schalast / tonkin the essen cl mate evaluat on schema ... essen cl mate evaluat on schema essences...

The Essen Climate Evaluation Schema – EssenCES

Norbert SchalastMatthew Tonkin(Eds.)

Schalast / Tonkin

The E

ssen Clim

ate Evaluation Schema E

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A Manual and More

EssenCES

This document is for personal use only. Reproduction or distribution is not permitted.From N. Schalast & M. Tonkin: The Essen Climate Evaluation Schema EssenCES (ISBN 9781616764814) © 2016 Hogrefe Publishing.

The Essen Climate Evaluation Schema EssenCESA manual and more

Norbert Schalast & Matthew Tonkin (Eds.)


Library of Congress Cataloging in Publication information for the print version of this bookis available via the Library of Congress Marc Database under the Library of Congress Control Number 2015955231

Library and Archives Canada Cataloguing in PublicationThe Essen climate evaluation schema EssenCES : a manual and more

/ Norbert Schalast & Matthew Tonkin, eds.

Includes bibliographical references. Issued in print and electronic formats. ISBN 978-0-88937-481-2 (paperback).--ISBN 978-1-61676-481-4 (pdf).--ISBN 978-1-61334-481-1 (html)

1. Essen Climate Evaluation Schema (EssenCES). 2. Interpersonal relations--Testing. 3. Institutional care--Social aspects--Testing. 4. Institutional care--Psychological aspects--Testing. I. Schalast, Norbert, editor II. Tonkin, Matthew, editor HM1106.E86 2015 158.2 C2015-907185-2 C2015-907186-0

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ISBN 978-0-88937-481-2 (print) • ISBN 978-1-61676-481-4 (PDF) • ISBN 978-1-61334-481-1 (EPUB)http://doi.org/10.1027/00481-000


Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the LC Control Number 2015955231


/ Norbert Schalast & Matthew Tonkin, eds. Includes bibliographical references. Issued in print and electronic formats. ISBN 978-0-88937-481-2 (paperback).--ISBN 978-1-61676-481-4 (pdf).--ISBN 978-1-61334-481-1 (html)






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Format: PDFISBN 978-0-88937-481-2 (print) • ISBN 978-1-61676-481-4 (PDF) • ISBN 978-1-61334-481-1 (EPUB)http://doi.org/10.1027/00481-000

PrefaceDesigned as a quick and easy tool to help assess the essential traits of the social and therapeutic atmosphere in forensic psychiatric settings (subsequently expanded for use in correctional facilities), the Essen Climate Evaluation Schema (EssenCES) was originally developed and first published in Germany. It has since been trans-lated into a number of other languages and been included in a considerable number of studies, among them a broad validation study in the UK. Following this study and the UK Commissioning for Quality and Innovation (CQUIN) initiating the regular use of the scale in forensic psychiatric services in the UK, we have received a large number of enquiries regarding support in using the scale and interpreting its findings. In particular, many researchers and clinicians have requested reference norms that would allow them to compare the EssenCES scores obtained in their particular unit/service with the scores obtained in other settings.

This manual aims to respond to these enquiries. It outlines the background and the concept of the instrument and discusses the variety of ways in which the EssenCES might be used to support research and practice within forensic services. It also includes considerations regarding the limitations of previous studies that have utilised the concept of social climate and a discussion of how the contribution of climate evaluations might be further improved in the future.

Given the assumable differences between correctional (i.e., prison) settings and forensic psychiatric hospital (i.e., healthcare) settings in terms of function and resi-dent demographics (such as mental health diagnosis), the statistical norms in this volume are presented separately for each setting. The statistical norms for health-care settings are based on assessments of the social climate of 79 wards in foren-sic psychiatric hospitals (33 in the UK and 46 in Germany) made by hundreds of patients and staff. (In addition, we were able to include a data set from a current German project in calculating the normative values presented in the appendix, see p. 85) The statistical norms for correctional settings are based on data from 30 prison units (16 in the UK and 14 in Germany). Furthermore, thanks to the kind assistance of the Singapore Prison Service and Corrections Victoria, Australia, data from these countries are also presented.

