Eating Disorder Examination Questionnaire required for Medicare items for some patients
The majority of clinicians choose to administer psychometric questionnaires face-to-face in session via the NovoPsych iPad app, however more practices are getting digital and tele-health savvy and administering questionnaires remotely. I want to show you how NovoPsych makes this possible, with features allowing assessments to be sent to your patients via email.
Clients can answer questionnaires on their smartphone or computer at home before your next session, or even before you first meet them.
With NovoPsych you can:
1. Login to the NovoPsych platform in your browser (note, these features are not available in the iPad app)
2. Press Email Assessment from the home screen
3. Select a client
4. Choose the assessments you would like to send
5. Press “Copy URL”. The link to the assessment will be ready for you to paste into an email or messaging service.
6. (Optional). If you’d like NovoPsych to send the assessment on your behalf (from the secure NovoPsych email address), you can press “Administer”, which will generate an email with the assessment. You can press “Customise Email” to amend the generic email message.
With more and more mental health consultations happening remotely this feature helps you measure key outcomes for your patients in a fast and effective way. I hope you find it useful!
In clinical practice we often get in the routine of administering the same assessments, just because we’re familiar with them. This post will help you get familiar with a new test; the Valuing Questionnaire, which I’ve just added to the NovoPsych library.
Used with: Adolescents and Adults
Measures: How consistently someone is living with their values.
Helpful for: Tracking progress in Acceptance and Commitment Therapy (ACT)
The Valuing Questionnaire (VQ: Smout et al. 2014) is a 10-item self-report scale designed to measure how consistently an individual has been living with their self-determined values and is particularly helpful when administered during a course of ACT.
Values are personal principles someone has chosen to guide their behaviour. Articulation of self-defined values is a core component of ACT-like therapies, and this scale is best used in conjunction with and subsequent to this process in therapy. The VQ measures “valuing”, which refers to actions one takes to live in accordance with values, rather than simply pleasant outcomes or satisfaction with life.
It measures two constructs:
1. Progress, defined as enactment of values, perseverance, and including clear awareness of what is personally important.
2. Obstruction, which reflects the disruption of valued living due to avoidance of unwanted experience, distraction from values by inattention to values or undue attention to distress.
Here are the 10 questions:
Scoring and Interpretation
Two subscale scores are presented, Progress and Obstruction, which typically have a negative correlation.
— Progress (items, 3, 4, 5, 7,9. Range = 0 to 30).
— Obstruction (items 1, 2, 6, 8, 10. Range = 0 to 30).
Scores indicative of psychological health are high scores on the Progress scale accompanied by low scores on the Obstruction scale.
As well as raw scores being presented, percentile ranks compared to an undergraduate university sample and a clinical sample are presented. A percentile of 50 on the clinical sample on each subscale represents a typical score for people presenting to outpatient psychology clinics.
When used as a monitoring tool during a course of ACT, successful treatment is indicated by increasing Progress Scores and decreasing Obstruction Scores.
I hope you’ll spend some time getting to know this test, among others. More information on NovoPsych assessments can be found here.
I’ve noticed momentum building around Routine Outcome Monitoring. The APS and other groups are all supporting reforms to the Medicare system to include standardised outcome measures.
In order to help psychologists administer psychometric instruments I created the NovoPsych iPad app (NovoPsych.com) and we now have thousands of psychologists using it. It computes useful metrics, graphs results over time and has dozens of assessments (DASS-21, Spence Children’s Anxiety Scale, CORE-10 etc). If you’re not already involved, you can sign up for free via www.novopsych.com.
– For users of NovoPsych, I hope you might be able to use this thread to provide any feedback about how to make the tool more useful for you?
– For others, I wonder what you make of the recommendations as part of the Medicare review about mandatory Routine Outcome Monitoring? Do you agree that it is a good idea? Are you wary of it? I personally think it *could* be great, provided the requirements don’t add too much of an administrative burden, and streamlined software like NovoPsych can make the process easy. We also need to avoid a “big brother” approach.
All feedback is really useful.
Dr Ben Buchanan
Addressable challenges in the mental health sector
NovoPsych is a technology platform designed for mental health clinicians to improve the efficiency and accuracy of mental health assessments, measurement of outcomes, communication between clinicians, and help patients in self-management.
We currently have over 3000 clinicians using the platform, primarily psychologists in private practice, but also work with larger agencies integrating the system into their model of care. The popularity and wide acceptance of our software platform is attributed to the focus on understanding the needs of clinicians, and educating them about the instant and measurable benefits for patients of routine outcome monitoring.
Routine Outcome Monitoring
Routine outcome monitoring is the regular evaluation of a patient’s treatment response during the course of treatment and provides health care professionals with information relevant to a patient’s progress. This monitoring can improve patient outcomes by enabling clinicians to detect and treat functional and psychological problems that previously may have been missed.
The monitoring is not only useful for clinician and patients themselves, but also provides an opportunity for treatment effectiveness to be evaluated at a systemic level.
Psychologists have specific training in this area on how to interpret outcome measures and understand how to evaluate such measures’ psychometric properties for appropriate use. This is a core skill of psychologists that is under-utilized in the current system.
