Wolpert, Miranda, Görzig, Anke ORCID: 0000-0002-7623-0836, Deighton, Jessica, Fugard, Andrew J.B. ORCID: 0000-0001-6507-2054, Newman, Robbie and Ford, Tamsin (2015) 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, 20 (2). pp. 94-101. ISSN 1475-357X (Print), 1475-3588 (Online) (doi:https://doi.org/10.1111/camh.12080)

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Abstract

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.

Item Type:	Article
Additional Information:	This article was first published online on the 24th of November 2014. It was corrected on the 2nd of January 2015. Corrections have been made to the formulae in Table 3 for d (effect size) and RCI; also the reference citations for effect size have been amended.
Uncontrolled Keywords:	reliable change index
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HM Sociology R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Vulnerable Children and Families Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Last Modified:	16 Mar 2022 11:25
URI:	http://gala.gre.ac.uk/id/eprint/35261

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