While this manual presents statistical norms for the EssenCES, one may debate whether these samples are representative of the settings from which they were drawn, bearing in mind that the real sample size in social climate research is not


Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the LC Control Number 2015955231


/ Norbert Schalast & Matthew Tonkin, eds. Includes bibliographical references. Issued in print and electronic formats. ISBN 978-0-88937-481-2 (paperback).--ISBN 978-1-61676-481-4 (pdf).--ISBN 978-1-61334-481-1 (html)






SALES & DISTRIBUTIONUSA: Hogrefe Publishing, Customer Services Department, 30 Amberwood Parkway, Ashland, OH 44805

Phone (800) 228-3749, Fax (419) 281-6883; E-mail [email protected]: Hogrefe Publishing, c/o Marston Book Services Ltd., 160 Eastern Ave.,

Milton Park, Abingdon, OX14 4SB, UKPhone +44 1235 465577, Fax +44 1235 465556; E-mail [email protected]



Copyright InformationThe e-book, including all its individual chapters, is protected under international copyright law. The unauthorized use or distribution of copyrighted or proprietary content is illegal and could subject the purchaser to substantial damages. The user agrees to recognize and uphold the copyright.

License AgreementThe purchaser is granted a single, nontransferable license for the personal use of the e-book and all related files.

Making copies or printouts and storing a backup copy of the e-book on another device is permitted for private, personal use only.

Other than as stated in this License Agreement, you may not copy, print, modify, remove, delete, augment, add to, publish, transmit, sell, resell, create derivative works from, or in any way exploit any of the e-book’s content, in whole or in part, and you may not aid or permit others to do so. You shall not: (1) rent, assign, timeshare, distribute, or transfer all or part of the e-book or any rights granted by this License Agreement to any other person; (2) duplicate the e-book, except for reasonable backup copies; (3) remove any proprietary or copyright notices, digital watermarks, labels, or other marks from the e-book or its contents; (4) transfer or sublicense title to the e-book to any other party.

These conditions are also applicable to any audio or other files belonging to the e-book. Should the print edition of this book include electronic supplementary material then all this material (e.g., audio, video, pdf files) is also available in the e-book-edition.

Format: PDFISBN 978-0-88937-481-2 (print) • ISBN 978-1-61676-481-4 (PDF) • ISBN 978-1-61334-481-1 (EPUB)http://doi.org/10.1027/00481-000

The Essen Climate Evaluation Schema EssenCESvi

the number of individual patients, prisoners or staff who complete a questionnaire but the number of units/wings/wards considered. From the editors’ point of view, generating significant norms – notably for specific subgroups of institutions – is still a work in progress.

The EssenCES is used by two very different groups of professionals, whose varying interests we have considered carefully in designing this manual: the gen-eral staff of psychiatric and correctional institutions on the one hand, and academic staff and researchers familiar with psychometrics on the other hand. The manual tries to meet the needs of both groups. Most notably, Chapter 3 details the basics of handling and evaluating a questionnaire and using the EssenCES in practice, and a glossary explains statistical terms in a straightforward and accessible manner. Other chapters discuss psychometric properties, referring to a number of concepts in psychological test theory and its statistical procedures.

Whether or not to include EssenCES total scores in the manual was a mat-ter of considerable debate. In the recent literature presenting EssenCES findings, total score statistics have usually been provided. However, the original idea of the EssenCES was not to provide a single, overall measure of the social climate but, instead, to identify a small number of dimensions that would obviously be relevant to measuring and describing climate in a wide range of settings. In discussing a ward’s or institution’s climate assessment, it is better to refer to these specific pro-files than to a total score. Therefore, the manual does not provide total score statis-tics and does not encourage the use of EssenCES total scores.That said, researchers who still want to explore and discuss the significance and validity of EssenCES total scores may contact us for a compilation of total score statistics from validation studies discussed in this manual.

We hope that this manual proves useful to our readers and encourage user feed-back – we’ll be happy to receive any comments, criticism, or additional data that might help further develop the measure. Feel free to e-mail us: [email protected] or [email protected].

