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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
Author(s) -
Wolpert Miranda,
Görzig Anke,
Deighton Jessica,
Fugard Andrew J.B.,
Newman Robbie,
Ford Tamsin
Publication year - 2015
Publication title -
child and adolescent mental health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.912
H-Index - 46
eISSN - 1475-3588
pISSN - 1475-357X
DOI - 10.1111/camh.12080
Subject(s) - mental health , index (typography) , medicine , clinical practice , psychology , demography , psychiatry , family medicine , computer science , world wide web , sociology
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.