Ci MH Palette of Measures Evaluation Training Aggression

Ci. MH Palette of Measures Evaluation Training: Aggression Questionnaire (AQ) Cricket Mitchell, Ph. D CIMH Evaluation Consultant

Palette of Measures Evaluation: What You Will Need (slide 1 of 2) • Palette of Measures Data Entry Shell v 2 (Excel file) – Developed by Ci. MH and customized for each participating agency – Holds all data for clients served thru the Palette of Measures project – Demographics, service delivery information, pre- and post- outcome measure data • Palette of Measures Data Dictionary v 2 (Word document) – A guide for using the associated data entry shell – Defines each column in the excel file 2

Palette of Measures Evaluation: What You Will Need (slide 2 of 2) • Outcome measures from the two-pronged approach – General Outcome Measure – Target-Specific Outcome Measure(s) – For example… • Aggression Questionnaire © (AQ) – Copyrighted and published by Western Psychological Services (WPS) • Must be purchased by interested Palette of Measures project participating agencies 3

Overview of Training • Brief Overview of Palette of Measures evaluation protocol • Aggression Questionnaire©: Target-specific measure for disruptive behavior – Administration – Scoring – Clinical Utility • Instructions for Palette of Measures data entry and data submissions – Data entry: AQ – Data entry: Demographics & Services – Data submissions to Ci. MH 4

Brief Overview of Palette of Measures Evaluation Protocol 5

Outcome Assessment • Palette of Measures providers will track outcomes using data from pre- and post- administrations of standardized measures of functioning • Pre- and Post- a “dose” of treatment / an intervention interval – General measure of youth mental health functioning (e. g. , YOQ/YOQ-SR, CANS, Ohio Scales) – Target-specific measure linked to focus of treatment/intervention (e. g. , AQ, ECBI, PHQ-9, PTSDRI, RCADS) • Providers may choose to administer mid-course assessments as well – e. g. , at 3 -month intervals in usual care 6

A note about the use of standardized assessment measures… (slide 1 of 2) • Assessment is the beginning of developing a relationship with the child and family – Demonstrates a desire to know what the child and family are experiencing – By incorporating standardized assessment measures of functioning, the efficiency and thoroughness of assessment is enhanced 7

A note about the use of standardized assessment measures… (slide 2 of 2) • Using standardized assessment measures of functioning… – Assists in initial clinical impressions – Provides valuable information to guide treatment/interventions – Assesses sufficiency of treatment delivered – Demonstrates treatment-related improvements in child functioning 8

Aggression Questionnaire© (AQ) 9

Ci. MH AQ Training • Information on the administration, scoring, and clinical utility of the AQ was obtained from the measure’s Manual, written by Arnold H. Buss, Ph. D. , and W. L. Warrant, Ph. D. , and published by Western Psychological Services (WPS) 10

© Aggression Questionnaire (AQ) Description • Target-specific measure for disruptive behavior • Measures youth tendencies to respond to situations in an aggressive manner – Youth self-report ages 9 -18 – Can also be used as adult self-report for ages 19+ (separate norms) • 10 minutes to complete 11

© Aggression Questionnaire (AQ) Description • Written at a 3 rd grade reading level • Valid and reliable • Copyrighted and published by Western Psychological Services (WPS) – After purchase of the manual (~$62) the cost per use ~$1. 80 – http: //portal. wpspublish. com/portal/page? _pageid =53, 70400&_dad=portal&_schema=PORTAL 12

AQ© Description • 34 items • 5 -point Likert scale response options – – – • Five Scale Scores – – – Physical Aggression (PHY) Verbal Aggression (VER) Anger (ANG) Hostility (HOS) Indirect Aggression (IND) Not at all like me (1) A little like me (2) Somewhat like me (3) Very much like me (4) • Total Score Completely like me (5) 13

Example: Items from the AQ© • My friends say that I argue a lot. • I may hit someone if he or she provokes me. • I have threatened people I know. • I wonder what people want when they are nice to me. • I have become so mad I have broken things. 14

AQ Administration • Administer pre- and post- a dose of treatment, or an intervention interval, focused on disruptive behavior – AQ completed by client – Some agencies may choose to administer mid -treatment assessments as well 15