Norbert Schalast & Matthew Tonkin


AcknowledgmentsThe editors express their gratitude to Prof. Andrew Day and Dr. Sharon Casey, Deakin University, Australia, who communicated the data from Singapore Prison Service and Corrections Victoria, Australia, and contributed to this manual. They also thank Dr. Mark Freestone, who reviewed early drafts of this manual.


Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vAcknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Norbert Schalast & Matthew TonkinAims and Background of the EssenCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Versions of the EssenCES and Web Information . . . . . . . . . . . . . . . . . . . . . . . 2Research and Publications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Objective of This Manual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

2 Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Norbert SchalastMeasuring Social Climate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Plausibility of the EssenCES Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Are Three Dimensions Sufficient? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

3 Administration and Scoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Matthew TonkinIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Why Should the EssenCES Be Used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Who Should Complete an EssenCES Questionnaire? . . . . . . . . . . . . . . . . . . 10Is the EssenCES Questionnaire Appropriate for Everybody? . . . . . . . . . . . . 11How Should the EssenCES Be Administered to Staff and Residents? . . . . . 11How Many Completed EssenCES Questionnaires Are Needed for an Assessment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12What to Do With the EssenCES Questionnaires Once They Have Been Completed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

4 Interpretation and Feedback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Matthew Tonkin, Andrew Day, Sharon Casey, and Norbert SchalastA Description of the Normative Samples Used . . . . . . . . . . . . . . . . . . . . . . . 15Normative Statistics for the EssenCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Interpretative Guidelines for the EssenCES. . . . . . . . . . . . . . . . . . . . . . . . . . 25


The Essen Climate Evaluation Schema EssenCESx

5 Psychometric Properties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Matthew Tonkin, Andrew Day, Sharon Casey, and Norbert SchalastBasic Psychometric Properties of the EssenCES in Forensic Psychiatric Hospital Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Basic Psychometric Properties of the EssenCES in Prison Settings . . . . . . . 31Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

6 Lessons Learnt From Past Studies and Directions for Future Research. . . . . . . . . 35Norbert SchalastLimitations of Past Social Climate Research . . . . . . . . . . . . . . . . . . . . . . . . . 35The Importance of Covering Heterogeneous Conditions in a Survey . . . . . . 37Evaluating Social Climate Scores on a Ward (or Wing) Level . . . . . . . . . . . 38On Meaningful Deployment of the EssenCES in Social Climate Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Multiple Determinants of the Social Climate. . . . . . . . . . . . . . . . . . . . . . . . . 40Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

7 Fostering the Social Climate in Secure Settings . . . . . . . . . . . . . . . . . . . . . . . . . 43Norbert Schalast and Birgit VöllmResearch on Improving the Social Climate of Wards and Units . . . . . . . . . . 43Difficult Environments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Using the EssenCES Dimensions to Consider Ways of Fostering the Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Facilitating the Discussion of Ward Climate Issues . . . . . . . . . . . . . . . . . . . . 49Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

8 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

9 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Appendix Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

10 Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107


1OverviewNorbert Schalast & Matthew Tonkin

Aims and Background of the EssenCES The Essen Climate Evaluation Schema (EssenCES) is a short questionnaire, origi-nally developed for assessing essential traits of the social and therapeutic atmo-sphere of forensic psychiatric wards, which is a crucial factor for the health and well-being of both staff and patients as well as the outcome of interventions. Beginning in 1993, different sets of questionnaire items were evaluated in a series of studies. The aim was to identify independent social climate traits stable across different settings and samples. The questionnaire was intended to be shorter and more economical than the well-known Ward Atmosphere Scale (WAS; Moos, 1996; Moos & Houts, 1968), with a simpler and more stable trait structure (see Chapter 2). The outcome of this process was a 15-item instrument (with an addi-tional opening and concluding item that are not scored), that became the Essen Cli-mate Evaluation Schema (EssenCES). It measures three dimensions of the social climate:

• Therapeutic Hold• Patients’ Cohesion and Mutual Support, and • Experienced Safety (vs. the threat of aggression and violence).


