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HGAPS New for Fall 2022: HGAPS and Psychology Conferences

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HGAPS is finding new ways to make psychological science conferences more accessible!

Here are examples from APA 2022 and the JCCAP Future Directions Forum. Coming soon... ABCT!
~ More at HGAPS.org ~

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← Step 9: Learn and use client preferences

Evidence-based assessment

Step 10: Goal setting: Milestones and outcomes →

Process, Progress, and Outcome Phase

Overview

Measuring process, progress, and outcome helps make adjustments over the course of therapy, often improving outcomes. Process refers to ways of looking at treatment mediators, and also measures of engagement, adherence, and fidelity. Progress refers to tracking change on target measures, typically measured with more brief and frequently repeated tools than used at other assessment stages. Outcome measures can include tools with predefined benchmarks or a priori definitions of reliable improvement or worsening. All of these are described in more detail below.

Rationale

The primary goal at this phase of assessment is to improve patient outcomes.

Process Measures

Progress Measures

Outcome Measures

Outcome measures are tools to document progress towards major goals in treatment. In clinical trials, these are often symptom severity measures based on interviews, and the average scores are compared for groups receiving different treatments (e.g., cognitive-behavioral therapy versus antidepressant, or dialectical behavioral-therapy versus treatment as usual), or comparing the average at the end of treatment to the average at baseline.

These tests are looking at the average outcome. There usually is a wide range of individual scenarios, though. Some people get much better than typical outcomes, some do less well, and some cases may actually get worse over the course of treatment. Clinical significance is a way of looking at an individual's outcome, and deciding whether treatment produced meaningful benefit. All of the different techniques within the "clinical significance" set focus on each individual case, rather than the group average.

Here's a link to a tool that shows the reliable change index and the A, B, C benchmarks for several widely used measures with youths. It includes some interactive graphics that may help visualize the comparisons with the clinical and nonclinical groups to see where the individual case falls.

Steps to put into practice

Ways of evaluating change

Visualization Methods

There are many ways of charting or visualizing change over time to get a sense of progress. These include line charts, dot plots, Brinley plots, and others.

Annotated bibliography

Tables and figures

Commonly Used Outcome and Process Measures
	Adult Behavior Checklist (ABCL)	Child Behavior Checklist (CBCL)	PROMIS	Pediatric Symptom Checklist (PSC)
Anorexia Nervosa
Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorder
Bipolar (adults)
Bipolar (child)
Conduct disorder
Depression (youth)
Generalized anxiety disorder
Non-suicidal self injury
Obsessive-compulsive disorder
Oppositional defiant disorder
Posttraumatic stress disorder
Schizophrenia
Simple phobia
Social anxiety disorder
Substance use disorder
Traumatic brain injury

Clinically significant change benchmarks for widely-used outcome measures

Click here for a set of slides explaining clinically significant change: Improving Diagnosis & Documenting Clinically Significant Change
More research on clinically significant change: Establishing Clinical Significance Benchmarks and Minimally Important Difference for 17 Measures

