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

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Wolpert, Miranda, Görzig, Anke ORCID: https://orcid.org/0000-0002-7623-0836, 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. ISSN 1475-357X

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Official URL: https://doi.org/10.1111/camh.12080

Abstract

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.

Item Type:	Article
Identifier:	10.1111/camh.12080
Additional Information:	© 2014 Association for Child and Adolescent Mental Health. This is the accepted version of the following article: Wolpert, M., Görzig, A., Deighton, J., Fugard, A. J.B., Newman, R. and Ford, T. (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 Adolesc Ment Health, 20: 94–101, which has been published in final form at https://doi.org/10.1111/camh.12080.
Keywords:	Indices of change; child mental health; difference scores; crossing clinical threshold; reliable change index; added value scores
Subjects:	Medicine and health > Mental health Medicine and health > Child health Psychology Social sciences
Depositing User:	Anke Görzig
Date Deposited:	18 Dec 2015 13:17
Last Modified:	04 Nov 2024 12:20
URI:	https://repository.uwl.ac.uk/id/eprint/1445