The Essen Climate Evaluation Schema EssenCES2

Versions of the EssenCES and Web InformationThe EssenCES was originally developed for use in forensic psychiatric wards, i.e., hospital environments. It has since been modified for additional use in correctional and prison settings, requiring only minor adaptions of wordings (such as “wing” instead of “ward,” “inmate” instead of “patient,” etc.). For correctional settings, the climate dimensions are, respectively, labelled

• Hold and Support, • Inmates’ Cohesion, and • Experienced Safety.

Translations have further expanded the scope of EssenCES use. The instrument is now available in a number of European and non-European languages, including (but not limited to) Danish, Dutch, English, Finnish, German, and Japanese. These versions and additional information are available for download from the website of the Institute of Forensic Psychiatry in Essen, Germany (www.forensik-essen.de).

One and the same questionnaire is used for all individuals involved in the cli-mate evaluation, i.e., both staff and patients (or inmates/prisoners), facilitating the comparison of assessments by these two groups in any setting.

Research and Publications In Germany, a validation study was conducted in 2007, that included 46 wards within 17 forensic mental hospitals (Schalast, 2008; Schalast, Redies, Collins, Stacey, & Howells, 2008). Patients and staff completed the EssenCES as well as other questionnaires, among them the WAS and a Good Milieu Index (Friis, 1986; Røssberg & Friis, 2003a). Problematic occurrences (such as drug use relapses, threatening face-offs, willful damage to property, etc.) were listed and counted on each ward over a period of three weeks. The intended three-factor structure of the instrument was clearly confirmed and high correlation coefficients supported the subscales’ validity (see Chapter 5).

A comparably comprehensive study was later conducted in the UK (see Tonkin et al., 2012). Data were collected from 33 wards within forensic psychiatric hos-pitals, but also from 16 wings across 4 prison services. Findings provided further support for the instrument’s psychometric qualities (see Chapter 5).

Since these validation studies, research applying the EssenCES has grown rap-idly, partly due to the scale having been adopted by a large number of forensic healthcare services across the UK as part of the Commissioning for Quality and Innovation (CQUIN) framework, which initiated the regular use of the scale in


1. Overview 3

forensic services in the UK. A list of publications referring to EssenCES data is presented on the EssenCES website.

Objective of This ManualSince the publication of the validation study and the initiation of regular use of the scale in forensic services in the UK, the EssenCES project has received a large number of enquiries regarding support in using the scale and interpreting its find-ings. In particular, many researchers and clinicians have requested reference norms that would allow them to compare the EssenCES scores obtained in their particular unit/service with the scores obtained in other settings.

This manual tries to respond to these enquiries, as well as providing an overview of the theoretical underpinnings, structure, development, testing, and application of the EssenCES, which will be of value to both clinicians and researchers. Chapter 2 explains the conceptual/theoretical framework underpinning the EssenCES. Chap-ter 3 provides a plain and practical synopsis of points to consider when applying the questionnaire and scoring and interpreting data. Chapters 4 and 5 offer specific guidance for interpreting EssenCES data from clinical or correctional settings and explain the use of statistical norms presented in the Appendix. In Chapter 6, the manual discusses some limitations of previous studies that have utilised the con-cept of social climate and considers how the contribution of climate evaluations to providing effective mental health services might be further improved in the future. The concluding Chapter 7 presents ideas regarding the fostering of social climate conditions in institutions.Last but not least, the Appendix offers a compilation of tables to facilitate the interpretation of data and forms for displaying the findings in a simple and easy-to-understand manner.


2Conceptual FrameworkNorbert Schalast

Measuring Social ClimateIn 1993, a survey on job satisfaction and strain among the staff of forensic and general psychiatric hospitals was prepared in Germany (Schalast, 1995). To meet the study’s objective, it appeared essential to evaluate the institutional atmosphere as a crucial aspect of the working and living environment that impacts on staff and patient well-being and satisfaction as well as on the delivery of care. In characteriz-ing a correctional or treatment setting, it is not sufficient to describe only its objec-tive features. The physical, social, and emotional conditions of an institutional set-ting interact in a specific way and constitute a condition that can be called “social climate or atmosphere,” which may over time influence the mood, behavior, and self-concept of the people involved.1

In the course of research for an adequate assessment instrument, the social cli-mate scales published by Rudolf H. Moos soon became apparent as the prevail-ing gold standard for such evaluations. Moos had developed a set of scales with comparable structure and content. Among them were the Correctional Institutions Environment Scale (Moos, 1975), the Community-Oriented Programs Environ-ment Scale (Moos, 1988; Moos, Finney, & Cronkite, 1990) and the well-known

1 This definition has occasionally been ascribed to Moos (1989) but was first suggested by Scha-last and Groenewald (2009).



