1. Cricket Mitchell, PhD CiMH Senior Associate
Use of the Patient Health Questionnaire-9 (PHQ-9) with DTQI in Ventura County
Cricket Mitchell, PhD
CiMH Senior Associate
Ventura DTQI PHQ-9 Training

2. Overview of Training Importance of Incorporating Standardized Data
Patient Health Questionnaire (PHQ-9) with DTQI
PHQ-9 Description
Administration
Scoring
Clinical Utility
Tracking Clinical Progress in DTQI
Outcome Assessment using the PHQ-9
Materials you will need
PHQ-9
Individual DTQI Client PHQ-9 Progress Graph
Ventura DTQI PHQ-9 Training

3. Importance of Incorporating Standardized Data Collection into Clinical Practice
Assessment is the beginning of developing a relationship with the client
Demonstrates a desire to know what the youth is experiencing
By incorporating standardized measures of functioning, the efficiency and thoroughness of assessment is enhanced
TFCBT Evaluation Training

4. Importance of Incorporating Standardized Data Collection into Clinical Practice
Using standardized measures of functioning…
Assists in initial clinical impressions
Provides valuable information to guide treatment/interventions
Tracks treatment progress over time
Assesses sufficiency of treatment delivered
Demonstrates treatment-related improvements in youth functioning
TFCBT Evaluation Training

5. Patient Health Questionnaire - 9 (PHQ-9)
Ventura DTQI PHQ-9 Training

6. CIMH PHQ-9Training
Information on the administration, scoring, and clinical utility of the PHQ-9 was obtained from:
The PHQ-9: Validity of a Brief Depression Severity Measure (Kurt Kroenke, Robert Spitzer, and Janet Williams; Journal of General Internal Medicine, 2001)
Patient Health Questionnaire 9 Validated for Depression Screening in Adolescents (Penny Murata; Pediatrics, 2010)
The National Council for Community Behavioral Healthcare,
Ventura DTQI PHQ-9 Training

7. PHQ-9 Description
Target-specific/Symptom-specific measure of functioning
To be used when the focus of treatment is depression
Measures the current severity of depressive symptoms
Self-report for ages 12+
Brief
Valid and reliable
Sensitive to clinical change
Available in the public domain at no charge 7 7

8. PHQ-9 Description
9 items – reflect the 9 symptoms of DSM-IV diagnostic criteria for depression
4-point Likert scale response options
Not at all (0)
Several days (1)
More than half the days (2)
Nearly every day (3)
10th item not scored, assesses functional impairment 8
TFCBT Evaluation Training 8

9. Let’s take a look at the PHQ-9...
Ventura DTQI PHQ-9 Training

10. PHQ-9 Administration Approximately 2 minutes to complete
Youth complete independently
Can be read aloud if necessary/desired
“Over the last 2 weeks...”
Encourage honest responses
Informants can easily be influenced by the attitude of the person administering the scale
Let youth know that this questionnaire will help you, as a clinician, better understand how they are doing and how you can best help them
Encourage responses on all items
Ventura DTQI PHQ-9 Training

11. PHQ-9 Scoring
Sum the items in the column labeled “Several days”, and put that number on the line below that column
Alternatively, you could count the number of items that have been circled in this column and multiply by 1
Sum the items in the column labeled “More than half the days”, and put that number on the line below that column
Alternatively, you could count the number of items that have been circled in this column and multiply by 2
Sum the items in the column labeled “Nearly every day”, and put that number on the line below that column
Alternatively, you could count the number of items that have been circled in this column and multiply by 3
Add the three subtotals together to obtain the Total Severity Score
In other words… sum all responses on items 1 thru 9
Ventura DTQI PHQ-9 Training

12. Clinical Utility of the PHQ-9
The PHQ-9 is a multipurpose tool that has been used for:
Screening
Diagnosing
Monitoring
Measuring the severity of depression
Ventura DTQI PHQ-9 Training

13. Clinical Utility of the PHQ-9
For initial provisional diagnosis...
If there are at least 4 “3’s” – including Q#1 and/or Q#2 – consider a depressive disorder
Consider a Major Depressive Disorder diagnosis...
If there are at least 5 “3’s”
One of which must correspond to either Q#1 or Q#2
Consider Other Depressive Disorder...
If there are between 2 and 4 “3’s”
Ventura DTQI PHQ-9 Training

