Evidence-based assessment/Process phase

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Process, Progress, and Outcome Phase[edit | edit source]

Overview[edit | edit source]

Measuring process, progress, and outcome helps make adjustments over the course of therapy, often improving outcomes. Process refers to ways of looking at treatment mediators, and also measures of engagement, adherence, and fidelity. Progress refers to tracking change on target measures, typically measured with more brief and frequently repeated tools than used at other assessment stages. Outcome measures can include tools with predefined benchmarks or a priori definitions of reliable improvement or worsening. All of these are described in more detail below.

Rationale[edit | edit source]

The primary goal at this phase of assessment is to improve patient outcomes.

Process Measures[edit | edit source]

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Progress Measures[edit | edit source]

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Outcome Measures[edit | edit source]

Outcome measures are tools to document progress towards major goals in treatment. In clinical trials, these are often symptom severity measures based on interviews, and the average scores are compared for groups receiving different treatments (e.g., cognitive-behavioral therapy versus antidepressant, or dialectical behavioral-therapy versus treatment as usual), or comparing the average at the end of treatment to the average at baseline.

These tests are looking at the average outcome. There usually is a wide range of individual scenarios, though. Some people get much better than typical outcomes, some do less well, and some cases may actually get worse over the course of treatment. Clinical significance is a way of looking at an individual's outcome, and deciding whether treatment produced meaningful benefit. All of the different techniques within the "clinical significance" set focus on each individual case, rather than the group average.


Here's a link to a tool that shows the reliable change index and the A, B, C benchmarks for several widely used measures with youths. It includes some interactive graphics that may help visualize the comparisons with the clinical and nonclinical groups to see where the individual case falls.

Steps to put into practice[edit | edit source]

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Ways of evaluating change

Visualization Methods[edit | edit source]

There are many ways of charting or visualizing change over time to get a sense of progress. These include line charts, dot plots, Brinley plots, and others.

Annotated bibliography[edit | edit source]


Tables and figures[edit | edit source]

Commonly Used Outcome and Process Measures[edit | edit source]

Adult Behavior Checklist (ABCL) Child Behavior Checklist (CBCL) PROMIS Pediatric Symptom Checklist (PSC)
Anorexia Nervosa
Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorder
Bipolar (adults)
Bipolar (child)
Conduct disorder
Depression (youth)
Generalized anxiety disorder
Non-suicidal self injury
Obsessive-compulsive disorder
Oppositional defiant disorder
Posttraumatic stress disorder
Schizophrenia
Simple phobia
Social anxiety disorder
Substance use disorder
Traumatic brain injury

Clinically significant change benchmarks for widely-used outcome measures[edit | edit source]

Benchmarks Based on Published Norms
Measure Subscale Cut-off scores Critical Change

(unstandardized scores)

A B C 95% 90% SEdifference
Beck Depression Inventory[1] BDI Mixed Depression 4 22 15 9 8 4.8
CBCL T-scores

(2001 Norms)

Total 49 70 58 5 4 2.4
Externalizing 49 70 58 7 6 3.4
Internalizing n/a 70 56 9 7 4.5
Attention Problems n/a 66 58 8 7 4.2
CBCL T-scores

Age 1 1/2 - 5

(2001 Norms)

Total 42.9 71.2 56.3 4.8 4.1 2.5
Externalizing 41.5 70.8 56.5 5.7 4.8 2.9
Internalizing 40.1 70.9 54.4 9.1 7.6 4.6
Attention Problems 40.0 67.3 57.1 7.6 6.4 3.9
CBCL T-scores

Age 6 - 11 (Male/Female)

(2001 Norms)

Male Total 49.1 69.3 59.2 4.5 3.8 2.3
Female Total 43.3 68.6 57.1 4.6 3.9 2.4
Male Externalizing 49.1 68.9 59.3 6.4 5.4 3.3
Female Externalizing 42.5 68.0 57.4 6.6 5.6 3.4
Male Internalizing 42.6 69.3 56.4 8.7 7.3 4.4
Female Internalizing 36.2 69.0 54.6 9.4 7.9 4.8
Male Attention Problems 45.4 65.2 58.7 7.8 6.6 4.0
Female Attention Problems 41.8 66.1 58.5 8.1 6.8 4.1
CBCL T-scores

