Clinical Uses of Assessment Measures The Chadwick Center for Children & Families Nicole Taylor, Ph.D. Robyn Igelman, M.A.

Objectives 1.Designing an assessment protocol 2.Capturing the Data 3.Getting staff buy-in 4.Providing clinicians with assessment results 5.Using the data clinically 6.Other uses of assessment data

THE CHADWICK CENTER’S ASSESSMENT and OUTCOME HISTORY

Example of Phases in Protocol Development Idea is Proposed Consultation/Brainstorming Initial Protocol Developed Pilot Program Program implemented with therapists Troubleshooting and Refining process

Steps to Take in Designing an Assessment Program: 1.Introduce idea and elicit support from ALL levels. 2.Form an assessment committee with representatives from each level. 3.Make preliminary decisions regarding measures and procedures. 4.Properly train therapists to administer & interpret measures.

Steps to Take (cont.): 5.Pilot measures and protocol on a sample population. 6.Be prepared to change as needs change and obstacles arise. 7.Remain committed.

Current Outcome Assessment Protocol Clients assigned to therapists Therapists collect all measures within first 3 visits and submit for data entry Data entered, measures scored and assessment summary given to therapists Measures collected by independent interviewer at six-month follow-up intervals Data entered, measures scored and assessment summary given to therapist, including data from all past assessments Quarterly and annual aggregate statistics compiled

Commonly Used Assessment Measures DomainInformants ChildParentClinician Gen. Beh.ProblemsYSR, CDICBCL Abuse SpecificTSCCCSBI, CDC TSCYC Therapist Follow-up Expectation/Satisf.EXP, SAT Family FxingFRI, FAM-III Parent FxingCES-D YSR – Youth Self Report; CDI – Children’s Depression Inventory; CBCL – Child Behavior Checklist; CSBI-Child Sexual Behavior Inventory; CDC – Child Dissociative Checklist; FRI – Family Relationship Index; FAM-III Family Assessment Measure III; CES-D – Center for Epidemiological Studies on Depression, TSCYC- Trauma Symptom Checklist for Young Children

Administration of measures: Do: –Properly introduce the purpose & benefit –Assess reading level prior to administration –Schedule adequate time for completion –Provide a quiet environment –Stay in the room –Encourage the client to complete all items Don’t: –Send measures home –Provide explanations of items (refer to manual) –Overlook missing items or incomplete measures –Forget to check critical items!

Data Management DO Establish an alliance with a reputable University professor Invest in a database designer Set team goals for follow-ups Design protocol to handle special populations/ circumstances DON’T Try to “wing it” if it is beyond your expertise Accept sloppy, invalid, measures Ignore uncompleted follow-ups Give up

Working with therapists: Guiding the assessment and providing feedback.

Guiding Therapists via Assessment Pathways integrated into assessment measures

Critical Items

Symptom Change Over Time

How to make sense of assessment results AKA –I’m just a clinician – I don’t get this mumbo jumbo…

How to make sense of assessment results: Know what each measure assesses and applicable populations Have a general understanding of each subscale Examine the validity scales (if any) Use assessment results as an adjunct to your clinical interview Clarify inconsistencies between assessment results and clinical impressions

How to make sense of assessment results (cont.): Involve the parents and children in your interpretive process Integrate results with clinical impressions & think about how the results can be used to plan treatment Don’t discount your clinical judgment!!

How do you provide feedback to your clients?

4 Phases of Providing Feedback: Re-establishing rapport Communicating assessment results Discussing recommendations and treatment plans Terminating the session Jerome Sattler, 2002

Parent and client feedback: Dos & Don’ts DO: Allow one therapy session to discuss results and give feedback Elicit client feedback and impressions regarding assessment results Discuss results with parent and child to confirm clinical impressions Address areas of concern not initially revealed through clinical interview Most important: Engage them in the process!

Parent and client feedback: Dos & Don’ts (cont.) DON’T: Avoid discussing results with your clients Act like the assessments are a waste of time (because your clients will too) Be afraid to share written feedback and printouts with parents and children Underestimate the ability of your clients to understand and appreciate your feedback

How clinicians integrate assessment into treatment planning

Confirm & enhance initial assessment Identify high risk clients Identify salient symptoms Assess changes in symptoms over time Establish treatment goals –Involve parents in treatment planning and goal setting, based on assessment results Treatment Planning:

Determining Interventions: Identify interventions with a sound theoretical basis and strong empirical support Select interventions that will address the highest priority symptoms first Utilize the treatment methods most effective for treating the symptoms you wish to target

Problem Solving: What Happens When the Measures & Clinician Don’t Agree?

Priorities in therapy…staying on task Don’t lose sight of the big picture with the daily crisis.

What clinical information can you get from a standardized assessment battery?

Applying the Data

How Outcome Data Helps: 10yo Sexually Abused Female USE OF DATA: Significant Child-Reported Symptoms found Explore Test Findings together to Validate Child’s Perceptions of Problems Data supported the need for the caretakers to increase their understanding of their daughter’s needs PROBLEM: Establishing need for therapy Involving child in therapy Resolving discrepancy between child & caretaker report of symptoms

How Outcome Data Helps: 10yo Sexually Abused Female (Cont.) PROBLEM: Client avoided discussing feelings due to shame Suicidal ideation emerged mid- treatment Elevations on specific scales: sexual concerns USE OF DATA: Normalized her experience Confirmed therapist concerns; Reinforced urgency and need for safety plan and family involvement Data helped therapist develop a treatment plan to target existing symptoms

How Do You Track Progress Over Time?

Other Uses of Data: Provide clinicians within aggregate information on client base Identifying holes in referral base Identify center deficiencies in terms of meeting client needs Research Develop clinical pathways

Reasons for Seeking Treatment by Year Physical abuse as a reason for referral consistently occurs between 21%-22%

Referral Source by Year Health care provider consistently refers 4%-5% of population

Enlisting Staff Buy-In DO Enlist Feedback early and regularly Provide easy to read feedback forms and trainings Provide feedback rapidly Be open to change based on feedback DON’T Implement a program w/o staff input Overload staff with measures Ignore staff complaints Evaluate staff based on feedback results

Staff’s Initial Comments “The measures interfere with the rapport building phase of therapy.” “This is too much to ask of our clients.” “Too much paperwork to initially give them.” “I can’t do the measures if the family is in crisis.” “I don’t understand how to interpret the measures.” “I don’t feel competent to give the measures. I’m an L.C.S.W.” “Too many measures.”

Staff’s Current Comments “I really like some of the measures and I use them to understand my clients symptomatology.” “It gives me an avenue to help the caretakers understand what is going on with their child.” “The CDI and the TSCC are very helpful and valuable. I like to use them to clarify the diagnosis and treatment plan.” “I appreciate getting feedback from Nicole regarding suicidal ideation and parents’ levels of depression.” “It sets our treatment program apart from others that don’t have this.”

Staff’s Current Comments (Continued) “Kids are able to disclose a lot more about themselves on the measures than if I were to ask them about symptoms face to face.” “It’s a lot to ask of our clients and caretakers but I find out so much valuable information.” “I’ve been able to get a client a medication evaluation much more quickly.” “It gives me a way to communicate the needs of my clients with regard to medication evaluations, IEPs, and attorneys representing the child.”

Adoption is a DOING thing! “BETTER IDEAS” Happens over time COMMUNICATED Thru a SOCIAL system Adapted from Rogers, 1995 In a certain way (C) 2001, Sarah W. Fraser