Wolpert, Miranda, Görzig, Anke, Deighton, Jessica, Fugard, Andrew J. B., Newman, Robbie and Ford, Tamsin (2015) Comparison of indices of clinically meaningful change in child and adolescent mental health services: difference scores, reliable change, crossing clinical thresholds and "added value" - an exploration using parent rated scores on the SDQ. Child and Adolescent Mental Health, 20 (2). pp. 94-101.
Wolpert_Gorzig_et_al_camh_repository.pdf - Accepted Version
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Background Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances. Method This paper reviews four indices of change [difference scores (DS), crossing clinical threshold (CCT), reliable change index (RCI) and added value scores (AVS)] drawing on outcome data for 9764 young people from child and adolescent mental health services across England. Results Looking at DS, the t-test for time one to time two scores indicated a significant difference between baseline and follow up scores, with a standardised effect size of d = 0.40. AVS analysis resulted in a smaller effect size of 0.12. Analysis of those crossing the clinical threshold showed 21.2% of cases were classified as recovered, while 5.5% were classified as deteriorated. RCI identified 16.5% of cases as showing reliable improvement and 2.3% of cases as showing reliable deterioration. Across RCI and CCT 80.5% of the pairings were exact (i.e., identified in the same category using each method). Conclusions Findings indicate that the level of agreement across approaches is at least moderate; however, the estimated extent of change varied to some extent based on the index used. Each index may be appropriate for different contexts: CCT and RCI may be best suited to use for individual case review; whereas DS and AVS may be more appropriate for case-mix adjusted national reporting.
|Subjects:||Medicine and health > Mental health
Medicine and health > Child health
|Depositing User:||Anke Goerzig|
|Date Deposited:||18 Dec 2015 13:17|
|Last Modified:||13 Jun 2016 13:53|
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