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| EBA Implementation |
|---|
| Assessment phases |
| Steps 1-2: Preparation phase |
| Steps 3-5: Prediction phase |
| Steps 6-9: Prescription phase |
| Steps 10-12: Process/progress/outcome phase |
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
Blah
Progress Measures
Blah
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
Blah
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
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
| Benchmarks Based on Published Norms | |||||||
| Measure | Subscale | Cut-off scores | Critical Change
(unstandardized scores) | ||||
| A | B | C | 95% | 90% | SEdifference | ||
| Beck Depression Inventory[1] | BDI Mixed Depression | 4 | 22 | 15 | 9 | 8 | 4.8 |
| 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 |
| 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 | |
| Attention Problems | 40.0 | 67.3 | 57.1 | 7.6 | 6.4 | 3.9 | |
| CBCL T-scores
Age 6 - 11 (Male/Female) (2001 Norms) |
Male Total | 49.1 | 69.3 | 59.2 | 4.5 | 3.8 | 2.3 |
| Female Total | 43.3 | 68.6 | 57.1 | 4.6 | 3.9 | 2.4 | |
| Male Externalizing | 49.1 | 68.9 | 59.3 | 6.4 | 5.4 | 3.3 | |
| Female Externalizing | 42.5 | 68.0 | 57.4 | 6.6 | 5.6 | 3.4 | |
| Male Internalizing | 42.6 | 69.3 | 56.4 | 8.7 | 7.3 | 4.4 | |
| Female Internalizing | 36.2 | 69.0 | 54.6 | 9.4 | 7.9 | 4.8 | |
| Male Attention Problems | 45.4 | 65.2 | 58.7 | 7.8 | 6.6 | 4.0 | |
| Female Attention Problems | 41.8 | 66.1 | 58.5 | 8.1 | 6.8 | 4.1 | |
| CBCL T-scores
Age 12 - 18 (Male/Female) (2001 Norms) |
Male Total | 46.8 | 69.3 | 58.2 | 4.4 | 3.7 | 2.2 |
| Female Total | 47.0 | 69.3 | 58.3 | 4.5 | 3.8 | 2.3 | |
| Male Externalizing | 45.8 | 69.4 | 58.1 | 6.4 | 5.4 | 3.3 | |
| Female Externalizing | 44.0 | 69.0 | 57.4 | 6.5 | 5.5 | 3.3 | |
| Male Internalizing | 42.2 | 69.6 | 56.6 | 8.4 | 7.1 | 4.3 | |
| Female Internalizing | 43.9 | 69.2 | 57.3 | 8.5 | 7.1 | 4.3 | |
| Male Attention Problems | 43.9 | 66.0 | 58.3 | 7.8 | 6.5 | 4.0 | |
| Female Attention Problems | 43.6 | 65.2 | 58.0 | 7.9 | 6.6 | 4.0 | |
| 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 |
| Female Total | 42.1 | 69.8 | 55.8 | 4.7 | 3.9 | 2.4 | |
| Male Externalizing | 43.4 | 67.9 | 56.9 | 5.1 | 4.3 | 2.6 | |
| Female Externalizing | 37.8 | 67.7 | 54.5 | 5.9 | 5.0 | 3.0 | |
| Male Internalizing | 36.8 | 69.9 | 54.5 | 8.9 | 7.5 | 4.6 | |
| Female Internalizing | 36.8 | 70.1 | 53.9 | 8.7 | 7.3 | 4.4 | |
| Male Attention Problems | 44.3 | 66.2 | 57.1 | 4.4 | 3.7 | 2.3 | |
| Female Attention Problems | 43.2 | 65.8 | 57.3 | 4.6 | 3.9 | 2.4 | |
| TRF T-scores
Age 12 - 18 (Male/Female) (2001 Norms) |
Male Total | 46.1 | 70.4 | 57.2 | 4.4 | 3.7 | 2.3 |
| Female Total | 47.5 | 70.3 | 58.0 | 4.5 | 3.7 | 2.3 | |
| Male Externalizing | 45.3 | 68.5 | 57.9 | 5.2 | 4.3 | 2.6 | |
| Female Externalizing | 41.7 | 68.1 | 56.2 | 5.9 | 4.9 | 3.0 | |
| Male Internalizing | 41.6 | 69.4 | 55.5 | 8.2 | 6.9 | 4.2 | |
| Female Internalizing | 41.8 | 69.0 | 55.8 | 8.2 | 6.9 | 4.2 | |
| Male Attention Problems | 43.2 | 67.6 | 57.1 | 4.7 | 4.0 | 2.4 | |
| Female Attention Problems | 45.5 | 66.8 | 58.1 | 4.6 | 3.9 | 2.4 | |
| 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 |
| Female Total | 36.8 | 69.8 | 54.1 | 6.4 | 5.4 | 3.3 | |
| Male Externalizing | 38.3 | 69.3 | 54.6 | 8.9 | 7.5 | 4.6 | |
| Female Externalizing | 35.7 | 70.2 | 53.8 | 9.2 | 7.8 | 4.7 | |
| Male Internalizing | 32.7 | 69.9 | 53.2 | 9.6 | 8.1 | 4.9 | |
| Female Internalizing | 35.6 | 70.2 | 53.8 | 9.3 | 7.8 | 4.8 | |
| Male Attention Problems | 38.6 | 67.1 | 56.6 | 10.5 | 8.8 | 5.3 | |
| Female Attention Problems | 39.8 | 65.8 | 56.2 | 9.5 | 8.0 | 4.8 | |
| Benchmarks Based on Published Norms | ||||||||||
| Measures | Subscale | Cut-off scores | Critical Change
(unstandardized scores) |
|||||||
| A | B | C | 95% | 90% | SEdifference | |||||
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.