Let’s take a look at the AQ. . . (not distributed due to copyright laws) 16

AQ Scoring • Tear off the perforated edge to open packet – The youth’s circled responses will show on the inside, and will reflect the value associated with the response • First, calculate the Inconsistent Responding Index (INC) – For 12 pairs of items, record the value of each response in the appropriate box – If the difference between the pair of scores is greater than 1, check the box off to the right • Sum the checked boxes to obtain the INC Score • INC Scores of 5 or greater indicate inconsistency in responding, and scores should be interpreted with caution 17

AQ Scoring • Next, go the AQ Scoring Worksheet and transfer the value of each circled response into the box at the right-hand side – Each item loads onto one of the five scales (e. g. , PHY, VER, ANG) • Sum all responses in each scale to determine Scale Scores • Sum the Scale Scores to determine Total Score • Raw scores can be plotted on the Profile Sheet, which will show the youth’s responses compare to typical youth responses 18

AQ Scoring • Missing Data (items that are left blank) – If 5 or more items are missing, consider the questionnaire invalid • OR 2 items from any one Scale – Substitute the median item response for the missing item • The median item response is based on the standardization sample and represents the response that divided the sample in half • The median response is bolded on the AQ Scoring Worksheet 19

Clinical Utility of the AQ • Total Score – Possible scores range from 34 to 170 – Clinical cutpoint • 110 or higher – Total Scores are reflective of the general level of anger and aggression reported by youth – High scores could reflect youth with relatively few, but extremely intense angry or aggressive episodes; as well as youth with less intense anger or aggression, but across relatively chronic circumstances • It is important to examine elevations on subscales to understand the profile of the youth’s experiences 20

Clinical Utility of the AQ • Physical Aggression (PHY) Scale – Possible scores range from 8 to 40 – Clinical cutpoints differ by gender • 30 or higher for Males • 26 or higher for Females – Assesses the use of physical force when expressing anger or aggression – High scores indicate that the youth is reporting a lack of ability to control urges toward physical aggression 21

Clinical Utility of the AQ • Verbal Aggression (VER) Scale – Possible scores range from 5 to 25 – Clinical cutpoint • 18 or higher – Assesses the use of quarrelsome and hostile speech – High scores indicate that the youth is aware of a tendency to be more argumentative than most people • Often aroused to anger by situations perceived as unfair 22

Clinical Utility of the AQ • Anger (ANG) Scale – Possible scores range from 7 to 35 – Clinical cutpoint • 24 or higher – Assesses the use of self-control and aspects of arousal related to anger – High scores are often associated with irritability, frustration, emotional lability, and temperamental gesturing 23

Clinical Utility of the AQ • Hostility (HOS) Scale – Possible scores range from 8 to 40 – Clinical cutpoint • 26 or higher – Assesses attitudes of bitterness, social alienation, and paranoia – High scores on the Hostility Scale magnify the implications of elevations on other scales because the youth is in a state of social alienation, and thus is not well able to take into account the needs or feelings of others 24

Clinical Utility of the AQ • Indirect Aggression (IND) Scale – Possible scores range from 6 to 30 – Clinical cutpoint • 20 or higher – Assesses the tendency to express anger in actions that avoid direct confrontation – High scores may be reflective of youth experiencing chronic frustration and disrupted peer relationships, largely as a result of an inability to satisfactorily resolve circumstances that lead to anger 25

Clinical Utility of the Aggression Questionnaire© • Assesses a variety of specific aspects of youth self-reported anger and aggression – e. g. , physical, verbal, indirect • Informs which aspects of aggressive tendencies youth have the greatest need for intervention • Comparisons of pre/post scores demonstrate treatment-related outcomes in specific aspects of anger and aggression 26

Summary of AQ Score Ranges and Clinical Cutpoints AQ Scale Range of possible scores Clinical Cutpoint Males: 30 Physical Aggression (PHY) 8 to 40 Verbal Aggression (VER) 5 to 25 18 Anger (ANG) 7 to 35 24 Hostility (HOS) 8 to 40 26 Indirect Aggression (IND) 6 to 35 20 34 to 170 110 Total Score Females: 26 27

