Swedish Association of Child and Adolescent Psychiatry
Annual meeting, Lund, 2nd April 2008
Making life easier for ourselves and families:
Using the online DAWBA in Swedish
to take some of the hard work out of detailed assessments
Robert Goodman
King’s College London Institute of Psychiatry
Starting from first principles
Key ingredients of effective clinical work:
1) Motivated and courteous staff
2) Thorough assessment of psychopathology and risk factors
3) Evidence based treatment
4) Routine monitoring of outcome
Additional principles from public health
5) Maximize cost-benefit ratio
6) Easy access to all potential beneficiaries
Automation
The use of machines can greatly increase the
productivity of workers
In the long run this:
1) Increases wages
2) Makes products and services cheaper
and therefore more widely available
Spinning
Harvesting
Washing clothes
Adding up numbers
Medical investigations
Thorough assessment of psychopathology and risk factors
There are several options:
• Questionnaires and fully structured interviews
• Semi-structured interviews
• Hybrid measures
Questionnaires and fully structured interviews
(respondent-based)
The questions and response categories are fixed.
These can be administered by a computer or an
interviewer, but the interviewer’s job is really just to read
the question, and not to modify the question or interpret
the response.
e.g. the DISC
Semi-structured interviews (investigator-based)
A highly trained interviewer uses flexible questioning to
decide if each of the relevant symptoms is present or not.
e.g. CAPA, K-SADS
Fully structured
Quick
Cheap
Clinically convincing
+
+
+
Semi-structured
++
For many fully and semi-structured interviews:
Answers
to the
interview
Fully automatic
computer
algorithm
Final
diagnoses
Development and Well-Being Assessment (DAWBA)
Computer or non-specialist interviewer administers two sorts of
questions:
1) Fixed questions with fixed response options
2) Open-ended follow-on questions to elicit descriptions of
problems in the respondents’ own words
Additional
clinical
interview
Answers to
fixed question
Computer
algorithm
Provisional
diagnosis
Experienced
clinical
rater makes
final diagnoses
Summaries
Answers to
open-ended
questions
10,000 : 300 : 3
The DAWBA clinical raters deal with 3 key questions:
1) Did the respondents understand the questions?
2) How should conflicting information be resolved?
3) Assign a non-operationalised diagnosis?
The validity of the DAWBA has been demonstrated in
British, Brazilian, Bangladeshi and Yemeni studies.
In addition:
• It generates sensible results for prevalence and
risk factors
• It is relatively quick and easy
• It works in difficult circumstances
The DAWBA in Swedish
With particular thanks to :
Jan-Olov Larrson
Hans Smedje
www.dawba.com
for a demonstration
of the online DAWBA
system
To register your team for a free trial of the
online DAWBA system:
www.dawba.net/user
Or email us with questions:
dawba@www.youthinmind.net