Evidence-based assessment/Process phase
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| EBA Implementation |
|---|
| Assessment phases |
| Steps 1-2: Preparation phase |
| Steps 3-5: Prediction phase |
| Steps 6-9: Prescription phase |
| Steps 10-12: Process/progress/outcome phase |
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]Progress Measures
[edit | edit source]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]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]Clinically significant change benchmarks for widely-used outcome measures
[edit | edit source]- Click here for a set of slides explaining clinically significant change: Improving Diagnosis & Documenting Clinically Significant Change
- More research on clinically significant change: Establishing Clinical Significance Benchmarks and Minimally Important Difference for 17 Measures
| Benchmarks Based on Published Norms | ||||||||
| Measure | Subscale | Cut-off scores | Critical Change
(unstandardized scores) |
MID (d 0.5) | ||||
| A | B | C | 95% | 90% | SEdifference | |||
| Beck Depression Inventory[1] | BDI Mixed Depression | 4 | 22 | 15 | 9 | 8 | 4.8 | 3.4 |
| 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 | 4.1 |
| Externalizing | 41.5 | 70.8 | 56.5 | 5.7 | 4.8 | 2.9 | 4.8 | |
| Internalizing | 40.1 | 70.9 | 54.4 | 9.1 | 7.6 | 4.6 | 7.6 | |
| Attention Problems | 40.0 | 67.3 | 57.1 | 7.6 | 6.4 | 3.9 | 6.4 | |
| CBCL T-scores
Age 6 - 11 (Male/Female) (2001 Norms) |
Male Total | 49.1 | 69.3 | 59.2 | 4.5 | 3.8 | 2.3 | 4.7 |
| Female Total | 43.3 | 68.6 | 57.1 | 4.6 | 3.9 | 2.4 | 4.9 | |
| Male Externalizing | 49.1 | 68.9 | 59.3 | 6.4 | 5.4 | 3.3 | 4.7 | |
| Female Externalizing | 42.5 | 68.0 | 57.4 | 6.6 | 5.6 | 3.4 | 5.0 | |
| Male Internalizing | 42.6 | 69.3 | 56.4 | 8.7 | 7.3 | 4.4 | 5.0 | |
| Female Internalizing | 36.2 | 69.0 | 54.6 | 9.4 | 7.9 | 4.8 | 5.5 | |
| Male Attention Problems | 45.4 | 65.2 | 58.7 | 7.8 | 6.6 | 4.0 | 6.6 | |
| Female Attention Problems | 41.8 | 66.1 | 58.5 | 8.1 | 6.8 | 4.1 | 6.8 | |
| CBCL T-scores
Age 12 - 18 (Male/Female) (2001 Norms) |
Male Total | 46.8 | 69.3 | 58.2 | 4.4 | 3.7 | 2.2 | 4.6 |
| Female Total | 47.0 | 69.3 | 58.3 | 4.5 | 3.8 | 2.3 | 4.7 | |
| Male Externalizing | 45.8 | 69.4 | 58.1 | 6.4 | 5.4 | 3.3 | 4.8 | |
| Female Externalizing | 44.0 | 69.0 | 57.4 | 6.5 | 5.5 | 3.3 | 4.8 | |
| Male Internalizing | 42.2 | 69.6 | 56.6 | 8.4 | 7.1 | 4.3 | 4.8 | |
| Female Internalizing | 43.9 | 69.2 | 57.3 | 8.5 | 7.1 | 4.3 | 4.9 | |
| Male Attention Problems | 43.9 | 66.0 | 58.3 | 7.8 | 6.5 | 4.0 | 6.5 | |
| Female Attention Problems | 43.6 | 65.2 | 58.0 | 7.9 | 6.6 | 4.0 | 6.6 | |
| 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 | 3.9 |
| Female Total | 42.1 | 69.8 | 55.8 | 4.7 | 3.9 | 2.4 | 3.9 | |
