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
Miranda WolpertTamsin Ford

Abstract

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. 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. 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). Findings indicate that the level of agreement across approaches is at least mod...Continue Reading

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Citations

Jul 10, 2019·Pilot and Feasibility Studies·Maya YaariHarriet Hiscock
Aug 22, 2018·Frontiers in Psychology·Cristina Cañete-MasséJoan Guàrdia-Olmos
Apr 13, 2020·Maternal and Child Health Journal·Gillian M MaherAli S Khashan
Apr 30, 2020·The British Journal of Psychiatry : the Journal of Mental Science·Jessica DeightonMiranda Wolpert
Nov 18, 2015·BMC Psychiatry·Benjamin Kwan, Debra J Rickwood
May 16, 2021·European Child & Adolescent Psychiatry·Katie FinningTamsin Ford
Nov 7, 2021·BMC Women's Health·Ola DemkowiczNeil Humphrey

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