1. Assessing Change in Clinical Practice Richard Bost, Ph.D., ABPP Frances Wen, Ph.D. Michael Basso, Ph.D

4. Reliable Change Index (RCI) Jacobsen & Truax (1991) Appropriate for measures not subject to practice effects Examples: measures of attitude, psychological disorders, life satisfaction, health habits, coping styles, marital adjustment

5. Reliable Change Index (RCI) Jacobsen & Truax (1991) Not appropriate for measures affected by practice effects Examples: measures of memory, intelligence

6. Reliable Change Index (RCI) Jacobsen & Truax (1991) Appropriate for measures with underlying normal distributions or frequency spreads Examples: Dyadic Adjustment Scale, Geriatric Depression Scale, SCL-90-R, BDI, SF-36, etc.

7. Reliable Change Index (RCI) Jacobsen & Truax (1991) Not appropriate for measures which do not have underlying normal distributions or frequency spreads Examples: the MCMI (I-III), and the MCMD (or MBHI)

8. Reliable Change Index (RCI) Jacobsen & Truax (1991) Does change exceed what would be expected based on measurement error alone? If “yes”, then change is considered to be “statistically reliable”

9. Reliable Change Index (RCI) 5 Steps to Assessing Reliable Change 1.Administer appropriate measure at pre-test 2.Re-administer measure at a post-test period 3.Calculate change score 4.Calculate the RCI 5.Compare change score to the RCI

10. Reliable Change Index (RCI) The Reliable Change Generator 2.0 ©Grant J. Devilly 2004 Web: www.swin.edu.au/victims

11. Reliable Change Index (RCI) The Reliable Change Generator Devilly, G.J. (2004). The Reliable Change Generator for Windows: Version 2.0 (computer programme). The Centre for Neuropsychology, Swinburne University, Australia.

12. Reliable Change Index (RCI) The Reliable Change Generator Jacobson, N.S., and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.

13. Reliable Change Index (RCI) Data for the Reliable Change Generator Test-retest reliability of the measure Sample Time period Standard deviation for the sample (at Time 1) which was used to estimate the test-retest reliability

15. Reliable Change Index (RCI) Assessing Clinical Meaningfulness Assess after a change in scores is found to be reliable Consider various criteria: diagnostic classification degree of change

16. Reliable Change Index (RCI) Assessing Clinical Meaningfulness Causation Reliable change implies lack of causation due to measurement error Variables unrelated to intervention may account for reliable change

17. Reliable Change Index (RCI) Assessing Clinical Meaningfulness Direction of Change Improvement? Deterioration?

18. Reliable Change Index (RCI) A Case Example: Jane D. 19 y.o., single, unemployed Wilson’s disease Candidate for liver transplant Pre-transplant assessment: clinical interview, BDI-II, SF-36, STAI, SWLS, WAIS subtests

19. Reliable Change Index (RCI) A Case Example: Jane D. Post-transplant psychotherapy Post-transplant/Pre-therapy re-assessment: –clinical interview –BDI-II –SF-36 –STAI –SWLS

20. Reliable Change Index (RCI) A Case Example: Jane D. Pre-transplantPost-transplant/ Pre-therapy 95% RCI BDI-II28235.78 SF-36 PCS30 51 7.47 STAI-Trait68 87 54 70 12.41 SWLS11156.99

21. Reliable Change Index (RCI) A Case Example: Jane D.

22. Diagnosis: –Adjustment Disorder with Mixed Anxiety and Depression Therapy Issues: –Physical, familial, social, occupational

23. Reliable Change Index (RCI) A Case Example: Jane D. Post-therapy Changed occupational and academic goals Changed social network Changed residence

24. Reliable Change Index (RCI) A Case Example: Jane D. Pre-therapyPost- therapy95% RCI BDI-II23 13 5.78 SF-36 PCS51537.47 STAI-Trait54 (70) 40 (54 ) 12.41 SWLS15 26 6.99

25. Reliable Change Index (RCI) A Case Example: Jane D.

26. Additional References Ferguson RJ, Robinson AB, Splaine M. (2002). Use of the reliable change index to evaluate clinical significance in SF-36 outcomes. Quality of Life Research, 11, 509-516. Pavot W, Diener E. (1993). Review of the Satisfaction With Life Scale. Psychological Assessment, 5, 164-172.

27. Additional References Sprinkle SD, Lurie D, Insko SL, Atkinson G, Jones GL, Logan AR, Bissada NN. (2002). Criterion validity, severity cut scores, and test-retest reliability of the Beck Depression Inventory-II in a university counseling center sample. Journal of Counseling Psychology, 49, 381-385.

28. Additional References Spielberger CD, Gorsuch RL, Lushene RE (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA; Consulting Psychologists Press. Ware JE, Kosinski M, Keller SK. SF-36® Physical and Mental Health Summary Scales: A User's Manual. Boston, MA: The Health Institute, 1994.