| Male Externalizing | 43.4 | 67.9 | 56.9 | 5.1 | 4.3 | 2.6 | 4.3 | |
| Female Externalizing | 37.8 | 67.7 | 54.5 | 5.9 | 5.0 | 3.0 | 5.0 | |
| Male Internalizing | 36.8 | 69.9 | 54.5 | 8.9 | 7.5 | 4.6 | 7.5 | |
| Female Internalizing | 36.8 | 70.1 | 53.9 | 8.7 | 7.3 | 4.4 | 7.3 | |
| Male Attention Problems | 44.3 | 66.2 | 57.1 | 4.4 | 3.7 | 2.3 | 3.7 | |
| Female Attention Problems | 43.2 | 65.8 | 57.3 | 4.6 | 3.9 | 2.4 | 3.9 | |
| TRF T-scores
Age 12 - 18 (Male/Female) (2001 Norms) |
Male Total | 46.1 | 70.4 | 57.2 | 4.4 | 3.7 | 2.3 | 3.7 |
| Female Total | 47.5 | 70.3 | 58.0 | 4.5 | 3.7 | 2.3 | 3.7 | |
| Male Externalizing | 45.3 | 68.5 | 57.9 | 5.2 | 4.3 | 2.6 | 4.3 | |
| Female Externalizing | 41.7 | 68.1 | 56.2 | 5.9 | 4.9 | 3.0 | 4.9 | |
| Male Internalizing | 41.6 | 69.4 | 55.5 | 8.2 | 6.9 | 4.2 | 6.9 | |
| Female Internalizing | 41.8 | 69.0 | 55.8 | 8.2 | 6.9 | 4.2 | 6.9 | |
| Male Attention Problems | 43.2 | 67.6 | 57.1 | 4.7 | 4.0 | 2.4 | 4.0 | |
| Female Attention Problems | 45.5 | 66.8 | 58.1 | 4.6 | 3.9 | 2.4 | 3.9 | |
| 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 | 5.6 |
| Female Total | 36.8 | 69.8 | 54.1 | 6.4 | 5.4 | 3.3 | 5.4 | |
| Male Externalizing | 38.3 | 69.3 | 54.6 | 8.9 | 7.5 | 4.6 | 7.5 | |
| Female Externalizing | 35.7 | 70.2 | 53.8 | 9.2 | 7.8 | 4.7 | 7.8 | |
| Male Internalizing | 32.7 | 69.9 | 53.2 | 9.6 | 8.1 | 4.9 | 8.1 | |
| Female Internalizing | 35.6 | 70.2 | 53.8 | 9.3 | 7.8 | 4.8 | 7.8 | |
| Male Attention Problems | 38.6 | 67.1 | 56.6 | 10.5 | 8.8 | 5.3 | 8.8 | |
| Female Attention Problems | 39.8 | 65.8 | 56.2 | 9.5 | 8.0 | 4.8 | 8.0 | |
| Benchmarks Based on Published Norms | ||||||||
| Measures | Subscale | Age | Cut-off scores | Critical Change
(unstandardized scores) | ||||
| A | B | C | 95% | 90% | SEdifference | |||
| CBCL (Raw Scores) | Total | Male 6-11 | 3.8 | 57.1 | 39 | 11.1 | 9.3 | 5.7 |
| Male 12-17 | 1.7 | 63 | 40 | 11.6 | 9.8 | 5.9 | ||
| Female 6-11 | - | 55.1 | 35 | 10.7 | 9 | 5.5 | ||
| Female 12-17 | - | 58.2 | 37 | 11.6 | 9.7 | 5.9 | ||
| TRF (Raw Scores) | Total | Male 6-11 | - | 70.1 | 38 | 13 | 11 | 6.6 |
| Male 12-17 | - | 75.4 | 40 | 14 | 11.8 | 7.2 | ||
| Female 6-11 | - | 55.1 | 27 | 11.7 | 9.9 | 6 | ||
| Female 12-17 | - | 54.6 | 29 | 12 | 10.1 | 6.1 | ||
| YSR (Raw Scores) | Total | Male 11-18 | - | 113 | 54 | 18.3 | 15.4 | 9.3 |
| Female 11-18 | 1 | 117 | 59 | 18 | 15.2 | 9.2 | ||
| Beck Depression Inventory | Mixed Depression | 13-80 | 4 | 22 | 15 | 9 | 8 | 4.8 |
| PGBI-10M | Total | 5-18 | 1 | 9 | 6 | 6 | 5 | 3.2 |
| CMRS 10 | Total | 5-18 | -- | 6 | 4 | 5 | 4 | 2.3 |
| PGBI-10Da | Total | 5-18 | -- | 7 | 4 | 6 | 5 | 3.0 |
| PGBI-10Db | Total | 5-18 | -- | 7 | 4 | 6 | 5 | 2.9 |
| AGBI-10M | Total | 11-90 | -- | 14 | 7 | 6 | 5 | 3.1 |
