugandan government collaborated to deliver sustainable treatments for traumatic depression, PTSD and other mental and neurological disorders in the post-conflict, underserved North. There are no locally valid function assessment tools for trauma victims with mental disorders in northern Uganda. Aims: To develop a contextually sensitive function assessment tool for trauma victims with mental disorders attending PCAF's four psycho-trauma clinics in northern Uganda. Method: Items were derived from qualitative interviews with individuals attending Gulu and Kitgum PCAF clinics. A draft was piloted and field-tested among 514 randomly recruited attendees. Internal consistency was assessed using Cronbach‘s alpha coefficient, inter-rater reliability and test-retest reliability, using Cohen‘s kappa values, and construct validity using principle component analysis with varimax rotation. Results: The overall Cronbach‘s alpha across the clinic populations (Gulu, Kitgum, Soroti,and Arua) was 0.70. Kappa values for combined inter-rater reliability and test-retest reliability were 0.65 and 0.75 respectively. Work functioning and social functioning were the two factors of the assessment tool identified by principal component analysis. Conclusion: The locally developed functioning assessment tool is a valid and reliable measure of function among individuals with trauma-related mental disorders attending PCAF clinics in northern Uganda. We have been able to demonstrate an inverse correlation between function and symptom-loads of traumatic depression and PTSD. Also, by serially assessing function, we have been able to measure the effectiveness of several therapeutic interventions.