14. Clinical Utility of the PHQ-9
Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require:
Impairment of social, occupational, or other important areas of functioning
See Q#10
And ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms
Ventura DTQI PHQ-9 Training

15. Clinical Utility of the PHQ-9
Total Score indicates Depression Severity:
Total Score
Depression Severity
1-4
Minimal depression
5-9
Mild depression
10-14
Moderate depression
15-19
Moderately severe depression
20-27
Severe depression
Ventura DTQI PHQ-9 Training

16. Clinical Utility of the PHQ-9
Question #9
Assesses presence and duration of suicidal ideation
Review this carefully after a youth has completed the measure
A “2” or “3”, reflecting more than half the days or nearly every day, requires additional assessment
Ventura DTQI PHQ-9 Training

17. Clinical Utility of the PHQ-9 with DTQI
Assessing Initial Severity of Depression
Treatment Monitoring / Tracking Clinical Progress
Periodic assessments provide valuable information regarding symptom severity relative to treatment/interventions
Outcome Assessment
Ventura DTQI PHQ-9 Training

18. Clinical Utility of the PHQ-9 with DTQI
In DTQI, the PHQ-9 will be administered (at least) four times:
Pre-DTQI
After Phase I (presumably, as you transition from the Activities module to the Thoughts module)
After Phase II (presumably, as you transition from the Thoughts module to the Social module)
Post-DTQI
Ventura DTQI PHQ-9 Training

19. Clinical Utility of the PHQ-9 with DTQI
Individual client PHQ-9 scores are shared with Maggie Rea (or other DTQI clinical expert/trainer) to guide the clinical consultation
Total scores on the PHQ-9 provide valuable information regarding the severity level of an individual client’s depressive symptomotology
Ventura DTQI PHQ-9 Training

20. Individual DTQI Client PHQ-9 Progress Graph
VCBH ID: ________________
Client Name: __Example_____________________
DTQI Therapist:: _________________________________ 27
20-27 = Severe 25
15-19 = Moderate Severe Depression 23 21
10-14 = Moderate Depression 19
5-9 = Mild Depression X 17 15
PHQ-9 Score
0-4 = None/minimal 13 X 11 X 9
Clients appreciate seeing their treatment progress as much as you do!! 7 X 5 3
Date:
Year: /
20 __ /
20 __ /
20 __ /
20 __
End of Phase 1
End of Phase 2
Pre-DTQI
Post-DTQI

21. Using the Individual DTQI Client PHQ-9 Graph
Print as a ‘Slide’ and you will get the graph on a full-page
Use one per client
Enter the Date of the Assessment at the appropriate interval (Pre-DTQI, End of Phase I, etc.)
Plot the PHQ-9 score on the graph within the appropriate assessment interval
Once multiple scores are plotted, connect the scores with a solid line

22. Outcome Assessment Using the PHQ-9
Comparisons of Pre- and Post- scores reveal specific areas of treatment-related improvement in child depression
e.g.,
Does the severity of depression symptoms decrease substantially after participation in DTQI?
Is there improvement across all domains of depressive symptoms?
Ventura DTQI PHQ-9 Training

23. Outcome Assessment Using the PHQ-9
Data entry instructions for the Pre-DTQI and Post-DTQI PHQ-9 scores will be forthcoming from Behavioral Health
Anticipated to begin July 1, 2012
Data collection for outcome assessment will begin with new clients
Must have a true Pre-DTQI score to evaluate outcomes
Data collection for monitoring clinical progress should begin immediately with current clients
Ventura DTQI PHQ-9 Training

24. Materials You Will Need
PHQ-9
Provided in English and in Spanish
Additional language versions are available at:
Individual DTQI Client PHQ-9 Graph
Provided in PowerPoint along with Example

25. Questions
Ventura DTQI PHQ-9 Training

26. The End
Contact Information
Cricket Mitchell, PhD
Cell phone:
Ventura DTQI PHQ-9 Training