Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience?

Abstract

Background: Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of this research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data. Method: We explored change in psychosocial difficulties and impact on daily life as evaluated by a broad standardized measure, the Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997, J. Child Psychol. Psychiatry, 38, 581) and progress toward goals as evaluated by a personalized idiographic measure, the Goal Based Outcomes tool (GBO) (Law, 2011, Goals and Goal Based Outcomes (GBOs): some useful information. London: CAMHS Press) in a sample of N = 137 CAMHS attenders. Results: Psychosocial difficulties and impact on daily life showed less change over the course of treatment than progress toward goals in this study. Change in psychosocial difficulties and impact on daily life were also less strongly associated with change in clinician-reported functioning and satisfaction with care at time two than change in progress toward goals. Conclusions: Findings of the present research may support previous studies in which service users and clinicians report that idiographic measures are more capable than standardized measures of capturing relevant change for individuals. Key Practitioner Message• For normative comparison and clinical purposes, it is important to know how to interpret change in standardized and idiographic measures in CAMHS.• Past research suggests that standardized measures (e.g. the Strengths and Difficulties Questionnaire or SDQ) may be less clinically useful than idiographic measures (e.g. the Goal Based Outcome tool or GBO), but more amenable for aggregation and therefore comparing groups of patients.• The SDQ showed less change than the GBO in this study in terms of mean score change and reliable change.• Change captured by the SDQ was less strongly associated with change in clinician-reported functioning and satisfaction with care at time two than change captured by the GBO, and only change in the GBO was uniquely associated with change in clinician-reported functioning over treatment.• Findings of this study suggest that change greater than 2.45 points in the GBO represents reliable change.

Effectiveness of school‐based humanistic counselling for psychological distress in young people: Pilot randomized controlled trial with follow‐up in an ethnically diverse sample

“…Young people are asked to identify up to three goals for therapy and, at each of the time points, rate on a 0–10 scale how much progress they feel they have made towards that goal. The GBO tool has shown convergent validity against measures of functioning and psychosocial difficulties, and acceptable levels of internal consistency (α = .71, Edbrooke‐Childs, Jacob, Law, Deighton, & Wolpert, ). The internal consistency in the present sample was .83 at 12 weeks.…”

Trajectories of care for children and adolescents with psychosocial problems: a 3‐year prospective cohort study

“…Studies on outcomes in naturalistic settings showed that children and adolescents with psychosocial problems who receive treatment experience some improvement, meaning less psychosocial problems were measured with SDQ at follow‐up (Deighton et al., ; Edbrooke‐Childs, Jacob, Law, Deighton, & Wolpert, ). In addition, another study showed a significant relationship between the number of treatment sessions (more than 8) and improvement in psychiatric symptoms (measured with the Child and Adolescent Psychiatric Assessment) at follow‐up (Angold, Costello, Burns, Erkanli, & Farmer, ).…”

Acceptability, reliability, referential distributions and sensitivity to change in the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE) outcome measure: replication and refinement

“…However, evidence of its psychometric properties is limited, and it has shown a strong negative skew at endpoint (Cooper, Stewart, Sparks, & Bunting, ). Goal‐based outcome measures are also strength‐oriented and, as idiographic measures, have the advantage of being adaptable to a wide range of individual concerns (Edbrooke‐Childs, Jacob, Law, Deighton, & Wolpert, ). As tools for service evaluation, however, they have the disadvantage of being more difficult to interpret, and compare, at the group level.…”