Presented By: Trish Gann, LPC The use of the DSM-5 Cross-Cutting Measures as Outcome Measurement Tools Presented By: Trish Gann, LPC

What are the DSM-5 Cross-Cutting Measures? Screening tools aka “Assessment Measures” are discussed (and a few are included) in Section III of the DSM-5 (American Psychiatric Association, 2013, pp. 733-748). “For further clinical evaluation and research, the APA is offering a number of “emerging measures” in Section III of DSM-5. These patient assessment measures were developed to be administered at the initial patient interview and to monitor treatment progress, thus serving to advance the use of initial symptomatic status and patient reported outcome (PRO) information, as well as the use of “anchored” severity assessment instruments.) (pp. 733-748). 

The following assessment measures are provided in the DSM-5 print book: DSM-5 Self-rated Level 1 Cross-Cutting Symptom Measure – Adult (pp. 738-739). Parent/Guardian-rated DSM-5 Level 1 Cross-Cutting Symptom Measure- Child Age 6-17 (pp. 740-741). Clinician Rated Dimensions of Psychosis Symptom Severity (p. 743). World Health Organization Disability Assessment Schedule 2.0 (pp. 745-748). (Note: Not all of the measures are in the book, you will need to go to the website to obtain the measures if you do not have a print copy.)

Online All of the assessment measures are available online @ www.psychiatry.org/dsm5 . Click on the online assessment measures link

Online Assessment Measures Level 1 Cross-Cutting Symptom Measures Level 2 Cross-Cutting Symptom Measures Disorder-Specific Severity Measures Disability Measures Personality Inventories Early Development and Home Background Cultural Formulation Interviews 

What is the rationale for the use of these measures? Begin with a brief screening tool written in laymen's terms. Provide additional measures that focus on domains of concern. Severity measures are available. Can be used as standard outcome measures. Reflect current best practices. Correspond to the DSM-5 diagnostic criteria and suggest directions for differential diagnoses.

How do we use them? We can use one brief measure that then suggests follow-up measures to be used to gain more detail in the areas (domains) of interest. Specifically, the scoring suggests a diagnostic direction (level one measures) which leads to further questioning (level two measures) and helps clinicians to determine severity.

Cross-Cutting Measures: Level One Cross-Cutting Symptom Measures Adult Child- Two versions of the level one measure DSM-5 Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure—Child Age 6–17 DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Child Age 11–17 Level Two Cross-Cutting Symptom Measures Adult- 8 different tools covering 13 Domains (no tool given for 5 of the domains) Child (for both level one measures)- 9 different tools covering 12 Domains (no tool given for 3 domains)

Level Two Measures: Domain I through IV Depression Adult (PROMIS Emotional Distress- Depression-Short Form) Domain II. Anger Adult (PROMIS Emotional Distress- Anger-Short Form) Domain III. Mania Mania- Adult (Altman Self-Rating Mania Scale) Domain IV. Anxiety Adult (PROMIS Emotional Distress- Anxiety-Short Form)

Level Two Measures: Domain V through VIII Somatic Symptoms Somatic Symptom- Adult (Patient Health Questionnaire 15 Somatic Symptom Severity [PHQ-15}) Domain VI. Suicidal Ideation No level two measure. Follow your company procedures. Domain VII. Psychosis No level two measure. Domain VIII. Sleep Problems Sleep Disturbance - Adult (PROMIS Sleep Disturbance-Short Form)

Level Two Measures: Domain IX through XIII Memory No level two measure. Domain X. Repetitive Thoughts and Behaviors Repetitive Thoughts and Behaviors – Adult (adapted from the Florida Obsessive-Compulsive Inventory [FOCI] Severity Scale [Part B]). Domain XI. Dissociation Domain XII. Personality Functioning Domain XIII. Substance Use Substance Abuse – Adult (adapted from the NIDA-modified ASSIST)

Appropriateness to Identified Population Appropriate and supported by APA

Administration and Scoring Any staff can administer, professionals interpret Level I and must score Level II. Level II scoring T-scores from individual tables. Minimal training required to interpret Level II scores. None for administration.

Time Taken to Administer Level I - 5 to 15 minutes 23 questions. Level II – time varies based on # of questions, no more than 5-10 minutes.

Costs of Administering and Purchasing Tool Free (paper and pencil version) Computer Version not available, but can possibly be computerized with author’s permission.

Age Range Children 6-17 There is also an adult version

Sensitivity to Change Instrument was designed to pick up change, no current research at this time to validate.

Reliability Level 1 reliabilities are presented first. All level 1 items were rated reliably by adult patients, with ICC estimates in the “good” range or better, except the two mania items which were in the “questionable” range. For parents of children under 11 years old, ICC estimates were in the good or excellent range for 19 of the 25 items in the cross-cutting symptom assessment. Two items fell into the questionable range (anxiety item 3 [“cannot do things because of nervousness”] and repetitive thoughts item 1 [“unpleasant thoughts, images or urges entering mind”]) and one item had unacceptable reliability (“misuse of legal drugs”). Lack of variability in responses prevented ICC estimation for the remaining three substance use items in this age group. Parents of children age 11 and over rated the cross-cutting items very reliably, with all ICCs in the good or excellent range except misuse of legal drugs. Reliabilities for child respondents were good or excellent for 17 items. Six items had questionable reliability: both mania items, anxiety item 3, somatic distress item 2 (“worried about health”), psychosis item 2 (“had a vision/saw things”), and repetitive thoughts item 1. Reliability coefficients for the remaining two substance use items (use of illegal drugs, misuse of legal drugs) are not presented because of instability of estimates at sites (i.e., the confidence interval range is over 0.5). There were no significant differences between child and parent reliability estimates, with the following exceptions: parents were more reliable reporters than children for somatic distress item 2, both psychosis items, and sleep. Children were more reliable in reporting “ever attempting suicide”.

Questions?