Benchmarks Based on Published Norms
Measure	Subscale	Cut-off scores			Critical Change (unstandardized scores)			MID (d 0.5)
Measure	Subscale	A	B	C	95%	90%	SE_difference	MID (d 0.5)
Beck Depression Inventory^[1]	BDI Mixed Depression	4	22	15	9	8	4.8	3.4
CBCL T-scores (2001 Norms)	Total	49	70	58	5	4	2.4	-
	Externalizing	49	70	58	7	6	3.4	-
	Internalizing	n/a	70	56	9	7	4.5	-
	Attention Problems	n/a	66	58	8	7	4.2	-
CBCL T-scores Age 1 1/2 - 5 (2001 Norms)	Total	42.9	71.2	56.3	4.8	4.1	2.5	4.1
	Externalizing	41.5	70.8	56.5	5.7	4.8	2.9	4.8
	Internalizing	40.1	70.9	54.4	9.1	7.6	4.6	7.6
	Attention Problems	40.0	67.3	57.1	7.6	6.4	3.9	6.4
CBCL T-scores Age 6 - 11 (Male/Female) (2001 Norms)	Male Total	49.1	69.3	59.2	4.5	3.8	2.3	4.7
	Female Total	43.3	68.6	57.1	4.6	3.9	2.4	4.9
	Male Externalizing	49.1	68.9	59.3	6.4	5.4	3.3	4.7
	Female Externalizing	42.5	68.0	57.4	6.6	5.6	3.4	5.0
	Male Internalizing	42.6	69.3	56.4	8.7	7.3	4.4	5.0
	Female Internalizing	36.2	69.0	54.6	9.4	7.9	4.8	5.5
	Male Attention Problems	45.4	65.2	58.7	7.8	6.6	4.0	6.6
	Female Attention Problems	41.8	66.1	58.5	8.1	6.8	4.1	6.8
CBCL T-scores Age 12 - 18 (Male/Female) (2001 Norms)	Male Total	46.8	69.3	58.2	4.4	3.7	2.2	4.6
	Female Total	47.0	69.3	58.3	4.5	3.8	2.3	4.7
	Male Externalizing	45.8	69.4	58.1	6.4	5.4	3.3	4.8
	Female Externalizing	44.0	69.0	57.4	6.5	5.5	3.3	4.8
	Male Internalizing	42.2	69.6	56.6	8.4	7.1	4.3	4.8
	Female Internalizing	43.9	69.2	57.3	8.5	7.1	4.3	4.9
	Male Attention Problems	43.9	66.0	58.3	7.8	6.5	4.0	6.5
	Female Attention Problems	43.6	65.2	58.0	7.9	6.6	4.0	6.6
TRF T-scores (2001 Norms)	Total	n/a	70	57	5	4	2.3	-
	Externalizing	n/a	70	56	6	5	3.0	-
	Internalizing	n/a	70	55	9	7	4.4	-
	Attention Problems	n/a	66	57	5	4	4.8	-
C-TRF T-scores Age 1 1/2 - 5 (2001 Norms)	Total	42.9	71.2	56.3	4.8	4.1	2.5	-
	Externalizing	41.5	70.8	56.5	5.7	4.8	2.9	-
	Internalizing	40.1	70.9	54.4	9.1	7.6	4.6	-
TRF T-scores Age 6 - 11 (Male/Female) (2001 Norms)	Male Total	43.7	70.2	56.6	4.7	3.9	2.4	3.9
	Female Total	42.1	69.8	55.8	4.7	3.9	2.4	3.9
	Male Externalizing	43.4	67.9	56.9	5.1	4.3	2.6	4.3
	Female Externalizing	37.8	67.7	54.5	5.9	5.0	3.0	5.0
	Male Internalizing	36.8	69.9	54.5	8.9	7.5	4.6	7.5
	Female Internalizing	36.8	70.1	53.9	8.7	7.3	4.4	7.3
	Male Attention Problems	44.3	66.2	57.1	4.4	3.7	2.3	3.7
	Female Attention Problems	43.2	65.8	57.3	4.6	3.9	2.4	3.9
TRF T-scores Age 12 - 18 (Male/Female) (2001 Norms)	Male Total	46.1	70.4	57.2	4.4	3.7	2.3	3.7
	Female Total	47.5	70.3	58.0	4.5	3.7	2.3	3.7
	Male Externalizing	45.3	68.5	57.9	5.2	4.3	2.6	4.3
	Female Externalizing	41.7	68.1	56.2	5.9	4.9	3.0	4.9
	Male Internalizing	41.6	69.4	55.5	8.2	6.9	4.2	6.9
	Female Internalizing	41.8	69.0	55.8	8.2	6.9	4.2	6.9
	Male Attention Problems	43.2	67.6	57.1	4.7	4.0	2.4	4.0
	Female Attention Problems	45.5	66.8	58.1	4.6	3.9	2.4	3.9
YSR T-scores (2001 Norms)	Total	n/a	70	54	7	6	3.3	-
	Externalizing	n/a	70	54	9	8	4.6	-
	Internalizing	n/a	70	54	9	8	4.8	-
YSR T-scores Age 11 - 18 (2001 Norms)	Male Total	35.3	69.8	54.0	6.7	5.6	3.4	5.6
	Female Total	36.8	69.8	54.1	6.4	5.4	3.3	5.4
	Male Externalizing	38.3	69.3	54.6	8.9	7.5	4.6	7.5
	Female Externalizing	35.7	70.2	53.8	9.2	7.8	4.7	7.8
	Male Internalizing	32.7	69.9	53.2	9.6	8.1	4.9	8.1
	Female Internalizing	35.6	70.2	53.8	9.3	7.8	4.8	7.8
	Male Attention Problems	38.6	67.1	56.6	10.5	8.8	5.3	8.8
	Female Attention Problems	39.8	65.8	56.2	9.5	8.0	4.8	8.0

