Talk:Evidence-based assessment/Preparation phase

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Hi, gang,

Great discussion questions below!

Here are some things that you guys could do to upgrade this page: Where I pasted in text, there are citations and a reference list in APA Style. Please go ahead and replace those with Wiki citations (I included most of the DOIs). Then see if you can link to a free copy of the article via PubMed; if not, just include a link to the abstract.

Thanks! Eyoungstrom (discuss • contribs) 15:34, 12 February 2017 (UTC)

Rachael Kang's question: Assessment thresholds

I really liked this reading! The dichotomy between Jane and Joe's approach to clinical work was clear, but not cheesy or fiction-like. One thought that kept occurring to me, though, was that Jane seemed to be putting in more effort than Joe at every phase. I don't think it's fair to say that Joe didn't do any work or put in any effort with his clients, but, in comparison, Jane put in the extra hours to create a "cheat sheet" of assessments, disorder prevalence rates, AUCs, etc... Creating this cheat sheet also helped her keep up with the current research on each disorder.

Interesting observation! I agree that it is more work for Jane to get set up. She'll be more accurate and efficient as a result of the installation, though. Something that this makes me wonder -- what if Jane could use a set of web resources as a starter toolkit? If there were a set of pages that gathered base rates, had links to copies of the measures, and pulled together the key information about interpretation so that there was a handy-dandy online "cheat sheet," then Jane wouldn't need to start from scratch. She'd be able to keep using the same online resources, whether she was in grad school, internship, or at a new clinic. If only.... ;-) Eyoungstrom (discuss • contribs) 15:51, 12 February 2017 (UTC)

One clarifying question I had was what the Wait-Test and Test-Treat thresholds were talked about on page 11, and how they related to guiding clinical action? Are they supposed to be thresholds like "this person is right around the cut-off score, so let's wait and see" or "wow, this person is 15 points above the cut-off, let's treat him now"?

   And one question that I thought of to just ponder about was in what ways can we as undergrads and grads going into the field of psychology do in order to further the utilization of EBA and EBP in psychology? 

--Rkang101 (discuss • contribs) 04:03, 1 February 2017 (UTC)

Regarding the Wait/Test and Test/Treat thresholds, they are guidelines for treatment/testing (hence Test/Treat) and waiting to see if symptoms develop/further testing (hence Wait/Test). Do note that those thresholds change depending on disorder.

As with doing more... definitely look into better methods of dissemination (app, Wikipedia, social media?). Also, the stronger your understanding in psychometrics (i.e. ROC party, differential item functioning, etc), the better! Ongmianli (discuss • contribs) 19:02, 3 February 2017 (UTC)

Hannah Lucero's question: Probability nomogram

One question I had after reading this was about Jane's preparation method of using the probability nomogram. This is a tool that I was completely unfamiliar with however after looking at the Figure and re-reading the sections where she explains it, I am still unsure as to how it works. I understand that it improves accuracy and consistency compared to clinical judgement, however I just don't understand the logistics of it. I guess my question would simply be, could someone clarify this for me? --Hjlucero (discuss • contribs) 01:27, 1 February 2017 (UTC)

We can talk about this briefly, but essentially...

• the leftmost column are prior probabilities (e.g., what is the incidence of bipolar disorder in my hospital in New York State?)
• the center column are diagnostic likelihood ratios (DLRs). These ratios are one of the things that you will do for your ROC paper. It essentially is a ratio.
• the rightmost column is a post-likelihood probability.

Then, you will draw a line between prior probability and DLR to obtain the posterior probability. Ongmianli (discuss • contribs) 19:09, 3 February 2017 (UTC)

A probability nomogram is a chart that lets people update a starting probability based on new information. It uses geometry to turn a series of algebra transformations into a "connect the dots" method. You can see that the spacing between the numbers on all three lines is not linear -- that's where the geometric magic is happening. In theory, you could have nomograms set up to do various different computations. If you go to the Wikipedia page about them, there are a bunch of examples from fields outside of medicine and psychology. Technically, the version that we are using is a "probability nomogram." Mian is right, the connection between ROC and the nomogram will become more clear as you learn more about ROC analyses and the diagnostic likelihood ratio (DLR) in particular. I have seen some cool online interactive versions of nomograms. We can look for some links and drop them in here and on the nomogram pages in the EBA Wikiversity.

Eyoungstrom (discuss • contribs) 15:59, 12 February 2017 (UTC)

Kenny's question: ROC/Visual example

I think something about the fluidity of Jane's preparation for clients, such as switching older, less pertinent measures for newer, more relevant ones, exemplified evidence-based practice in a reassuring way. Reading about how Joe doesn't do much consideration past his battery test and the initial session was concerning. An theoretical issue I can see with applying EBP to more clinics is that discrepancy in practice; for example, Joe mentioned he was still using the BASC and others were using the SDQ. Would this foreshadow a rather slow ripple effect in adopting possibly better validated measures, even if EBP becomes more popular? Or would these measures quickly gain something akin to "gold-standard" status like we are familiar with?

This might be beyond the scope of the discussion we intend to have, but a great visual example would be to explain how Jane goes from step A to step K in her first meeting with a client? Is she striking the disorders out as she's hearing the client talk or is she hand-writing notes and then referencing her cheat sheet?

Overall I want to emphasize that this was a very enjoyable reading! --Kennyle78 (discuss • contribs) 06:43, 2 February 2017 (UTC)

Cindy's question

I really enjoyed the reading, and I like how in the end, the best method was to incorporate both of Jane's and Joe's method. My question is how do we reconcile both models effectively. How do we incorporate both into practice? - Cindy Vo Cindy824 (discuss • contribs) 16:25, 2 February 2017 (UTC) Cindy824

Delaney's question

While reflecting on the reading and trying to compose my question, the questions above cover a lot of what I was thinking about while reading. With that being said, I guess my question would be how effective is the patient preference/question step (Step L) in Jane's approach? I feel as though the patient would just want to do whatever the therapist says is best because they are the knowledgeable authority figures. I see how the patient preference would make them more likely to come to the next session but clients might find a therapist incapable if they don't have a plan of action. --Dwagg96 (discuss • contribs) 20:08, 2 February 2017 (UTC)

Logan's question

Could we talk about how exactly DLRs work? And how they're related to ROC and other assessment evaluators? Also I really enjoyed the phrase "Rorschach-hugging dinosaur." --Logan520 (discuss • contribs) 20:47, 2 February 2017 (UTC)

Lizzie's Question

The DLR sounds awesome in terms of accuracy and efficiency, although it would be nice to have a little more explanation on the specifics of how it works with sensitivity and specificity. It sounds a little like the ROC... Also the probability monogram overall seems really wonderful for diagnosis and progress! Overall it was a very helpful read.--Eldeane (discuss • contribs) 21:45, 2 February 2017 (UTC)

Shelby's question

I agree with Rkang101 because it seems like Joe, though has good rapport with his clients, doesn't know them as well as he thinks he might. I think this because he can't even list the top 10 most common diagnoses he gives to these same clients.--Sjohnso (discuss • contribs) 22:21, 2 February 2017 (UTC)

Hannah Kim's question

I was originally pretty apprehensive about reading what I expected to be 30 pages of dense writing, but it surprisingly flows extremely well and is easy to understand for even someone that does not have much background in psychology. Most of the concepts I didn't originally understand were explained pretty sufficiently. I think I would agree with Sjohnso and Rkang101 that the chapter seemed to put Jane in a much more favorable light than Joe. --Hkim243 (discuss • contribs) 22:39, 2 February 2017 (UTC)