Ward Atmosphere Scale (WAS; Moos, 1996; Moos & Houts, 1968). He designed similar instruments to be used in schools, families, companies, and other social systems.

The WAS had been designed with considerable effort, as indicated by norms derived from a sample including 160 wards and almost 3,600 patients and 2,000 employees (Moos & Otto, 1974). Moos (1974, p. 27) stated that it had “excellent psychometric properties” with satisfactory item–subscale correlation and low to moderate subscale inter-correlation. However, Moos’ scales have been called into question frequently for a variety of reasons (e.g., Alden, 1978; Denny, Costello, & Cochran, 1984; Røssberg & Friis, 2003b; Wright & Boudouris, 1982), including that the instrument’s length and complexity (100 items measuring 10 social climate facets) are not justified by psychometric findings such as factor analysis.

Given these limitations to the WAS, Schalast (1997) drafted a concise list of 15 items characterizing facets of the work environment. Subsequent statistical item analyses identified three potential climate traits that were interpreted as “quality of the living environment,” “experienced safety,” and “feeling of success in thera-peutic work”. Encouraged by promising pilot results, additional testing of the scale was undertaken that used modified and extended lists of climate items (Schalast, 1997; Schalast, 2000; Schalast, 2008). Scale and factor analyses were used to select appropriate items and to identify climate traits that were stable across different population samples (e.g., patients and staff). A total of 43 “candidate” items were examined in the process of scale development.

Finally, a 15-item instrument emerged, measuring three climate features inter-preted as Therapeutic Hold, Patients’ Cohesion and Mutual Support, and Expe-rienced Safety, which became the EssenCES. A validation study (Schalast et al., 2008) conducted in 46 forensic psychiatric wards in Germany confirmed these subscales (see Chapters 4 and 5 for details). In subsequent studies, the EssenCES questionnaire has also been proven to reliably measure social climate in different forensic settings, with its three-trait structure receiving further support (e.g., Day, Casey, Vess, & Huisy, 2012; Howells et al., 2009; Milsom, Freestone, Duller, Bou-man, & Taylor, 2014).

With a total of 17 items – 5 per scale plus 2 filler items – the EssenCES is an easy to use and economical scale.

Plausibility of the EssenCES DimensionsWhile there is no complex theoretical background to the questionnaire’s dimen-sional structure, the three identified dimensions might be seen to possess consider-able “face validity” (Bornstein, 1996). Furthermore, there is manifold psychologi-cal evidence indicating their relevance.


2. Conceptual Framework 7

Providing a sufficient level of Therapeutic Hold and support is an essential fea-ture of any therapeutic setting and relationship. From a patient’s perspective, staff should be interested, open-minded, and supportive. Many studies provide evidence that experiencing a positive and supportive therapeutic relationship is one of the best predictors of patient treatment outcomes (Budman, Soldz, Demby, Davis, & Merry, 1993; Luborsky, McLellan, Woody, OʼBrien, & Auerbach, 1985; Martin, Garske, & Davis, 2000).

Patients’/Inmates’ Cohesion and Mutual Support may indicate whether char-acteristics of a “therapeutic community” (Rapoport, 1960) exist on a ward/wing. In group psychotherapy, patients’ cohesion is strongly associated with treatment outcome (Beech & Fordham, 1997; Budman et al., 1993) and group cohesiveness is considered a central curative factor (Yalom, 1985). Furthermore, many group-based psychological treatments aim to establish a cooperative and cohesive group climate as a decisive factor in the treatment process (Foulkes, 1975; Linehan et al., 1999; Ross & Fabiano, 1985).