Palette of Measures Data Entry and Data Submissions 28

Palette of Measures Data Entry Shell • There is a separate spreadsheet in the excel workbook (aka database) for each type of data: – Demographics & Services – Pre- General outcome measure – Post- General outcome measure – Pre- Target-specific measure(s) – Post- Target-specific outcome measure(s) • Specific outcome measure spreadsheets included in each agency’s database varies across Palette of Measures project participants 29

Palette of Measures Data Entry Shell • In addition to the spreadsheets that hold data. . . – There is an Instructions spreadsheet • Basic data entry instructions • Contact information for T. A. (Cricket Mitchell) – There is a Data Lists spreadsheet at the end of the workbook that you will not use • Data Lists populate the pull-down menus in other spreadsheets 30

Palette of Measures Data Entry: AQ Pre-AQ Client ID# Date of Self-Report (ages 9+) Aggression Questionnaire Raw Scores Assessment AQTot 1 AQ-PA 1 AQ-VA 1 AQ-H 1 AQ-IN 1 • There is a separate spreadsheet for Pre-AQ data, Post-AQ data, and Mid-AQ data • In each spreadsheet, there is a separate field for each of the AQ Scale Scores and Total Scores • In the event of missing data, leave the fields blank/empty. Do not enter text into any of the fields. 31

Palette of Measures Data Entry: AQ Mid-AQ Date of Client ID# Self-Report (ages 9+) Aggression Questionnaire Raw Assessment Scores Assessment Interval AQTot. M AQ-PAM AQ-VAMAQ-AM AQ-HM AQ-INM • For agencies who will conduct mid-treatment assessments, indicate the Assessment Interval in the Mid-AQ spreadsheet by selecting from the available pull-down menu • e. g. , 1 st mid-treatment assessment, 2 nd mid-treatment assessment 32

But, before you enter any outcome data, you’ll enter Demographics & Service Delivery Information. . . 33

Palette of Measures Data Entry: Demographics & Services (1 of 2) Client Information: Client ID# DOB Primary (DSM-IV code) Gender Ethnicity Language Primary Axis I Secondary Axis I Therapist ID • Use a unique identifier for Client ID# • Categorical variables will have pull-down menus from which you’ll select an option (e. g. , gender, ethnicity, language) • Dates should be entered as xx/xx/xxxx • Axis I diagnoses s/b the numeric DSM-IV code • Therapist ID is optional 34

Palette of Measures Data Entry: Demographics & Services (2 of 2) Focus 1 of Treatment Date of First Session Focus 1 Date of Total # Completed Last of Sessions Focus 1? (if Focus 1 not completed) Completed (if Services not completed) Reason Services? Reason • Select Focus from pull-down menu (e. g. , anxiety, depression) • The shell will hold data for up to 4 foci, or treatment targets • Enter Date of First Session • The remaining fields are to be completed at the end of treatment targeting this particular focus (e. g. , Date of Last, # Sessions) • 2 levels of “Completed? ” • Treatment targeting this particular focus • Overall service delivery 35

Palette of Measures Data Submissions (slide 1 of 3) • Data submissions to Ci. MH will occur twice a year throughout the duration of the project – The end of each May (reflecting all clients served from the initiation of the project through the end of that April) – The end of each December (reflecting all clients served from the initiation of the project through the end of that November) – Note that this is the anticipated schedule; actual data submission dates may vary slightly • An email notice will be sent to Palette of Measures site leads approximately one month in advance of each data submission deadline 36

Data Submissions (slide 2 of 3) • Providers may choose from among the following methods for submitting their Palette of Measures Excel databases to Ci. MH: – Use You. Send. It, or another secure web-based transfer site, to submit data electronically • You. Send. It (www. You. Send. It. com) is a vendor that supports the secure transfer of electronic data (encrypted and passwordprotected) – Mail a password-protected CD to Ci. MH and submit the password separately (via email or phone) – Email an encrypted, password-protected file(s) to Ci. MH and submit the password separately (via email or phone) 37

Data Submissions (slide 3 of 3) • After data are submitted, sites continue to enter new data into the same database – Always reflects an ongoing, historical record of clients served through the Palette of Measures project • Every effort is made to distribute reports within two months of each data submission – Aggregate and site/agency-specific reports 38

Questions 39

The End Contact Information • Cricket Mitchell, Ph. D • Email: cmitchell@cimh. org • Cell phone: 858 -220 -6355 40