Cricket Mitchell, PhD CIMH Evaluation Consultant

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

2. 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

3. 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

4. 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

5. Brief Overview of Palette of Measures Evaluation Protocol

6. 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

7. 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

8. 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

9. Revised Child Anxiety and Depression Scales (RCADS)

10. 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, CharmaineHiga-McMillan, Brad Nakamura, Jennifer Regan, & Roxanna Lynch; Journal of Abnormal Child Psychology, 2010)

11. 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

12. 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

13. 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

14. 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

15. Let’s take a look at the RCADS...

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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”)?

22. 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

23. 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

24. 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)

25. 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?

26. Palette of Measures Data Entry and Data Submissions

27. 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

28. 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

29. Palette of Measures Data Entry: RCADS • 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

30. Palette of Measures Data Entry: RCADS • 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

31. But, before you enter any outcome data, you’ll enter Demographics & Service Delivery Information...

32. Palette of Measures Data Entry: Demographics & Services (1 of 2) • 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

33. Palette of Measures Data Entry: Demographics & Services (2 of 2) • 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

34. 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

35. 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)

36. 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

37. Questions

38. The End • Contact Information • Cricket Mitchell, PhD • Email: cmitchell@cimh.org • Cell phone: 858-220-6355