A further issue is that of reactivity, which is the change in behaviour due to the patient's awareness of the presence of an observer. Reactivity factors may be reduced by making the observation procedure as minimally intrusiveness as possible (by, for example, careful siting of the observer). There is a debate about the ethical acceptability of completely unobtrusive measures where the patient is unaware of being assessed, since then the patient cannot give informed consent to the procedure. When a patient presents a serious risk of self-harm then some level of close observation may often be imposed without consent. Both these issues may be addressed by training the observers before the clinical use of the measure. Any live observer will induce some reactivity effects, and this issue is often totally ignored. However, the advent of computerized assessment procedures means that many measures, including behavioural ones, can be administered in this way, and the evidence is that they are well accepted.(7)

There are also a number of other practical factors to bear in mind. In general, shorter measures are preferred to longer ones. Coding categories should be simple enough to be entered quickly. When continuous observation is used, especially for high rates of behaviour, the observer must be allowed regular rest periods.

Materials should be written at a level of vocabulary simple enough for the lowest level of educational attainment likely to be encountered by observers.

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