CiMH Palette of Measures
Evaluation Training: Revised Child
Anxiety and Depression Scale
(RCADS)
Cricket Mitchell, PhD
CIMH Evaluation Consultant
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
2
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
3
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
4
Brief Overview of Palette of
Measures Evaluation Protocol
5
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
6
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
7
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
8
Revised Child Anxiety and
Depression Scales (RCADS)
9
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 HigaMcMillan, Brad Nakamura, Jennifer Regan, & Roxanna
Lynch; Journal of Abnormal Child Psychology, 2010)
10
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
11
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
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
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
14
Let’s take a look at the
RCADS...
15
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
16
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
17
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
18
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
19
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
20
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”)?
21
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
22
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
23
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 anxietyrelated symptoms that are most similar to
children who meet diagnostic criteria for
that particular disorder or syndrome (e.g.,
social phobia, generalized anxiety)
24
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?
25
Palette of Measures Data Entry
and Data Submissions
26
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
27
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
28
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, PostRCADS 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
29
Palette of Measures Data Entry:
RCADS
Mid-RCADS
PARENT/CAREGIVER REPORT: (ages 6-18)
Date of
Assessment RCADS-P (Raw Scale and Total Scores)
PPPPPPPPClient ID# Assessment Interval SepM GenM PanM SocM OCM DepM TotAnxM 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
30
But, before you enter any
outcome data, you’ll enter
Demographics & Service
Delivery Information...
31
Palette of Measures Data Entry:
Demographics & Services (1 of 2)
Client Information:
Primary (DSM-IV code) (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
32
Palette of Measures Data Entry:
Demographics & Services (2 of 2)
Focus 1 of Treatment
Focus1
Date of
First
Session
Date of Total # Completed
Last
of
Session Sessions Focus 1?
(if Focus 1 not
completed)
Completed
(if Services not
completed)
Reason
Services?
Reason
•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
33
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
34
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 passwordprotected)
– 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)
35
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
36
Questions
37
The End
Contact Information
•Cricket Mitchell, PhD
•Email: cmitchell@cimh.org
•Cell phone: 858-220-6355
38