Ward Behavior Rating Scale (WBRS)

Abstract

The Ward Behavior Rating Scale (WBRS) is a comprehensive behavioral assessment instrument developed in 1960 by Burdock, Hardesty, Hakerem, and Zubin. Comprising 150 items, the WBRS was designed primarily to quantify the observable severity of mental illness and to serve as a reliable index for evaluating patient response to various forms of treatment within institutional settings.

The scale is applicable across diverse patient populations, including both newly admitted individuals and long-term, chronic residents of mental hospitals. Raters, typically nurses or attendants, evaluate behaviors based on a simple dichotomous response format: “T” (True) if the patient exhibits the behavior, or “NT” (Not True) if the behavior is absent. The items cover a broad spectrum of observable clinical phenomena, such as facial expressions, general grooming, physical status, level of cooperativeness, communication patterns, speech characteristics, interpersonal relations, and overall affect. Item selection was rigorously informed by existing psychopathology literature and extensive consultation with mental health professionals.

Keywords

Ward Behavior Rating Scale, WBRS, Mental Illness Severity, Treatment Response, Behavioral Rating Scale, Interrater Reliability, Internal Consistency, Criterion Validity, Hospitalized Patients.

Authors

Burdock, E. I., Hardesty, A. S., Hakerem, G., Zubin, J.

Purpose

The core purpose of the Ward Behavior Rating Scale (WBRS) is twofold. First, it functions as a standardized behavioral instrument for objectively assessing the current severity of illness in institutionalized mental patients. By focusing on 150 specific, observable behaviors, the scale provides a quantitative measure of patient functioning within the ward environment.

Second, and equally important, the WBRS was designed to serve as a critical index for evaluating the efficacy of treatment programs. By measuring behavioral changes over time, clinicians and researchers can utilize the WBRS scores to determine the response of both new admissions and long-term residents to pharmacological, psychological, or environmental interventions.

Construct

The primary psychological construct measured by the WBRS is Mental Illness Severity, as manifested through observable behavior within a hospital setting. This construct is operationalized across various domains of patient functioning, which include but are not limited to:

• Physical and Self-Care Status: Grooming, physical state, and general appearance.
• Social and Interpersonal Functioning: Cooperativeness, communication skills, and quality of interpersonal relations.
• Affective and Expressive Behavior: Observable facial expressions and overall emotional affect.
• Cognitive and Motor Functioning: Speech patterns and general motoric activity.

The scale aims to capture the totality of manifest psychopathology in a systematic way, allowing for consistent measurement across different raters and time points.

Validity

Initial studies established the validity of the WBRS primarily through measures of Criterion Validity. This form of validation demonstrated the scale’s ability to correlate with, or distinguish between, groups based on an external criterion (treatment outcome).

Specifically, the WBRS exhibited significant criterion validity by successfully distinguishing between a group of female geriatric patients who received active drug treatment and a carefully matched placebo control group. This distinction was statistically significant at the 0.05 level, confirming the scale’s sensitivity to clinically meaningful changes resulting from therapeutic intervention.

Reliability

The reliability of the WBRS was investigated using standard psychometric methods, demonstrating strong consistency across both raters and items.

• Interrater Reliability: An intra-class correlation coefficient (ICC) of 0.67 was reported. This value was derived from a one-way analysis of variance applied to paired ratings collected from 107 patients at the New York Psychiatric Institute, indicating acceptable consistency between different observers scoring the same patient.
• Internal Consistency: The scale demonstrated exceptionally high internal consistency, yielding a coefficient of 0.95. This finding was calculated using Hoyt’s model for a two-way analysis of variance on a substantial sample of 177 protocols obtained from multiple state hospitals, suggesting that the 150 items measure a unified underlying construct.

Factor Analysis

Information regarding the explicit factor structure or factor analysis of the Ward Behavior Rating Scale (WBRS) was not provided in the source documentation. While the scale’s high internal consistency suggests a strong underlying dimension related to Mental Illness Severity, detailed reports on subscales or latent factors are unavailable based on the provided material.

Instrument

Test Type: Rating Scale

Format: Paper-based test

Language Available: English (Original) – Location of development: United States

Population Group: Adult males and females with mental health conditions, including both new admissions and chronic residents in mental hospitals.

Age Group: Adulthood (18 years & older)

Population Details: The scale is specifically designed for use in inpatient psychiatric settings, requiring observations by trained ward staff (nurses and attendants).

Test Methodology: The test is a 150-item behavioral checklist where raters mark “T” (True) or “NT” (Not True) based on observable patient behavior. The development included rigorous initial testing for item clarity and specificity by nursing staff. Validation included assessments of test reliability (interrater, internal consistency) and test validity (criterion).

Keywords

Ward Behavior Rating Scale, WBRS, Behavioral Assessment, Psychiatric Inpatients, Psychopathology, Inter-Rater Agreement, Hoyt’s Model, Clinical Psychology, 1960.

Authors

Author ORCID Identifier: Information not available in source content.

Affiliation Email addresses: Information not available in source content.

Correspondence Address: Information not available in source content.

Permissions & Fee and Test Year

The Ward Behavior Rating Scale (WBRS) was initially published in 1960. Information regarding current permissions, licensing fees, and accessibility for clinical or research use is not provided in the original source documentation. Users should consult the original publishers or authors’ estates for current usage rights.

Reference’s

• Burdock, E. I., Hardesty, A. S., Hakerem, G., & Zubin, J. (1960). A ward behavior rating scale for mental hospital patients. Journal of Clinical Psychology, 16, 246–247. https://doi.org/10.1002/1097-4679(196007)16:3<246::AID-JCLP2270160306>3.0.CO;2-Y

Items of the Ward Behavior Rating Scale (WBRS)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The source content did not provide the specific list of the 150 items comprising the Ward Behavior Rating Scale (WBRS). The scale includes items related to observable behaviors such as facial expressions, grooming, physical status, cooperativeness, communication, speech patterns, interpersonal relations, and affect.