Age 12 - 18 (Male/Female)

(2001 Norms)

Male Total 46.8 69.3 58.2 4.4 3.7 2.2
Female Total 47.0 69.3 58.3 4.5 3.8 2.3
Male Externalizing 45.8 69.4 58.1 6.4 5.4 3.3
Female Externalizing 44.0 69.0 57.4 6.5 5.5 3.3
Male Internalizing 42.2 69.6 56.6 8.4 7.1 4.3
Female Internalizing 43.9 69.2 57.3 8.5 7.1 4.3
Male Attention Problems 43.9 66.0 58.3 7.8 6.5 4.0
Female Attention Problems 43.6 65.2 58.0 7.9 6.6 4.0
TRF T-scores

(2001 Norms)

Total n/a 70 57 5 4 2.3
Externalizing n/a 70 56 6 5 3.0
Internalizing n/a 70 55 9 7 4.4
Attention Problems n/a 66 57 5 4 4.8
C-TRF T-scores

Age 1 1/2 - 5

(2001 Norms)

Total 42.9 71.2 56.3 4.8 4.1 2.5
Externalizing 41.5 70.8 56.5 5.7 4.8 2.9
Internalizing 40.1 70.9 54.4 9.1 7.6 4.6
TRF T-scores

Age 6 - 11 (Male/Female)

(2001 Norms)

Male Total 43.7 70.2 56.6 4.7 3.9 2.4
Female Total 42.1 69.8 55.8 4.7 3.9 2.4
Male Externalizing 43.4 67.9 56.9 5.1 4.3 2.6
Female Externalizing 37.8 67.7 54.5 5.9 5.0 3.0
Male Internalizing 36.8 69.9 54.5 8.9 7.5 4.6
Female Internalizing 36.8 70.1 53.9 8.7 7.3 4.4
Male Attention Problems 44.3 66.2 57.1 4.4 3.7 2.3
Female Attention Problems 43.2 65.8 57.3 4.6 3.9 2.4
TRF T-scores

Age 12 - 18 (Male/Female)

(2001 Norms)

Male Total 46.1 70.4 57.2 4.4 3.7 2.3
Female Total 47.5 70.3 58.0 4.5 3.7 2.3
Male Externalizing 45.3 68.5 57.9 5.2 4.3 2.6
Female Externalizing 41.7 68.1 56.2 5.9 4.9 3.0
Male Internalizing 41.6 69.4 55.5 8.2 6.9 4.2
Female Internalizing 41.8 69.0 55.8 8.2 6.9 4.2
Male Attention Problems 43.2 67.6 57.1 4.7 4.0 2.4
Female Attention Problems 45.5 66.8 58.1 4.6 3.9 2.4
YSR T-scores

(2001 Norms)

Total n/a 70 54 7 6 3.3
Externalizing n/a 70 54 9 8 4.6
Internalizing n/a 70 54 9 8 4.8
YSR T-scores

Age 11 - 18

(2001 Norms)

Male Total 35.3 69.8 54.0 6.7 5.6 3.4
Female Total 36.8 69.8 54.1 6.4 5.4 3.3
Male Externalizing 38.3 69.3 54.6 8.9 7.5 4.6
Female Externalizing 35.7 70.2 53.8 9.2 7.8 4.7
Male Internalizing 32.7 69.9 53.2 9.6 8.1 4.9
Female Internalizing 35.6 70.2 53.8 9.3 7.8 4.8
Male Attention Problems 38.6 67.1 56.6 10.5 8.8 5.3
Female Attention Problems 39.8 65.8 56.2 9.5 8.0 4.8
Benchmarks Based on Published Norms (Raw Scores)
Benchmarks Based on Published Norms
Measures Subscale Cut-off scores Critical Change

(unstandardized scores)

A B C 95% 90% SEdifference

References[edit | edit source]