Instruments for tx planning, monitoring, & outcome assessments Flashcards
explain why brief instruments are used
Brief instruments are used as quick assessments of where client
s mood is at currently, have things changed, has tx been successful etc.ie some kind of outcome is measured. Need to consider how reliable the measure is and how useful it is. A brief instrument should be easy to administer, easy to interpret, and economical, and not take long to do.
describe types of brief instruments
The following are some of the brief instruments available.
SYMPTOM CHECKLIST-90-R;
quickly assesses client’s self-reported symptoms. Asks re current symptoms over the past week. 90 symptoms are described from 0-4 (not at all-extreme). Need only 6th grade reading level. takes 15 min. Each item has mean of 50, and a standard deviation of 10. Can compare to normal values from 4 populations (psychiatric adult inpatient, psychiatric adult outpatient, adult nonpatient, or adolescent non patient. Best as a general indicator, is not a diagnostic tool.
Scored on 9 domains & 3 global indices;
A) Global indices;
1. Global Severity Index; intensity of experienced distress. Best single indicator of distress. T score>63=significant problem. Note this index has been found to be quite stable over time, so maybe not the best indicator if change has successfully occurred or not.
2. Positive Symptom Distress Index (PSDI); average of intensity
of symptoms experienced.
3. Positive Symptom Total (PST); a measure of the breadth of symptoms (ie total number of symptoms). ie big score =more complex problem.
B) Symptom Dimensions;
1. Somatization; elevations indicate distress experienced through actual, amplified, or imagined physical dysfn.
2. Obsessive-Compulsive; experience irresistible, repetitive, uncontrolled thoughts/urges/impulses.
3. Interpersonal Sensitivity; high scores indicate discomfort in this area. High scorers are self-conscious and expect relationships to be negative.
4. Depression; loss of appetite, loneliness, pointlessness, loss of pleaseure, lack of motivation, suicidal thoughts etc
5. Anxiety;apprehension, nervousness, dread
6. Hostility; resentment, irritability, rage, aggression.
7. Phobic Anxiety;excessive & irrational fear related to person, object, place or situation. High scores may indicate agorophobia or panic attacks, as opposed to a specific phobia.
8.Paranoid Ideation; paranoid thought, fear of being watched, suspicions, grandiosity, fear of losing control etc.
9. Psychoticism; high scorers are extremely isolated and withdrawn and may be experiencing schizophrenic symptoms, or severe psychotic symptoms. The psychoticism dimension in this test is possibly the weakest in validity, so interpret with caution.
May need to also look at specific items which have been rated highly.
The BRIEF SYMPTOM INVENTORY is a shorted for of the SC-90-R, having 53 of the same items.
BECK DEPRESSION INVENTORY -II
21-item self report, primarily looking at depression symptoms over past 2 weeks. grade 0-3 (different items are scored differently though). Takes 5 minutes. Validated for adults and adolescents. Need 6th grade reading level. Possible total scores from 0-63. Severe levels of depression are eg 40 or 50. Score of 14-28 usually means not diagnosed but are depressed. Appears able to discriminate between primary depression and primary anxiety (no mean feat). Has both cognitive factors(suicide, self-thoughts, ) and non cognitive somatic factors (sleeplessness,lack of appetite,loss of energy, crying). Symptoms overlap and best value of interpretation is from total score as opposed to considering cognitive or non cognitive factors separately.
Total scores;
0-13=no or minimal depression (but beware<4 may be faking good)
14-19= mild depression
20-28=moderate depression
29-63=severe depression.
There are 21 area as follows (concern if any area scores 3);
1. Sadness
2. Pessimism
3. Past failure
4. Loss of pleasure
5. Guilty feelings
6. Punishment feelings
7. Self-dislike
8.self-criticalness
9. suicidal thoughts
10.crying
11. agitation
12. loss of interest
13. indecisiveness
14. worthlessness
15. loss of energy
16. changes in sleeping pattern
17. irritability
18 change in appetite
19. difficulty concentrating
20. fatigue
21. loss of sexual interest.
Great screening tool, but still insufficient for dx.
STATE TRAIT ANXIETY INVENTORY
40 item, self report, requires 6th grade reading. Sensitive to both transitory states of anxiety and more stable forms. 4-point scale (almost never-almost always for trait, and not at all-very much so for state items).
Has difficulty differentiating between anxious and depressed states.
Has 2 uni-directional subscales (state and trait).
Interpretation:
1. High Trait anxiety; finds high number of situations stressful. Worried re how others assess them.
2. High State Anxiety; high feelings of apprehension. Likely somatic symptoms
3. High S with Low T; probable external threat is the stressor.Likely to resolve itself but may find problem solving strategies useful, or focussing on social support, desensitisation, what have learnt from experience, meditation,relaxation or sympathetic support etc.
4. High T with low S;not currently anxious but is prone to.
identify measures of non-symptom outcomes.
These include
1.Difficulties in Emotion Regulation Scale
2.Self-Compassion Scale
3. Measures of Self-Concept
4. Measure of Experiential Avoidance
5. Measures of Coping Skills.
There is also the OUTCOME RATING SCALE 4 items. Measures individual, interpersonal, social, and overall functioning.
SESSION RATING SCALE measures therapeutic relationship (eg “I felt heard…” “my goals were reached…”, “therapist’s approach is a good fit for me”… or “this session was right… we worked on what I wanted to work on”…. etc)
