Download ppt - Assessing Change in Clinical Practice Richard Bost, Ph.D., ABPP Frances Wen, Ph.D. Michael Basso, Ph.D

Assessing Change in Clinical Practice

Richard Bost, Ph.D., ABPPFrances Wen, Ph.D.Michael Basso, Ph.D

Reliable Change Index (RCI)Jacobsen & Truax (1991)

• Appropriate for measures not subject to practice effects

• Examples: measures of attitude, psychological disorders, life satisfaction, health habits, coping styles, marital adjustment


• Not appropriate for measures affected by practice effects

• Examples: measures of memory, intelligence


• Appropriate for measures with underlying normal distributions or frequency spreads

• Examples: Dyadic Adjustment Scale, Geriatric Depression Scale, SCL-90-R, BDI, SF-36, etc.


• Not appropriate for measures which do not have underlying normal distributions or frequency spreads

• Examples: the MCMI (I-III), and the MCMD (or MBHI)


• Does change exceed what would be expected based on measurement error alone?

• If “yes”, then change is considered to be “statistically reliable”

Reliable Change Index (RCI)5 Steps to Assessing Reliable Change

1. Administer appropriate measure at pre-test

2. Re-administer measure at a post-test period

3. Calculate change score

4. Calculate the RCI

5. Compare change score to the RCI

Reliable Change Index (RCI)

The Reliable Change Generator 2.0

©Grant J. Devilly 2004

Web: www.swin.edu.au/victims

Reliable Change Index (RCI) The Reliable Change Generator

Devilly, G.J. (2004). The Reliable Change Generator for Windows: Version 2.0 (computer programme). The Centre for Neuropsychology, Swinburne University, Australia.

Reliable Change Index (RCI) The Reliable Change Generator

Jacobson, N.S., and Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.

Reliable Change Index (RCI)Data for the Reliable Change Generator

• Test-retest reliability of the measure

• Sample• Time period

• Standard deviation for the sample (at Time 1) which was used to estimate the test-retest reliability

Reliable Change Index (RCI)Assessing Clinical Meaningfulness

• Assess after a change in scores is found to be reliable

• Consider various criteria:

• diagnostic• classification• degree of change


Causation• Reliable change

implies lack of causation due to measurement error

• Variables unrelated to intervention may account for reliable change


Direction of Change

• Improvement?

• Deterioration?

Reliable Change Index (RCI)A Case Example: Jane D.

• 19 y.o., single, unemployed

• Wilson’s disease

• Candidate for liver transplant

• Pre-transplant assessment: clinical interview, BDI-II, SF-36, STAI, SWLS, WAIS subtests


• Post-transplant psychotherapy

• Post-transplant/Pre-therapy re-assessment:– clinical interview– BDI-II– SF-36– STAI– SWLS


Pre-transplant Post-transplant/

Pre-therapy

95% RCI

BDI-II 28 23 5.78

SF-36 PCS 30 51 7.47

STAI-Trait 68

87

54 70

12.41

SWLS 11 15 6.99


0

10

20

30

40

50

60

70

80

90

1st Testing 2nd Testing

BDI-II STAI Trait SWLS


• Diagnosis:– Adjustment Disorder

with Mixed Anxiety and Depression

• Therapy Issues:– Physical, familial,

social, occupational


Post-therapy • Changed occupational

and academic goals• Changed social

network• Changed residence


Pre-therapy Post- therapy 95% RCI

BDI-II 23 13 5.78

SF-36 PCS 51 53 7.47

STAI-Trait 54

(70)

40

(54)

12.41

SWLS 15 26 6.99


0

10

20

30

40

50

60

70

80

90

1st Testing 2nd Testing 3rd Testing

BDI-II STAI Trait SWLS

Additional References

• Ferguson RJ, Robinson AB, Splaine M. (2002). Use of the reliable change index to evaluate clinical significance in SF-36 outcomes. Quality of Life Research, 11, 509-516.

• Pavot W, Diener E. (1993). Review of the Satisfaction With Life Scale. Psychological Assessment, 5, 164-172.


• Sprinkle SD, Lurie D, Insko SL, Atkinson G, Jones GL, Logan AR, Bissada NN. (2002). Criterion validity, severity cut scores, and test-retest reliability of the Beck Depression Inventory-II in a university counseling center sample. Journal of Counseling Psychology, 49, 381-385.


• Spielberger CD, Gorsuch RL, Lushene RE (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA; Consulting Psychologists Press.

• Ware JE, Kosinski M, Keller SK. SF-36® Physical and Mental Health Summary Scales: A User's Manual. Boston, MA: The Health Institute, 1994.