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

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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 Disorders

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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

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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 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

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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 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

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Graphically represent the results

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Change in 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 in 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 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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