Cricket Mitchell, PhD CIMH Evaluation Consultant CiMH Palette of Measures Evaluation Training: Revised Child Anxiety and Depression Scale (RCADS) Cricket Mitchell, PhD CIMH Evaluation Consultant Palette of Measures Evaluation Training: RCADS

Palette of Measures Evaluation: What You Will Need (slide 1 of 2) Palette of Measures Data Entry Shell v2 (Excel file) Developed by CiMH and customized for each participating agency Holds all data for clients served thru the Palette of Measures project Demographics, service delivery information, pre- and post- outcome measure data Palette of Measures Data Dictionary v2 (Word document) A guide for using the associated data entry shell Defines each column in the excel file Palette of Measures Evaluation Training: RCADS

Palette of Measures Evaluation: What You Will Need (slide 2 of 2) Outcome measures from the two-pronged approach General Outcome Measure Target-Specific Outcome Measure(s) For example… Revised Child Anxiety and Depression Scale (RCADS) In the public domain, no fee for use Palette of Measures Evaluation Training: RCADS

Overview of Training Brief Overview of Palette of Measures evaluation protocol Revised Child Anxiety and Depression Scale (RCADS): Target-specific measure when the focus of treatment is anxiety Administration Scoring Clinical Utility Instructions for Palette of Measures data entry and data submissions Data entry: RCADS Data entry: Demographics & Services Data submissions to CiMH Palette of Measures Evaluation Training: RCADS

Brief Overview of Palette of Measures Evaluation Protocol Palette of Measures Evaluation Training: RCADS

Outcome Assessment Palette of Measures providers will track outcomes using data from pre- and post- administrations of standardized measures of functioning Pre- and Post- a “dose” of treatment / an intervention interval General measure of youth mental health functioning (e.g., YOQ/YOQ-SR, CANS, Ohio Scales) Target-specific measure linked to focus of treatment/intervention (e.g., AQ, ECBI, PHQ-9, PTSD-RI, RCADS) Providers may choose to administer mid-course assessments as well e.g., at 3-month intervals in usual care Palette of Measures Evaluation Training: RCADS

A note about the use of standardized assessment measures… (slide 1 of 2) Assessment is the beginning of developing a relationship with the child and family Demonstrates a desire to know what the child and family are experiencing By incorporating standardized assessment measures of functioning, the efficiency and thoroughness of assessment is enhanced Palette of Measures Evaluation Training: RCADS

A note about the use of standardized assessment measures… (slide 2 of 2) Using standardized assessment measures of functioning… Assists in initial clinical impressions Provides valuable information to guide treatment/interventions Assesses sufficiency of treatment delivered Demonstrates treatment-related improvements in child functioning Palette of Measures Evaluation Training: RCADS

Revised Child Anxiety and Depression Scales (RCADS) Palette of Measures Evaluation Training: RCADS

CIMH RCADS Training Information on the RCADS and RCADS-P was obtained from: Psychometric properties of the Revised Child Anxiety and Depression Scale in a Clinical Sample (Bruce Chorpita, Catherine Moffitt, & Jennifer Gray; Behaviour Research and Therapy, 2005) A psychometric analysis of the Revised Child Anxiety and Depression Scale – Parent version in a clinical sample (Chad Ebesutani, Adam Bernstein, Brad Nakamura, Bruce Chorpita & John Weisz; Journal of Abnormal Child Psychology, 2010) A psychometric analysis of the Revised Child Anxiety and Depression Scale – Parent version in a school sample (Chad Ebesutani, Bruce Chorpita, Charmaine Higa-McMillan, Brad Nakamura, Jennifer Regan, & Roxanna Lynch; Journal of Abnormal Child Psychology, 2010) Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Please refer to the UCLA Child First website periodically for updated materials http://www.childfirst.ucla.edu/resources.html e.g., a User’s Manual was released and posted on this website Feb 2, 2011 Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Description Target-specific measure when the focus of treatment is anxiety Measures the current frequency of anxiety symptoms (and depression) Parent/caregiver report for ages 6-18 Child self-report for ages 6-18 Valid and reliable Available in the public domain, provided to partnering agencies by CiMH 12 12

RCADS and RCADS-P Description Parallel versions of the same measure 47 items 4-point Likert scale response options Never (0) Sometimes (1) Often (2) Always (3) Six Scale Scores Separation Anxiety Generalized Anxiety Panic Social Phobia Obsessions/ Compulsions Depression Total Anxiety Score Total Anxiety and Depression Score 13 TFCBT Evaluation Training 13