Safety is thought to reflect a basic human need (Maslow, 1943). An atmosphere of aggressive tension and threat of violence is not conducive to effective treatment. “By definition, a therapeutic in-patient environment will be one where there is little or no violence and aggression” (Collins & Munroe, 2004, p. 131). On the other hand, posing a risk to others may be the rationale for psychiatric in-patient treat-ment and is a required precondition of forensic psychiatric detention. Undoubtedly, such forced collectives – composed of at-risk personalities – constitute problematic social systems. Hence, Experienced Safety can be considered a crucial dimension to characterise a therapeutic climate in both general and forensic psychiatry, as well as a rehabilitative climate in prison settings.

Are Three Dimensions Sufficient?Narrowing down the inspection to three facets of the social climate doubtless rep-resents a limitation and it might seem worthwhile to consider a greater number of social climate dimensions. On the other hand, studies exploring the dimensionality of social climate data have frequently yielded three-factor solutions (Ellinghaus, Groeneveld, Baumann, & Eckmann, 1981; Schöttke & Wiedl, 1990; Wilkinson, 1973; Wright & Boudouris, 1982). Consequently, a model of social climate that focuses on three simple, well separated facets that provide face validity and obvi-ous relevance seems appropriate. It represents a compromise in that it is sufficiently complex to recognise that social climate is not a unitary construct, and at the same time avoids being overly complex in a way that cannot be supported by statistical findings. The specific usefulness of the EssenCES dimensions for evaluating and fostering the social climate of a treatment setting is also considered in Chapter 7.


3Administration and ScoringMatthew Tonkin

IntroductionThis chapter discusses issues relating to the administration and scoring of the EssenCES. It covers why the EssenCES should be completed, who it should be given to, how many completed questionnaires are needed to gain a reliable esti-mate of social climate, how the EssenCES should be filled out, how to score the EssenCES, and how to deal with missing responses. The limitations of using the EssenCES with certain populations (e.g., those with an intellectual disability) are also discussed.

Why Should the EssenCES Be Used?The very first decision that must be made when implementing the EssenCES in practice is why the monitoring of social climate is needed. Generally speaking, there are two basic situations in which the EssenCES can be used to inform the



functioning of secure units (Tonkin & Howells, 2011). First, the EssenCES can be used to evaluate the impact of a given intervention. For example, a secure unit might adopt a new method of working that involves significant staff and resident restructuring. Alternatively, the intervention might be a particular treatment pro-gram that is designed to improve the interpersonal relationships between residents and staff. In both instances, the EssenCES can be administered before and after the intervention to determine whether any change in social climate has occurred. Thus, the EssenCES can be used as an indicator of change/treatment success.

Second, the EssenCES can be used to inform the functioning of secure units as a means of monitoring the social climate over a period of months or years (Tonkin & Howells, 2011). In this context, the EssenCES would be completed at regular inter-vals to determine whether and how the social climate of a given unit fluctuates over time. This would help to identify particular wards/wings where the climate is not conducive to the safe and successful rehabilitation of offenders (Tonkin et al., 2012). The EssenCES profile of that particular ward/wing could then be used to guide the development of interventions that are designed to improve the social climate.

Thus, the EssenCES can be completed as part of either a short-term or a long-term evaluation of secure units. That is, it can be used to monitor how safe, secure, and supported residents and staff feel within a given unit over time, or it can be used in a more targeted manner to evaluate the specific outcomes of an intervention.

Who Should Complete an EssenCES Questionnaire?Once the reason for monitoring the social climate has been determined, one of the next issues is to whom the EssenCES should be administered. To some extent (as with most of the issues discussed in this chapter), the answer depends on why the EssenCES is being used in the first place. Nevertheless, in most instances the key issue is to ensure that a variety of people with different roles within the unit complete the EssenCES because different people will have varied attitudes towards and perceptions of the “same” social climate (Britton, 1997; Wright & Saylor, 1992). This means that both residents and staff should participate in the assessment, including staff from various professional backgrounds, such as nursing, psychol-ogy, medical, and social work. This will help to ensure that a varied and balanced view of the social climate is obtained (Tonkin & Howells, 2011).

Despite the importance of diverse staff and residents completing the EssenCES, it is also vital to exclude raters who may not be able to give a reliable assessment of the social climate. Certain individuals (e.g., cleaning or secretarial staff) may not have sufficient contact with a ward/unit to offer well-founded assessments of the social climate, for example.


