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MEASURES AS ESSENTIALCLINICAL TOOLS

Tom Hall MAASW, (Adv.Acc.) AMHSW

Clinical Specialist / Training Consultant, MHTDU, NWMH

Mental 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

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

Tiers of Mental Disorders

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 implemented

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

Michael and Alexis share perspectives

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 and understanding norms or cut-offpoints

• 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 and treatment

Rapid Assessment Inventories

Measures offer an opportunity to shareperspectives on key problem areas

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

Entering the data

Automate the calculation of Subscales

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 iseasier 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

Graphically represent the results

Change in Sub-scales is clear

100.0%

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 in Sub-scales is clear

Behavr Impairmt Symptm Social

Subscale Scores as Percentage of Total Subscale ProblemIdentification - HoNOS

14/07/2013

3/08/2013

Michael and Alexis share perspectives

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

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

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

homelessness. Journal of Sociology. (49) 1 : 60-77.

Corcoran, K. & Fischer, J. (2013) Measures for ClinicalPractice 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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