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

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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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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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Tiers of Mental Disorders

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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 implementes
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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Michael and Alexis share perspectives

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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, 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

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Rapid Assessment Inventories

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Measures offer an opportunity to share

perspectives on key problem areas

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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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Entering the data

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Automate the calculation of Subscales

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

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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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Graphically represent the results

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Change is Sub-scales is clear

BASIS-32 Subscale Scores over 3 time periods
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Daily living / Role functioning
[36]

Depression / Anxiety [24]

Relationship with self and others

[28]

14/07/2013

8/03/2013

14/09/2013

Psychosis [16]

Impulsive / Addictive [24]

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Change is Sub-scales is clear

Subscale Scores as Percentage of Total Subscale Problem
Identification - HoNOS
80.0%

70.0%

60.0%

50.0%
14/07/2013

40.0%

3/08/2013
30.0%

20.0%

10.0%

0.0%
Behavr

Impairmt

Symptm

Social

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Michael and Alexis share perspectives

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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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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 subgroup populations
Applying sub-scales method to routine outcome
measures
Importance of privacy issues in using measures

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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