Using and Displaying Measures in Clinical Mental Health Practice

1. MEASURES AS ESSENTIAL
CLINICAL TOOLS
Tom Hall MAASW, (Adv.Acc.) AMHSW
Clinical Specialist / Training Consultant, MHTDU, NWMH
Mental Heath Coordinator, Living Room, Youth Projects
First-Step Social Solutions

2. Learning Outcomes
• Understand the importance of clinical measures
beyond routine clinical measurement
• Supplementing routine clinical measures with
identified problem area measures
• Using Excel to simply map change over time for
targeted consumers
• Understanding the importance of norms, cut-off
scores and specialised groups
• Importance of privacy issues in using measures
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3. 2014

4. Focus on the context
• Private / Not for Profit / Primary Health Care
• Homeless people
• Substance dependent people
• Mentally disordered people
• General population
• What are the challenges in private practice and
primary health care?
• Cost to the consumer / state
• Poor engagement / intoxication
• Time limited intervention / treatment
• Multiplicity of problem areas that interact
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5. Tiers of Mental Disorders
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6. Focus on solutions
• Supplementing routine clinical measures with
problem specific measures can help
• Most therapeutic approaches (MI, DBT, ACT etc.)
focus on working with the issue / problem the
consumer wants addressed
• Clinical practice directs an assessment (including
risk issues) is made, a diagnosis formulated and
treatment implemented
• Rapid Assessment Inventories assist the clinician in
exploring with the consumer the issues the person
brings, their severity of impact on functioning, and
agreed treatment goals
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7. Michael and Alexis share perspectives
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8. What scales / measures are about
• Assessing validity, reliability, factor analysis to
determine clusters of items forming a subscale
• Understanding the usefulness of a scale relies on
your scoring and understanding norms or cut-off
points
• These translate in understanding with the person
the severity of the problem in comparison with other
populations e.g. US college students, women in
refuges, adult male prisoners etc
• In combination with routine outcome measures
these can help reach agreement with the person
about the direction, goals and expected outcomes of
care and treatment
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9. Rapid Assessment Inventories
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10. 2014

11. 2014

12. Measures offer an opportunity to share
perspectives on key problem areas
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13. Excel and Subscales
• Commonly loaded software program on
organisational computers
• The task is to semi-automate the summary of OM
and other routinely used scale items into subscales
• As illustrated above these summaries can be used,
classically, with outcome measures to highlight
assessment and intervention strategies in
collaboration with the consumer
• Requires multiple entry of the OM data but provides
greater flexibility in how data are presented in
discussion
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14. Entering the data
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15. Automate the calculation of Subscales
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o Here the actual score is represented (calculated) as a percentage
of the total score
o Because the BASIS-32 shows higher scores when the item is
worse for the person it can be called a problem scale (Compare to
APQ6)
o The percentage of problem for the person is consistent with higher
score, so higher percentages represent the intensity of problem
over all the items in that subscale - this is much easier to
understand than item scores

16. Copy the Subscales to a Summary
• Here a comparison over time is
easier to make and discuss
with the consumer
• Changes to the subscales
indicate greater improvement
in progress in some areas
compared to others
• A direct comparison between
HoNOS scores and BASIS-32
scores is possible to discuss
with the consumer
• The measures provide both
consumer and clinician the
opportunity to discuss context
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17. Graphically represent the results
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18. Change in Sub-scales is clear
2014
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Daily living / Role functioning
[36]
Depression / Anxiety [24] Relationship with self and others
[28]
Psychosis [16] Impulsive / Addictive [24]
BASIS-32 Subscale Scores over 3 time periods
14/07/2013 8/03/2013 14/09/2013

19. Change in Sub-scales is clear
2014
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Behavr Impairmt Symptm Social
Subscale Scores as Percentage of Total Subscale Problem
Identification - HoNOS
14/07/2013
3/08/2013

20. Michael and Alexis share perspectives
2014

21. The importance of consent
• Clarity about why information is collected
• Purpose in requesting scale to be completed
• Feedback from results being shared
• Discussing the psychosocial context for change
• Medication and self-medication effects on
functioning
• Keeping data safely for periods of time
• Using de-identified data to understand the outcomes
of program provision – how do we know the
program had an effect compared to simple activity
data
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22. What has been covered
• Identifying the importance of sub-scales in
collaborative assessment and treatment
• Awareness of the importance of problem
specific Rapid Assessment Inventories
• Discussing a persons issues in relation to sub-
group populations
• Applying sub-scales method to routine outcome
measures
• Importance of privacy issues in using measures
2014

23. References
Chamberlain, C. & Johnson, G.(2011) Pathways into adult
homelessness. Journal of Sociology. (49) 1 : 60-77.
Corcoran, K. & Fischer, J. (2013) Measures for Clinical
Practice and Research: a sourcebook (5th Ed) Vols 1 & 2.
New York : Oxford University Press.
Graham-Kevan, N. & Archer, J. (2003) Physical aggression
and control in heterosexual relationships: the effects of
sampling, Violence and Victims. (18), 2
Pallant, J. (2011) SPSS Survival Manual: a step by step
guide to data analysis using SPSS (4th Ed) Crows Nest :
Allen & Unwin.
Contact: tomhas@bigpond.com
2014