MEASURES AS ESSENTIALCLINICAL TOOLS

Tom Hall MAASW, (Adv.Acc.) AMHSWClinical Specialist / Training Consultant, MHTDU, NWMHMental Heath Coordinator, Living Room, Youth Projects

First-Step Social Solutions

Learning Outcomes

Understand the importance of clinical measuresbeyond routine clinical measurement

Supplementing routine clinical measures withidentified problem area measures

Using Excel to simply map change over time fortargeted consumers

Understanding the importance of norms, cut-offscores and specialised groups

Importance of privacy issues in using measures

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Focus on the context Private / Not for Profit / Primary Health Care

Homeless people Substance dependent people Mentally disordered people General population

What are the challenges in private practice andprimary health care? Cost to the consumer / state Poor engagement / intoxication Time limited intervention / treatment Multiplicity of problem areas that interact

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Tiers of Mental Disorders2014

Focus on solutions Supplementing routine clinical measures withproblem specific measures can help

Most therapeutic approaches (MI, DBT, ACT etc.)focus on working with the issue / problem theconsumer wants addressed

Clinical practice directs an assessment (includingrisk issues) is made, a diagnosis formulated andtreatment implementes

Rapid Assessment Inventories assist the clinician inexploring with the consumer the issues the personbrings, their severity of impact on functioning, andagreed treatment goals

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Michael and Alexis share perspectives

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What scales / measures are about Assessing validity, reliability, factor analysis todetermine clusters of items forming a subscale

Understanding the usefulness of a scale relies onyour scoring, understanding norms or cut-off points

These translate in understanding with the personthe severity of the problem in comparison with otherpopulations e.g. US college students, women inrefuges, adult male prisoners etc

In combination with routine outcome measuresthese can help reach agreement with the personabout the direction, goals and expected outcomes ofcare

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Rapid Assessment Inventories

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Measures offer an opportunity to shareperspectives on key problem areas

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Excel and Subscales Commonly loaded software program onorganisational computers

The task is to semi-automate the summary of OMand other routinely used scale items into subscales

As illustrated above these summaries can be used,classically, with outcome measures to highlightassessment and intervention strategies incollaboration with the consumer

Requires multiple entry of the OM data but providesgreater flexibility in how data are presented indiscussion

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Entering the data

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Automate the calculation of Subscales

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o Here the actual score is represented (calculated) as a percentageof the total score

o Because the BASIS-32 shows higher scores when the item isworse for the person it can be called a problem scale (Compare toAPQ6)

o The percentage of problem for the person is consistent with higherscore, so higher percentages represent the intensity of problemover all the items in that subscale - this is much easier tounderstand than item scores

Copy the Subscales to a Summary Here a comparison over time is

easier to make and discusswith the consumer

Changes to the subscalesindicate greater improvementin progress in some areascompared to others

A direct comparison betweenHoNOS scores and BASIS-32scores is possible to discusswith the consumer

The measures provide bothconsumer and clinician theopportunity to discuss context

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Graphically represent the results

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Change is Sub-scales is clear

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Daily living / Role functioning[36]

Depression / Anxiety [24] Relationship with self and others[28]

Psychosis [16] Impulsive / Addictive [24]

BASIS-32 Subscale Scores over 3 time periods

14/07/2013 8/03/2013 14/09/2013

Change is Sub-scales is clear

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Behavr Impairmt Symptm Social

Subscale Scores as Percentage of Total Subscale ProblemIdentification - HoNOS

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3/08/2013

Michael and Alexis share perspectives

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The importance of consent Clarity about why information is collected Purpose in requesting scale to be completed Feedback from results being shared Discussing the psychosocial context for change Medication and self-medication effects onfunctioning

Keeping data safely for periods of time Using de-identified data to understand the outcomesof program provision how do we know theprogram had an effect compared to simple activitydata

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What has been covered Identifying the importance of sub-scales incollaborative assessment and treatment

Awareness of the importance of problemspecific Rapid Assessment Inventories

Discussing a persons issues in relation to sub-group populations

Applying sub-scales method to routine outcomemeasures

Importance of privacy issues in using measures

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ReferencesChamberlain, C. & Johnson, G.(2011) Pathways into adult

homelessness. Journal of Sociology. (49) 1 : 60-77.Corcoran, K. & Fischer, J. (2013) Measures for Clinical

Practice and Research: a sourcebook (5th Ed) Vols 1 & 2.New York : Oxford University Press.

Graham-Kevan, N. & Archer, J. (2003) Physical aggressionand control in heterosexual relationships: the effects ofsampling, Violence and Victims. (18), 2

Pallant, J. (2011) SPSS Survival Manual: a step by stepguide to data analysis using SPSS (4th Ed) Crows Nest :Allen & Unwin.

Contact: tomhas@bigpond.com

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