Development and content validity of the behavioral assessment screening tool (BAST β )

Shannon B. Juengst, Lauren Terhorst, Brad E. Dicianno, Janet P. Niemeier, Amy K. Wagner

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Purpose: Develop and establish the content validity of the Behavioral Assessment Screening Tool (BAST β ), a self-reported measure of behavioral and emotional symptoms after traumatic brain injury. Methods: This was an assessment development study, including two focus groups of individuals with traumatic brain injury (n = 11) and their family members (n = 10) and an expert panel evaluation of content validity by experts in traumatic brain injury rehabilitation (n = 7). We developed and assessed the Content Validity Index of the BAST β . Results: The BAST β initial items (n = 77) corresponded with an established conceptual model of behavioral dysregulation after traumatic brain injury. After expert panel evaluation and focus group feedback, the final BAST β included 66 items (60 primary, 6 branching logic) rated on a three-level ordinal scale (Never, Sometimes, Always) with reference to the past two weeks, and an Environmental Context checklist including recent major life events (n = 23) and four open-ended questions about environmental factors. The BAST β had a high Content Validity Index of 89.3%. Conclusion: The BAST β is a theoretically grounded, multidimensional self-reported assessment of behavioral dysregulation after traumatic brain injury, with good content validity. Future translation into mobile health modalities could improve effectiveness and efficiency of long-term symptom monitoring post-traumatic brain injury. Future work will establish and validate the factor structure, internal consistency reliabilities and other validities of the BAST.Implications for Rehabilitation Behavioral problems after traumatic brain injury is one of the strongest contributing factors to poor mood and community integration outcomes after injury. Behavior is complex and multidimensional, making it a challenge to measure and to monitor long term. The Behavioral Assessment Screening Tool (BAST) is a patient-oriented outcome assessment developed in collaboration with individuals with traumatic brain injury, their care partners, and experts in the field of traumatic brain injury rehabilitation to be relevant and accessible for adults with traumatic brain injuries. The BAST is a long-term monitoring and screening tool for community-dwelling adults with traumatic brain injuries, to improve identification and management of behavioral and emotional sequelae.

Original languageEnglish (US)
Pages (from-to)1200-1206
Number of pages7
JournalDisability and Rehabilitation
Issue number10
StatePublished - May 8 2019


  • Traumatic brain injury
  • behavior
  • emotions
  • measurement
  • psychometrics

ASJC Scopus subject areas

  • Rehabilitation


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