Cricket Mitchell, PhD CiMH Senior Associate Use of the Patient Health Questionnaire-9 (PHQ-9) with DTQI in Ventura County Cricket Mitchell, PhD CiMH Senior Associate Ventura DTQI PHQ-9 Training

Overview of Training Importance of Incorporating Standardized Data Patient Health Questionnaire (PHQ-9) with DTQI PHQ-9 Description Administration Scoring Clinical Utility Tracking Clinical Progress in DTQI Outcome Assessment using the PHQ-9 Materials you will need PHQ-9 Individual DTQI Client PHQ-9 Progress Graph Ventura DTQI PHQ-9 Training

Importance of Incorporating Standardized Data Collection into Clinical Practice Assessment is the beginning of developing a relationship with the client Demonstrates a desire to know what the youth is experiencing By incorporating standardized measures of functioning, the efficiency and thoroughness of assessment is enhanced TFCBT Evaluation Training

Importance of Incorporating Standardized Data Collection into Clinical Practice Using standardized measures of functioning… Assists in initial clinical impressions Provides valuable information to guide treatment/interventions Tracks treatment progress over time Assesses sufficiency of treatment delivered Demonstrates treatment-related improvements in youth functioning TFCBT Evaluation Training

Patient Health Questionnaire - 9 (PHQ-9) Ventura DTQI PHQ-9 Training

CIMH PHQ-9Training Information on the administration, scoring, and clinical utility of the PHQ-9 was obtained from: The PHQ-9: Validity of a Brief Depression Severity Measure (Kurt Kroenke, Robert Spitzer, and Janet Williams; Journal of General Internal Medicine, 2001) Patient Health Questionnaire 9 Validated for Depression Screening in Adolescents (Penny Murata; Pediatrics, 2010) The National Council for Community Behavioral Healthcare, http://www.thenationalcouncil.org/cs/best_practices_programs Ventura DTQI PHQ-9 Training

PHQ-9 Description Target-specific/Symptom-specific measure of functioning To be used when the focus of treatment is depression Measures the current severity of depressive symptoms Self-report for ages 12+ Brief Valid and reliable Sensitive to clinical change Available in the public domain at no charge 7 7

PHQ-9 Description 9 items – reflect the 9 symptoms of DSM-IV diagnostic criteria for depression 4-point Likert scale response options Not at all (0) Several days (1) More than half the days (2) Nearly every day (3) 10th item not scored, assesses functional impairment 8 TFCBT Evaluation Training 8

Let’s take a look at the PHQ-9... Ventura DTQI PHQ-9 Training

PHQ-9 Administration Approximately 2 minutes to complete Youth complete independently Can be read aloud if necessary/desired “Over the last 2 weeks...” Encourage honest responses Informants can easily be influenced by the attitude of the person administering the scale Let youth know that this questionnaire will help you, as a clinician, better understand how they are doing and how you can best help them Encourage responses on all items Ventura DTQI PHQ-9 Training

PHQ-9 Scoring Sum the items in the column labeled “Several days”, and put that number on the line below that column Alternatively, you could count the number of items that have been circled in this column and multiply by 1 Sum the items in the column labeled “More than half the days”, and put that number on the line below that column Alternatively, you could count the number of items that have been circled in this column and multiply by 2 Sum the items in the column labeled “Nearly every day”, and put that number on the line below that column Alternatively, you could count the number of items that have been circled in this column and multiply by 3 Add the three subtotals together to obtain the Total Severity Score In other words… sum all responses on items 1 thru 9 Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 The PHQ-9 is a multipurpose tool that has been used for: Screening Diagnosing Monitoring Measuring the severity of depression Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 For initial provisional diagnosis... If there are at least 4 “3’s” – including Q#1 and/or Q#2 – consider a depressive disorder Consider a Major Depressive Disorder diagnosis... If there are at least 5 “3’s” One of which must correspond to either Q#1 or Q#2 Consider Other Depressive Disorder... If there are between 2 and 4 “3’s” Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 Diagnoses of Major Depressive Disorder or Other Depressive Disorder also require: Impairment of social, occupational, or other important areas of functioning See Q#10 And ruling out normal bereavement, a history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 Total Score indicates Depression Severity: Total Score Depression Severity 1-4 Minimal depression 5-9 Mild depression 10-14 Moderate depression 15-19 Moderately severe depression 20-27 Severe depression Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 Question #9 Assesses presence and duration of suicidal ideation Review this carefully after a youth has completed the measure A “2” or “3”, reflecting more than half the days or nearly every day, requires additional assessment Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 with DTQI Assessing Initial Severity of Depression Treatment Monitoring / Tracking Clinical Progress Periodic assessments provide valuable information regarding symptom severity relative to treatment/interventions Outcome Assessment Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 with DTQI In DTQI, the PHQ-9 will be administered (at least) four times: Pre-DTQI After Phase I (presumably, as you transition from the Activities module to the Thoughts module) After Phase II (presumably, as you transition from the Thoughts module to the Social module) Post-DTQI Ventura DTQI PHQ-9 Training

Clinical Utility of the PHQ-9 with DTQI Individual client PHQ-9 scores are shared with Maggie Rea (or other DTQI clinical expert/trainer) to guide the clinical consultation Total scores on the PHQ-9 provide valuable information regarding the severity level of an individual client’s depressive symptomotology Ventura DTQI PHQ-9 Training

Individual DTQI Client PHQ-9 Progress Graph VCBH ID: ________________ Client Name: __Example_____________________ DTQI Therapist:: _________________________________ 27 20-27 = Severe 25 15-19 = Moderate Severe Depression 23 21 10-14 = Moderate Depression 19 5-9 = Mild Depression X 17 15 PHQ-9 Score 0-4 = None/minimal 13 X 11 X 9 Clients appreciate seeing their treatment progress as much as you do!! 7 X 5 3 Date: Year: / 20 __ / 20 __ / 20 __ / 20 __ End of Phase 1 End of Phase 2 Pre-DTQI Post-DTQI

Using the Individual DTQI Client PHQ-9 Graph Print as a ‘Slide’ and you will get the graph on a full-page Use one per client Enter the Date of the Assessment at the appropriate interval (Pre-DTQI, End of Phase I, etc.) Plot the PHQ-9 score on the graph within the appropriate assessment interval Once multiple scores are plotted, connect the scores with a solid line

Outcome Assessment Using the PHQ-9 Comparisons of Pre- and Post- scores reveal specific areas of treatment-related improvement in child depression e.g., Does the severity of depression symptoms decrease substantially after participation in DTQI? Is there improvement across all domains of depressive symptoms? Ventura DTQI PHQ-9 Training

Outcome Assessment Using the PHQ-9 Data entry instructions for the Pre-DTQI and Post-DTQI PHQ-9 scores will be forthcoming from Behavioral Health Anticipated to begin July 1, 2012 Data collection for outcome assessment will begin with new clients Must have a true Pre-DTQI score to evaluate outcomes Data collection for monitoring clinical progress should begin immediately with current clients Ventura DTQI PHQ-9 Training

Materials You Will Need PHQ-9 Provided in English and in Spanish Additional language versions are available at: http://www.phqscreeners.com/overview.aspx?Screener=02_PHQ-9 Individual DTQI Client PHQ-9 Graph Provided in PowerPoint along with Example

Questions Ventura DTQI PHQ-9 Training

The End Contact Information Cricket Mitchell, PhD Email: cmitchell@cimh.org Cell phone: 858-220-6355 Ventura DTQI PHQ-9 Training