RCADS and RCADS-P Administration Administer pre- and post- a dose of treatment, or an intervention interval RCADS completed by client RCADS-P completed by mother/mother figure or father/father figure (when available) Both can be completed for clinical purposes; however, only one should be entered for outcome tracking purposes Select parent/caregiver who spends most time with client Palette of Measures Evaluation Training: RCADS

Let’s take a look at the RCADS... Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Administration Approximately 5-10 minutes to complete Youth are asked to report how often each item applies to them (“...how often each of these things happen to you?”) Parents/caregivers are asked to report how often each of these items applies to their child Can be read aloud if desired/necessary Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Administration Encourage honest responses Informants can easily be influenced by the attitude of the person administering the scale Let respondents know that this questionnaire will help you, as a clinician, better understand how they are doing and how you can best help them There are no right or wrong answers Encourage responses on all items Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Scoring RCADS and RCADS-P Scoring Worksheet Appropriate for entire age range of 6-18 For each Scale, transfer the values associated with the child or parent’s responses next to the appropriate Question # Sum the values to determine each Scale score To obtain the Total Anxiety Score: Sum the Separation Anxiety, Generalized Anxiety, Panic, Social Phobia, and Obsessions/Compulsions Scale Scores To obtain the Total Anxiety and Depression Score: Sum all Scale scores Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Scoring Excel Scoring Programs Appropriate for children in grades 3-12 Should not be used to score RCADS or RCADS-P measures for children younger than grade 3 Available from UCLA Child First website http://www.childfirst.ucla.edu/resources.html Enter the values associated with the child or parent’s responses next to the appropriate Question # Scale Scores and Total Scores will automatically be calculated T Scores are also generated Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Score Interpretation T Score Interpretation for children in grades 3-12 T Scores are standardized scores that have a mean (average) of 50 and standard deviation of 10 Automatically generated by UCLA Child First excel scoring programs; also available in User’s Manual RCADS and RCADS-P T Scores > 65 are borderline clinically significant T Scores > 70 are clinically significant Palette of Measures Evaluation Training: RCADS

RCADS and RCADS-P Score Interpretation Raw score interpretation for children younger than grade 3 **T Scores conversions have not yet been developed for children younger than grade 3** Use clinical judgment in evaluating raw scores What is the possible range of scores for this particular scale or total score? Is this child’s score closer to the high end of the range? Or closer to the low end of the range? Out of the total number of items assessed on this scale or within this total score, what proportion are endorsed at a 2 (“often”) or 3 (“always”)? Palette of Measures Evaluation Training: RCADS

Clinical Utility of the RCADS Provides both child self-report and parent/caregiver report of the same set of symptoms Whenever possible, gathering information on the same construct from multiple informants is recommended However, research has demonstrated little concordance between child self-report and parent-report (not specific to RCADS) Disagreement should be viewed as different, yet equally valid perceptions of youth problems Palette of Measures Evaluation Training: RCADS

Clinical Utility of the RCADS Explicitly designed to assess symptomotology associated with current diagnostic systems Each scale includes items that correspond to selected DSM-IV anxiety disorders Separation Anxiety Disorder Social Phobia Generalized Anxiety Disorder Obsessive-Compulsive Disorder Panic Disorder Also includes a scale for DSM-IV Major Depression Palette of Measures Evaluation Training: RCADS

Clinical Utility of the RCADS For children grades 3-12, T Scores at or above the clinical threshold (70) or borderline clinical threshold (65) indicate that the child is experiencing anxiety-related symptoms that are most similar to children who meet diagnostic criteria for that particular disorder or syndrome (e.g., social phobia, generalized anxiety) Palette of Measures Evaluation Training: RCADS

Clinical Utility of the RCADS Assesses symptoms associated with a range of DSM-IV anxiety diagnoses Assists in initial clinical impressions and diagnostic formulations Provides valuable information to guide treatment/interventions Comparisons of pre/post scores reveal treatment-related improvement in child anxiety e.g., Does the severity of diagnostic-specific anxiety symptoms decrease substantially? Palette of Measures Evaluation Training: RCADS

Palette of Measures Data Entry and Data Submissions Palette of Measures Evaluation Training: RCADS

Palette of Measures Data Entry Shell There is a separate spreadsheet in the excel workbook (aka database) for each type of data: Demographics & Services Pre- General outcome measure Post- General outcome measure Pre- Target-specific measure(s) Post- Target-specific outcome measure(s) Specific outcome measure spreadsheets included in each agency’s database varies across Palette of Measures project participants Palette of Measures Evaluation Training: RCADS

