Ci MH Palette of Measures Evaluation Training Revised

Ci. MH Palette of Measures Evaluation Training: Revised Child Anxiety and Depression Scale (RCADS) 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… • Revised Child Anxiety and Depression Scale (RCADS) – In the public domain, no fee for use 3

Overview of Training • Brief Overview of Palette of Measures evaluation protocol • Revised Child Anxiety and Depression Scale (RCADS): Target-specific measure when the focus of treatment is anxiety – Administration – Scoring – Clinical Utility • Instructions for Palette of Measures data entry and data submissions – Data entry: RCADS – 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

Revised Child Anxiety and Depression Scales (RCADS) 9

CIMH RCADS Training • Information on the RCADS and RCADS-P was obtained from: – Psychometric properties of the Revised Child Anxiety and Depression Scale in a Clinical Sample (Bruce Chorpita, Catherine Moffitt, & Jennifer Gray; Behaviour Research and Therapy, 2005) – A psychometric analysis of the Revised Child Anxiety and Depression Scale – Parent version in a clinical sample (Chad Ebesutani, Adam Bernstein, Brad Nakamura, Bruce Chorpita & John Weisz; Journal of Abnormal Child Psychology, 2010) – A psychometric analysis of the Revised Child Anxiety and Depression Scale – Parent version in a school sample (Chad Ebesutani, Bruce Chorpita, Charmaine Higa. Mc. Millan, Brad Nakamura, Jennifer Regan, & Roxanna Lynch; Journal of Abnormal Child Psychology, 2010) 10

RCADS and RCADS-P v. Please refer to the UCLA Child First website periodically for updated materials – http: //www. childfirst. ucla. edu/resources. html – e. g. , a User’s Manual was released and posted on this website Feb 2, 2011 11

RCADS and RCADS-P Description Descripti • Target-specific measure when the focus of treatment is anxiety • Measures the current frequency of anxiety symptoms (and depression) – Parent/caregiver report for ages 6 -18 – Child self-report for ages 6 -18 • Valid and reliable • Available in the public domain, provided to partnering agencies by Ci. MH 12

RCADS and RCADS-P Description Descripti • Parallel versions of the same measure • 47 items • 4 -point Likert scale response options – – Never (0) Sometimes (1) Often (2) Always (3) • Six Scale Scores – – – Separation Anxiety Generalized Anxiety Panic Social Phobia Obsessions/ Compulsions – Depression • Total Anxiety Score • Total Anxiety and Depression Score 13

RCADS and RCADS-P Administration • Administer pre- and post- a dose of treatment, or an intervention interval – RCADS completed by client – RCADS-P completed by mother/mother figure or father/father figure (when available) • Both can be completed for clinical purposes; however, only one should be entered for outcome tracking purposes – Select parent/caregiver who spends most time with client 14

Let’s take a look at the RCADS. . . 15

RCADS and RCADS-P Administration • Approximately 5 -10 minutes to complete • Youth are asked to report how often each item applies to them (“. . . how often each of these things happen to you? ”) – Parents/caregivers are asked to report how often each of these items applies to their child • Can be read aloud if desired/necessary 16

RCADS and RCADS-P Administration • Encourage honest responses – Informants can easily be influenced by the attitude of the person administering the scale – Let respondents know that this questionnaire will help you, as a clinician, better understand how they are doing and how you can best help them • There are no right or wrong answers • Encourage responses on all items 17

RCADS and RCADS-P Scoring • RCADS and RCADS-P Scoring Worksheet – Appropriate for entire age range of 6 -18 – For each Scale, transfer the values associated with the child or parent’s responses next to the appropriate Question # • Sum the values to determine each Scale score – To obtain the Total Anxiety Score: • Sum the Separation Anxiety, Generalized Anxiety, Panic, Social Phobia, and Obsessions/Compulsions Scale Scores – To obtain the Total Anxiety and Depression Score: • Sum all Scale scores 18

RCADS and RCADS-P Scoring • Excel Scoring Programs – Appropriate for children in grades 3 -12 • Should not be used to score RCADS or RCADS-P measures for children younger than grade 3 – Available from UCLA Child First website • http: //www. childfirst. ucla. edu/resources. html – Enter the values associated with the child or parent’s responses next to the appropriate Question # – Scale Scores and Total Scores will automatically be calculated • T Scores are also generated 19