3. Administration and Scoring 11

Is the EssenCES Questionnaire Appropriate for Everybody?The questionnaire was designed for use with patients in forensic institutions, who frequently have little education and average or below average intelligence. There-fore, questionnaire items were developed with a view to being easy to read and understand. However, a basic level of thought and language capabilities is essential in order to provide appropriate EssenCES responses. The use of the EssenCES questionnaire (in its current form, at least) with intellectually disabled populations or with individuals who have experienced brain injury is, therefore, not recom-mended until sufficient evidence of its validity has been published. Readers who are interested in the suitability of the EssenCES for intellectually disabled individuals are referred to several recent publications (Alderman & Groucott, 2012; Milsom et al., 2014; Quinn, Thomas, & Chester, 2012).

How Should the EssenCES Be Administered to Staff and Residents?Once the decision has been made to use the EssenCES, the method of administer-ing the questionnaire needs to be addressed. For example, should the questionnaire be sent to staff/residents through the unit’s internal mail system or should they be approached in person? Should the questionnaire be handed over by someone the participants know or by someone unfamiliar to them? Again, there are no right or wrong answers to these questions, and the most appropriate approach will depend on the purpose of the monitoring, the type of residents being surveyed, and other logistical/staffing issues. It might also be helpful to keep in mind that assessments may be more realistic and valid if staff and residents participate upon invitation, rather than being pushed to do so.

However, it is important that all participants are allowed to complete the EssenCES questionnaire anonymously and confidentially. The importance of this principle is clearly highlighted by Moos (1975), who found substantial differences in the perceived social climate between participants who were allowed to respond anonymously and those who were asked to give their name. Typically, anonymous responders had a more negative perception of the climate than those who were clearly identifiable. While it is understandable that there might be pressure to obtain high EssenCES scores from managers or other policy makers, it is of paramount importance that participants are assured that they can be honest about their feelings and perceptions. If a unit does not ensure assessment anonymity and confidentiality, it may invalidate the monitoring of its social climate.



How Many Completed EssenCES Questionnaires Are Needed for an Assessment?Another important question is how many completed questionnaires are required in order to get a reliable estimate of the social climate. For an effective assess-ment, it is not necessary that all patients/inmates and members of staff partici-pate in the evaluation. In discussions of other questionnaire measures of social cli-mate, researchers have suggested that between 25% and 50% of individuals within a given unit should complete a questionnaire (Moos, 1975). For the EssenCES, it has been proposed that 7–10 completed questionnaires per ward/wing and per group (i.e., patients/staff) are necessary to provide a sufficiently reliable assessment of social climate. It must be pointed out, though, that this suggestion has not yet been fully tested. Furthermore, it does not take into account differences in ward/wing size, which would impact on the number of completed questionnaires that are needed. Therefore, the most valid recommendation at present is for administrators to obtain as many completed questionnaires as possible within the limits of time and cost. This is particularly important where the number of staff and residents on a given ward/wing is small.

What to Do With the EssenCES Questionnaires Once They Have Been Completed?Once the questionnaires have been completed they must be scored and interpreted. This section deals with the various issues that occur at this stage of an evaluation.

First, each item on the EssenCES questionnaire must be given a score ranging from 0 to 4 (see the Appendix for scoring details). With the exception of items 1 and 17, which are unscored filler items, each item on the questionnaire corresponds to one of the three EssenCES subscales (Patients’/Inmates’ Cohesion, Experienced Safety, or Therapeutic Hold/Support). There are five items per subscale. A subscale score is calculated by adding the five relevant responses, which creates a score that ranges from 0 to 20. High total scores are indicative of a positive social climate, whereas low scores indicate a negative climate.

As the EssenCES is a very short questionnaire, the problem of missing responses sometimes encountered with more extensive measures does not occur very fre-quently. However, in individual instances a participant may not provide responses to all items.There are explicit guidelines for dealing with missing responses. Pro-vided that there is no more than one response missing from each of the three sub-scales, the mean score obtained across the other four questions on that subscale can be used as a substitute for the missing value (see Box 3.1).


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