Palette of Measures Data Entry Shell In addition to the spreadsheets that hold data... There is an Instructions spreadsheet Basic data entry instructions Contact information for T.A. (Cricket Mitchell) There is a Data Lists spreadsheet at the end of the workbook that you will not use Data Lists populate the pull-down menus in other spreadsheets Palette of Measures Evaluation Training: RCADS

Palette of Measures Data Entry: RCADS Pre-RCADS   PARENT/CAREGIVER REPORT: (ages 6-18) Date of RCADS-P (Raw Scale and Total Scores) Client ID# Assessment P-Sep1 P-Gen1 P-Pan1 P-Soc1 P-OC1 P-Dep1 P-TotAnx1 P-TotAnxDep1 There is a separate spreadsheet for Pre-RCADS data, Post-RCADS data, and Mid-RCADS data In each spreadsheet, there is a separate field for each of the Raw scores for all Scales, Total Anxiety, and Total Anxiety & Depression for both informants In the event of missing data, please leave fields blank/empty LA PEI MAP Evaluation Training: RCADS

Palette of Measures Data Entry: RCADS Mid-RCADS   PARENT/CAREGIVER REPORT: (ages 6-18) Date of Assessment RCADS-P (Raw Scale and Total Scores) Client ID# Interval P- SepM GenM P-PanM SocM OCM P-DepM P-TotAnxM P-TotAnxDepM For agencies who will conduct mid-treatment assessments, indicate the Assessment Interval in the Mid-RCADS spreadsheet by selecting from the available pull-down menu e.g., 1st mid-treatment assessment, 2nd mid-treatment assessment Palette of Measures Evaluation Training: AQ

But, before you enter any outcome data, you’ll enter Demographics & Service Delivery Information... Palette of Measures Evaluation Training: RCADS

Palette of Measures Data Entry: Demographics & Services (1 of 2) Client Information:    Primary (DSM-IV code) Client ID# DOB Gender Ethnicity Language Primary Axis I Secondary Axis I Therapist ID Use a unique identifier for Client ID# Categorical variables will have pull-down menus from which you’ll select an option (e.g., gender, ethnicity, language) Dates should be entered as xx/xx/xxxx Axis I diagnoses s/b the numeric DSM-IV code Therapist ID is optional Palette of Measures Evaluation Training: AQ

Palette of Measures Data Entry: Demographics & Services (2 of 2) Focus 1 of Treatment   Date of Total # Completed (if Focus 1 not completed) (if Services not completed) Focus1 First Session Last Session of Sessions Focus 1? Reason Services? Select Focus from pull-down menu (e.g., anxiety, depression) The shell will hold data for up to 4 foci, or treatment targets Enter Date of First Session The remaining fields are to be completed at the end of treatment targeting this particular focus (e.g., Date of Last, # Sessions) 2 levels of “Completed?” Treatment targeting this particular focus Overall service delivery Palette of Measures Evaluation Training: AQ

Palette of Measures Data Submissions (slide 1 of 3) Data submissions to CiMH will occur twice a year throughout the duration of the project The end of each May (reflecting all clients served from the initiation of the project through the end of that April) The end of each December (reflecting all clients served from the initiation of the project through the end of that November) Note that this is the anticipated schedule; actual data submission dates may vary slightly An email notice will be sent to Palette of Measures site leads approximately one month in advance of each data submission deadline Palette of Measures Evaluation Training: RCADS

Data Submissions (slide 2 of 3) Providers may choose from among the following methods for submitting their Palette of Measures Excel databases to CiMH: Use YouSendIt, or another secure web-based transfer site, to submit data electronically YouSendIt (www.YouSendIt.com) is a vendor that supports the secure transfer of electronic data (encrypted and password-protected) Mail a password-protected CD to CiMH and submit the password separately (via email or phone) Email an encrypted, password-protected file(s) to CiMH and submit the password separately (via email or phone) Palette of Measures Evaluation Training: RCADS

Data Submissions (slide 3 of 3) After data are submitted, sites continue to enter new data into the same database Always reflects an ongoing, historical record of clients served through the Palette of Measures project Every effort is made to distribute reports within two months of each data submission Aggregate and site/agency-specific reports Palette of Measures Evaluation Training: RCADS

Questions Palette of Measures Evaluation Training: RCADS

The End Contact Information Cricket Mitchell, PhD Email: cmitchell@cimh.org Cell phone: 858-220-6355 Palette of Measures Evaluation Training: RCADS