RCADS and RCADS-P Score Interpretation • T Score Interpretation for children in grades 3 -12 – T Scores are standardized scores that have a mean (average) of 50 and standard deviation of 10 • Automatically generated by UCLA Child First excel scoring programs; also available in User’s Manual – RCADS and RCADS-P • T Scores > 65 are borderline clinically significant • T Scores > 70 are clinically significant 20

RCADS and RCADS-P Score Interpretation • Raw score interpretation for children younger than grade 3 – **T Scores conversions have not yet been developed for children younger than grade 3** – Use clinical judgment in evaluating raw scores • What is the possible range of scores for this particular scale or total score? – Is this child’s score closer to the high end of the range? Or closer to the low end of the range? • Out of the total number of items assessed on this scale or within this total score, what proportion are endorsed at a 2 (“often”) or 3 (“always”)? 21

Clinical Utility of the RCADS • Provides both child self-report and parent/caregiver report of the same set of symptoms – Whenever possible, gathering information on the same construct from multiple informants is recommended – However, research has demonstrated little concordance between child self-report and parent -report (not specific to RCADS) • Disagreement should be viewed as different, yet equally valid perceptions of youth problems 22

Clinical Utility of the RCADS • Explicitly designed to assess symptomotology associated with current diagnostic systems • Each scale includes items that correspond to selected DSM-IV anxiety disorders • • • Separation Anxiety Disorder Social Phobia Generalized Anxiety Disorder Obsessive-Compulsive Disorder Panic Disorder Also includes a scale for DSM-IV Major Depression 23

Clinical Utility of the RCADS • For children grades 3 -12, T Scores at or above the clinical threshold (70) or borderline clinical threshold (65) indicate that the child is experiencing anxietyrelated symptoms that are most similar to children who meet diagnostic criteria for that particular disorder or syndrome (e. g. , social phobia, generalized anxiety) 24

Clinical Utility of the RCADS • Assesses symptoms associated with a range of DSM-IV anxiety diagnoses • Assists in initial clinical impressions and diagnostic formulations • Provides valuable information to guide treatment/interventions • Comparisons of pre/post scores reveal treatment-related improvement in child anxiety – e. g. , • Does the severity of diagnostic-specific anxiety symptoms decrease substantially? 25

Palette of Measures Data Entry and Data Submissions 26

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 27

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 28

Palette of Measures Data Entry: RCADS Pre-RCADS PARENT/CAREGIVER REPORT: (ages 6 -18) Date of RCADS-P (Raw Scale and Total Scores) Client ID# Assessment P-Sep 1 P-Gen 1 P-Pan 1 P-Soc 1 P-OC 1 P-Dep 1 P-Tot. Anx. Dep 1 • There is a separate spreadsheet for Pre-RCADS data, Post. RCADS data, and Mid-RCADS data • In each spreadsheet, there is a separate field for each of the Raw scores for all Scales, Total Anxiety, and Total Anxiety & Depression for both informants • In the event of missing data, please leave fields blank/empty 29

Palette of Measures Data Entry: RCADS Mid-RCADS PARENT/CAREGIVER REPORT: (ages 6 -18) Date of Assessment RCADS-P (Raw Scale and Total Scores) PPPPPPPClient ID# Assessment Interval Sep. M Gen. M Pan. M Soc. M OCM P-Dep. M Tot. Anx. Dep. M • For agencies who will conduct mid-treatment assessments, indicate the Assessment Interval in the Mid-RCADS spreadsheet by selecting from the available pull-down menu • e. g. , 1 st mid-treatment assessment, 2 nd mid-treatment assessment 30

But, before you enter any outcome data, you’ll enter Demographics & Service Delivery Information. . . 31

Palette of Measures Data Entry: Demographics & Services (1 of 2) Client Information: Primary (DSM-IV code) Client ID# DOB 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 32

Palette of Measures Data Entry: Demographics & Services (2 of 2) Focus 1 of Treatment Focus 1 Date of First Session 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 33

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 34

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) 35

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 36

Questions 37

The End Contact Information • Cricket Mitchell, Ph. D • Email: cmitchell@cimh. org • Cell phone: 858 -220 -6355 38