Evidence based assessment/Process phase

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Process, Progress, and Outcome Phase[edit]

Overview[edit]

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]

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

Process Measures[edit]

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Progress Measures[edit]

Blah

Outcome Measures[edit]

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]

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Ways of evaluating change

Visualization Methods[edit]

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]


Tables and figures[edit]

Commonly Used Outcome and Process Measures[edit]

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]

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
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
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

References[edit]