ORIGINAL PAPER Measuring Difficult-to-Measure Concepts in Clinical Social Work Practice Operationalizing Psychosocial Well-Being Among War-Affected Women: A Case Study in Northern Uganda Martha Bragin • Janepher Taaka • Kelsey Adolphs • Hannah Gray • Tonka Eibs Ó Springer Science+Business Media New York 2014 Abstract This article addresses the question of how to define, operationalize, and measure psychological and social well-being. Well-being is a concept central to suc- cessful outcomes in clinical social work practice, and its promotion is a goal of the profession, yet it is rarely taken into account when we develop evidence-based practices. The complexity of the construct has led to it being described in the literature as ‘‘unmeasurable’’ (Corlazzoli and White in Measuring the un-measurable: solutions to measurement challenges in fragile and conflict-affected environments. Department for International Development (DFID), London, 2013). This article describes and dis- cusses a participatory study of 649 conflict-affected women in a post-conflict region of Northern Uganda that used grounded theory to define and operationalize this concept from the standpoint of women program participants for the purpose of future monitoring and evaluation. The results indicated that poor and often marginalized conflict-affected women were able to envision, articulate, and describe their future well-being, with implications for other populations experiencing severe adversity. The study resulted in the development of a practical method to evaluate the effec- tiveness of future programs from the standpoint of program participants. Keywords Hard-to-measure concepts Á Psychosocial well-being Á Post-conflict Á Women Á Participatory research Á Northern Uganda Á Trauma Introduction The end goal of professional social work is the promo- tion of human and community well-being, regardless of method, area of expertise, or target population (CSWE (Council on Social Work Education) 2008). But what do we mean by human and community well-being? How do we and our clients understand these concepts? Are they just rhetoric for social work journals, or can we actually use them to measure the effectiveness of clinical social work programs for populations in need of the diagnosis, treat- ment and prevention of psychosocial dysfunction, the pri- mary purpose of clinical social work practice? In the following study, we hear how a group of women in the Acholi Sub-Region of Northern Uganda explain their own understanding of the term ‘‘psychosocial well-being’’ as aspects of human and community well-being and use it to evaluate the efforts of clinicians to improve their well- being after surviving the effects of a long and brutal war. While comprehensive community-based psychosocial interventions are now widely recommended for survivors of traumatogenic situations such as these (Hobfoll et al. 2007; IASC 2007), evidence supporting their effectiveness of remains sparse (Tol and van Ommeren 2012). Opera- tionalizing what we mean by psychological and social well-being in personal, social and cultural context is The full study, To be well at heart: Conflict-affected women’s perceptions of well-being: A participatory study in Burundi, Nepal, and Northern Uganda is available at http://care.at/expert/coe- resources/psychosocial. M. Bragin (&) Á K. Adolphs Á H. Gray Silberman School of Social Work at Hunter College, CUNY, 2180 3rd Ave., New York, NY 10035, USA e-mail: marthabragin@verizon.net J. Taaka Dan Church Aid, Kampala, Uganda T. Eibs UNICEF, Pristina, Kosovo 123 Clin Soc Work J DOI 10.1007/s10615-014-0507-0 Author's personal copy