| AGBI-10Da | Total | 11-90 | -- | 18 | 7 | 6 | 5 | 3.2 |
| AGBI-10Db | Total | 11-90 | -- | 16 | 7 | 6 | 5 | 2.9 |
| 7 Up | Total | 11-90 | -- | 8 | 4 | 4 | 4 | 2.2 |
| 7 Down | Total | 11-90 | -- | 12 | 5 | 5 | 4 | 2.3 |
| KMRS | Total | 5-18 | 19 | 19 | 19 | 3 | 3 | 1.6 |
| KDRS | Total | 5-18 | 12 | 19 | 18 | 5 | 4 | 2.4 |
| CDRS-R Total | Total | 5-18+ | -- | 24 | 22 | 6 | 5 | 2.9 |
| YMRS Total | Total | 5-90 | 4 | 3 | 3 | 3 | 3 | 1.8 |
| Measure | Disorder | Subscale | Cut-off scores | Critical Change (Unstandardized scores) | MID (d .5) | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| Acronym | Full Name | A | B | C | 95% | 90% | SE Difference | |||
| 7PS | 7-Item Psychosis Screener | Psychosis | ||||||||
| AAQ-II | Acceptance and Action Questionnaire-II | |||||||||
| A-ASWS | Abbreviated Adolescent Sleep Wake Scale | Going to Bed, Falling Asleep, Maintaining Sleep, Reinitiating Sleep, and Returning to Wakefulness | ||||||||
| AQ-10 | Autism Spectrum Quotient | Autism | ||||||||
| ASQ | Ask Suicide-Screening Questions | |||||||||
| BCMRS | Brief Child Mania Rating Scale | Mania | ||||||||
| BFCRS | Bush-Francis Catatonia Rating Scale | Catatonia | ||||||||
| CAST | Childhood Autism Spectrum Test | Autism | ||||||||
| CHRT | Concise Health Risk Tracking Scale | |||||||||
| CRAFFT + N | Car, Relax, Alone, Forget, Friends, Trouble | |||||||||
| EDS | Everyday Discrimination Scale (Short Version) | |||||||||
| FAD | Family Assessment Device | |||||||||
| FIRM | Family Index of Risk for Mood | |||||||||
| GAD-7 | Generalized Anxiety Disorder-7 | Anxiety | ||||||||
| HHS | Healthy Habits Survey | |||||||||
| HSQ | Home Situations Questionnaire | |||||||||
| PHQ-8 | Patient Health Questionnaire - 8 items | Depression | ||||||||
| PSC-17 | Pediatric Symptom Checklist | Attention, Externalizing, Internalizing | ||||||||
| PAM | Physical Activity Monitoring | |||||||||
| SCARED | Screen for Child Anxiety Related Emotional Disorders | Anxiety | ||||||||
| SCOFF | make self Sick, loss of Control, One-month weight loss, believe am Fat, and Food dominates life | |||||||||
| SMFQ | Short Mood and Feelings Questionnaire | |||||||||
| SOCS | Short Obsessive-Compulsive Disorder Screener | OCD | ||||||||
| VADPRS | Vanderbilt ADHD Diagnostic Parent Rating Scale | ADHD | ||||||||
| VADTRS | Vanderbilt ADHD Diagnostic Teacher Rating Scale | ADHD | ||||||||
| YP-CORE | Young Person's Clinical Outcomes in Routine Evaluation | |||||||||
Will be updated as RISE internship continues!
References
[edit | edit source]- ↑ Beck, AT (1988). "Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.". Clinical Psychology Review 8 (1). http://www.sciencedirect.com/science/article/pii/0272735888900505. Retrieved 10 February 2014.