Standardized Scales
Standardization
 Use of identical procedures to collect,
score, interpret, and report results of a
measure
 Assures that differences over time or
among different people are due to the
variable being measured and not to
different measurement procedures
What are Standardized Scales?
 Set of uniform procedures to collect,
score, interpret, and report numerical
results
 Usually have norms and empirical evidence
of reliability and validity
 Typically include multiple items aggregated
into one or more composite scores
 Frequently used to measure constructs
Construct
 Complex concept (e.g., intelligence, well-
being, depression)
 Inferred or derived from a set of
interrelated attributes (e.g., behaviors,
experiences, subjective states, attitudes)
of people, objects, or events
 Typically embedded in a theory
 Oftentimes not directly observable but
measured using multiple indicators
Evaluating and Selecting
Standardized Scales
 Purpose
 Reference populations and normative
groups
 Reliability
 Validity
 Practical considerations
Purpose
 Identify whether or not a client has a
significant problem
 Measure and monitor your client’s
outcomes to determine if your client is
making satisfactory progress
Reference Population
Population of people for which a measure is
intended and from which a normative group is
sampled and norms are created
Normative Group
 Representative sample of a reference
population, used to estimate norms for
that population and, more generally, used
to develop and test standardized measures
 Also known as a “standardization group” or
“standardization sample”
Population
Sample
Reliability
 Internal consistency reliability (coefficient
alpha) (most important)
 Interrater rater reliability (sometimes)
 Test-retest reliability
Validity
 Face
 Content
 Criterion
 Construct
 Sensitivity to change especially important
Practical Considerations
 Time
 Effort
 Training
 Cost
 Availability
 Acceptability (e.g., clients, practitioners,
etc.)
Decisions, Decisions…
 Who
 Where
 When
 How often to
collect outcome
data
Who
 Client
 Practitioner
 Relevant others
 Independent evaluators
Where and When
 Private, quiet, physically comfortable
location
 Complete at about the same time and under
the same conditions on a regular basis
How Often
 Regular, frequent, pre-designated intervals
 Often enough to detect significant changes
in the problem, but not so often that it
becomes problematic
 In general about once per week
Engage and Prepare Clients
 Be certain the client understands and
accepts the value and purpose of
monitoring progress
 Discuss confidentiality
 Present measures with confidence
 Don’t ask for info the client
can’t provide
Engage and Prepare Clients
(cont’d)
 Be sure the client is prepared
 Be careful how you respond to information
 Use the information that is collected
 Be careful how you respond to information
 Use the information that is collected
Administering, Scoring, and
Interpreting Standardized Scales
 Score, scoring formula, composite score
 Unidimensional and multidimensional scales
 Cut scores
 Reverse-worded items
 Reliable change, reliable improvement,
reliable deterioration
 Clinically significant improvement
 Expected treatment response
Score
 Generic term for a number derived from a
measure that represents the quantity or
amount of an attribute or observation (e.g.,
number of times a behavior is observed,
value obtained from a standardized scale)
 Interpret in context of all available
quantitative and qualitative information
Scoring
Procedure by which data from a measure are
used to produce a score (e.g., number of
times a behavior occurs or value on a
standardized scale) or category (e.g.,
diagnostic category)
Scoring Formula
A mathematical rule by which data from a
measure are used to produce a score (e.g.,
sum or average of responses to items on a
multi-item standardized scale)
Item
1
Item
2
Item
3
Score
Composite Score
Score that combines results from two or
more related items or other measures using a
specified formula (e.g. percentage of items
answered correctly on a statistics test)
Item
2
Item
1
Item
3
Score
Unidimensional Scale
Scale that measures a single attribute or
construct (e.g., depression). (Contrast with
multidimensional scale.)
Multidimensional Scale
Scale that measures two or more distinct but
related attributes or constructs, and
measures of the different attributes or
constructs are referred to as “subscales”
Problems &
Symptoms
Subjective
Social
Functioning
Well-Being
Global
Distress
Cut Scores
 Specific predetermined numerical values
along a continuum of scores


Used to separate people into categories with
distinct substantive interpretations (e.g.,
clinically depressed or not)
Used to make decisions (provide treatment for
depression or not)
 Only as good as the normative sample(s) on
which it is derived
 Interpret in context of all available
quantitative and qualitative information
Reverse-Worded Item
Item for which smaller numbers indicate a
higher score on the measured variable
because the item is worded to mean the
opposite of the measured variable
Reliable Change
Change in a score from one time to another
that is more than expected just from random
measurement error
 Clinical significance.xls
Reliable Improvement
Improvement in a score from one time to
another that is more than expected just
from random measurement error
Reliable Deterioration
Deterioration in a score from one time to
another that is more than expected just
from random measurement error
Clinically Significant Improvement
Change that occurs when a client’s measured
functioning on a standardized scale is:



In the dysfunctional range before intervention
(e.g., greater than 5 on the QIDS-SR)
In the functional range after intervention (e.g.,
5 or below on the QIDS-SR)
Change is reliable
Clinically Significant Improvement
(cont’d)
 Interpret in context of all available
quantitative and qualitative information
 Does not guarantee a meaningful change in
a client’s real-world functioning or quality
of life
 Only as good as the normative sample(s) on
which it is derived
 Does not speak to the question of whether
it was your intervention or something else
that caused the change
Expected Treatment Response
 Session-by-session progress is determined
in comparison to normative data from
ongoing responses to treatment of
thousands of clients
 Feedback used in real time to monitor client
progress and modify services as needed to
reduce treatment failures and increase
overall effectiveness
Global Rating
Single rating based on a rater’s integration
of information about numerous factors (e.g.,
global rating of change, improvement, or
social functioning)
Single-Item Global Standardized
Scales
 Global Assessment of Functioning (GAF)
 Children’s Global Assessment Schedule
(CGAS)
 Social and Occupational Functioning
Assessment Scale (SOFAS)
 Global Assessment of Relational
Functioning (GARF)
Potential Advantages of
Standardized Scales
 Pretested for reliability and validity
 Structured, so information less likely to be
missed
 Can be used to compare individual
functioning to normative group functioning
 Can be efficient and simple to use
Cautions in the Use of
Standardized Scales
 May not measure concept suggested by
scale name
 Different measures of the same concept
may not be equivalent
 Sometimes limited information about
reliability and validity
 Concepts as measured
may not be completely
relevant to individual
clients
Resources
 Compendiums of measures
 See Appendix B
 Web measurement resources
 See Appendix B