While state based funded mental health services collect and report on outcome data through the Australian Mental Health Outcomes and Classification Network (AMHOCN) there is no such collection of outcome data being undertaken in MBS funded Better Access services. This was identified as a gap in the initial evaluation of the initiative and considering the significant level of investment in primary mental health care it remains a major gap in the collection of data to inform service planning and the effectiveness of funded services. While many clinicians regularly collect such data using NovoPsych as part of their clinical practice, outcomes measurement is not currently a requirement of the Medicare Benefits Schedule items.
Using Data Analytics to Improve Care
Advances in data analytics and computing power mean that large datasets are an important resource in the decision making process. The best datasets are generally those that are routinely collected by clinicians as a core part of practice– but contain enough detail for researchers and funders to use for valuable secondary analysis.
It is possible to use these datasets to understand trends, patterns and correlations at a large scale and investigate a range of questions much more rapidly and cost-effectively than using methods such as surveys and clinical trials alone. Not only this, datasets can be used to predict with a high degree of accuracy the progression of illness, and therefore what interventions/funding would be optimal.
The wealth of high quality longitudinal data collected by NovoPsych (over 200 million pieces of health information for over 150,000 patients) provides an opportunity to undertake an evaluation of programs and design systems to provide people the best care in a real-time, evidence-based way. Rather than funding models where “one size fits all”, this health data system could be used to provide objective triggers for staged care.
Reducing the strain on Australia’s mental healthcare system requires finding novel approaches to sustainable healthcare delivery. Key to this is investing in a mental healthcare environment that predicts, prevents and delays the onset of chronic and long-term dysfunction, eliminates low-value care and has the capacity to scrutinize and adjust funding in a timely way.
It is urgent that funding systems be person centric, have a degree of precision in the likely outcomes of treatment, and be able to measure the outcome of treatment reliably.
Dr Ben Buchanan
Co-Founder and Director
Research supports an association between regularly administering standardised measures to assess client progress (progress monitoring) and improved treatment outcomes. However, some research suggests clinicians often rely heavily and solely on clinical judgement when making treatment decisions. This study was the first to explore psychologists’ implementation of progress monitoring, within an Australian clinical context.
A self‐report survey investigated Australian psychologists’ (N = 208; gender and age proportional to national representation) attitude, awareness, use, motives, and barriers towards implementing standardised assessment and progress monitoring. The survey comprised of the Attitudes towards Standardised Assessment Scales, and existing literature on progress monitoring implementation.
Ninety‐eight per cent of psychologists were aware of progress monitoring measures, and 69% reported using them in practice. Majority of progress monitoring users rated these measures as very useful (51%) and over one third (39%) used them with most of their clients. Contrary to the hypothesis, a t‐test demonstrated that attitude towards standardised assessment did not differ between progress monitoring users and non‐users. Among the clinicians who have not implemented progress monitoring, time barriers were rated as most important.
This study demonstrates that although awareness of progress monitoring may be widely known, perceived barriers may outweigh the potential benefits for some. It is also concluded that further qualitative research is needed to adequately understand these barriers and their importance. Future interventions may then promote evidence‐based recommendations and focus on the practicality, utility, and workflow difficulties associated with incorporating progress monitoring.
Article punished in InPsych Magazine, August 2018.
The regular use of standardised self-assessment and progress monitoring forms has been associated with improved client treatment outcomes. Research suggests that clinical judgment alone may not be the most accurate and effective method of predicting deterioration in client wellbeing or progress. Progress monitoring forms can be administered at regular intervals during therapy and provide ongoing, individualised and immediate client feedback. Australian researchers surveyed psychologists (N=208) about their attitudes towards using such forms with clients. About half of the psychologists surveyed found such forms useful, and 69 per cent of psychologists were using them with clients. This is in contrast with similar past surveys and with research suggesting that only 12 to 33 per cent of North American psychologists regularly use structured tools with clients. The researchers suggested that in Australia there is increased awareness of their usefulness and emphasis placed on practical- and evidence-based recommendations by government and funding regimes.
It is also becoming easier to incorporate self-monitoring tools into practice, with online tools providing access to a variety of forms and in some cases quicker scoring and evaluation methods. Those Australian psychologists using self-monitoring forms believed strongly in their usefulness, particularly for tracking client progress and to determine if changes to treatment were needed.
Contrary to expectations, attitudes towards standardised assessment did not differ between psychologists who were regularly using progress monitoring forms and those who were not. Among those not using forms the main barriers to their use was believing they take too long to administer and score and would be too much of a burden on clients.
Psychologists were more likely to be using self-monitoring forms if they were primarily treating adults and working in private practice. This suggests a need to increase awareness of self-monitoring measures relevant for work with children. The researchers suggest more psychologists might use self-monitoring forms if their perceptions of their usefulness and practicality were enhanced and if they were given suggestions for workflow management.
Chun, J., Buchanan, B (2018) A Self‐Report Survey: Australian Clinicians’ Attitudes Towards Progress Monitoring Measures. Australian Psychologist. https://onlinelibrary.wiley.com/doi/abs/10.1111/ap.12352