Benchmarks Based on Published Norms (Raw Scores)
Benchmarks Based on Published Norms
Measures	Subscale	Age	Cut-off scores			Critical Change (unstandardized scores)
Measures	Subscale	Age	A	B	C	95%	90%	SE_difference
CBCL (Raw Scores)	Total	Male 6-11	3.8	57.1	39	11.1	9.3	5.7
		Male 12-17	1.7	63	40	11.6	9.8	5.9
		Female 6-11	-	55.1	35	10.7	9	5.5
		Female 12-17	-	58.2	37	11.6	9.7	5.9
TRF (Raw Scores)	Total	Male 6-11	-	70.1	38	13	11	6.6
		Male 12-17	-	75.4	40	14	11.8	7.2
		Female 6-11	-	55.1	27	11.7	9.9	6
		Female 12-17	-	54.6	29	12	10.1	6.1
YSR (Raw Scores)	Total	Male 11-18	-	113	54	18.3	15.4	9.3
YSR (Raw Scores)	Total	Female 11-18	1	117	59	18	15.2	9.2
Beck Depression Inventory	Mixed Depression	13-80	4	22	15	9	8	4.8
PGBI-10M	Total	5-18	1	9	6	6	5	3.2
CMRS 10	Total	5-18	--	6	4	5	4	2.3
PGBI-10Da	Total	5-18	--	7	4	6	5	3.0
PGBI-10Db	Total	5-18	--	7	4	6	5	2.9
AGBI-10M	Total	11-90	--	14	7	6	5	3.1
AGBI-10Da	Total	11-90	--	18	7	6	5	3.2
AGBI-10Db	Total	11-90	--	16	7	6	5	2.9
7 Up	Total	11-90	--	8	4	4	4	2.2
7 Down	Total	11-90	--	12	5	5	4	2.3
KMRS	Total	5-18	19	19	19	3	3	1.6
KDRS	Total	5-18	12	19	18	5	4	2.4
CDRS-R Total	Total	5-18+	--	24	22	6	5	2.9
YMRS Total	Total	5-90	4	3	3	3	3	1.8

Measure		Disorder	Subscale	Cut-off scores			Critical Change (Unstandardized scores)			MID (d .5)
Acronym	Full Name	Disorder	Subscale	A	B	C	95%	90%	SE Difference	MID (d .5)
7PS	7-Item Psychosis Screener	Psychosis
AAQ-II	Acceptance and Action Questionnaire-II
A-ASWS	Abbreviated Adolescent Sleep Wake Scale		Going to Bed, Falling Asleep, Maintaining Sleep, Reinitiating Sleep, and Returning to Wakefulness
AQ-10	Autism Spectrum Quotient	Autism
ASQ	Ask Suicide-Screening Questions
BCMRS	Brief Child Mania Rating Scale	Mania
BFCRS	Bush-Francis Catatonia Rating Scale	Catatonia
CAST	Childhood Autism Spectrum Test	Autism
CHRT	Concise Health Risk Tracking Scale
CRAFFT + N	Car, Relax, Alone, Forget, Friends, Trouble
EDS	Everyday Discrimination Scale (Short Version)
FAD	Family Assessment Device
FIRM	Family Index of Risk for Mood
GAD-7	Generalized Anxiety Disorder-7	Anxiety
HHS	Healthy Habits Survey
HSQ	Home Situations Questionnaire
PHQ-8	Patient Health Questionnaire - 8 items	Depression
PSC-17	Pediatric Symptom Checklist		Attention, Externalizing, Internalizing
PAM	Physical Activity Monitoring
SCARED	Screen for Child Anxiety Related Emotional Disorders	Anxiety
SCOFF	make self Sick, loss of Control, One-month weight loss, believe am Fat, and Food dominates life
SMFQ	Short Mood and Feelings Questionnaire
SOCS	Short Obsessive-Compulsive Disorder Screener	OCD
VADPRS	Vanderbilt ADHD Diagnostic Parent Rating Scale	ADHD
VADTRS	Vanderbilt ADHD Diagnostic Teacher Rating Scale	ADHD
YP-CORE	Young Person's Clinical Outcomes in Routine Evaluation

Will be updated as RISE internship continues!

References

↑ Beck, AT (1988). "Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.". Clinical Psychology Review 8 (1). http://www.sciencedirect.com/science/article/pii/0272735888900505. Retrieved 10 February 2014.