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Motivational factors are generally regarded as an important ingredient for change in therapy. However, there is currently a lack of available instruments that can measure clients’ readiness for change in therapy.
The objective of this paper was to create an instrument, the Readiness for Therapy Questionnaire (RTQ), which could measure clients’ readiness for change.
The RTQ was created by researchers following analysis of themes drawn from a review of the literature and interviews with patients at the end of therapy. This included both people who completed therapy and those who dropped out. As part of the standard assessment process, the RTQ was administered to 349 participants (69.6% female and 30.4% male; mean age 37.1 years; 90.5% Caucasian) who were patients at a psychological therapy service for common mental health difficulties.
An initial 12-item scale was reduced to 6 items. This scale significantly correlated with post-therapy PHQ-9 and GAD-7 scores and changes in these scores across therapy. After controlling for baseline scores and demographic variables, a logistic regression showed that scores on this 6-item measure pre-therapy significantly predicted three outcome variables: completing therapy, being recovered on both PHQ-9 and GAD-7 post-therapy, and having a reliable change in both the PHQ-9 and GAD-7 post-therapy. However, receiver operating characteristic (ROC) curve analysis showed the measure had poor sensitivity and specificity. Symptom severity did not have a significant impact on motivation to change.
The RTQ is potentially a valid measure with useful clinical applications in treatment of common mental health difficulties.
This paper provides specific guidelines for the neurodevelopmental evaluation of children aged birth through 5 years with complex congenital heart disease. There is wide recognition that children with congenital heart disease are at high risk for neurodevelopmental impairments that are first apparent in infancy and often persist as children mature. Impairments among children with complex congenital heart disease cross developmental domains and affect multiple functional abilities. The guidelines provided are derived from the substantial body of research generated over the past 30 years describing the characteristic developmental profiles and the long-term trajectories of children surviving with complex congenital heart conditions. The content and the timing of the guidelines are consistent with the 2012 American Heart Association and the American Academy of Pediatrics scientific statement documenting the need for ongoing developmental monitoring and assessment from infancy through adolescence. The specific guidelines offered in this article were developed by a multidisciplinary clinical research team affiliated with the Cardiac Neurodevelopmental Outcome Collaborative, a not-for-profit organisation established to determine and implement best neurodevelopmental practices for children with congenital heart disease. The guidelines are designed for use in clinical and research applications and offer an abbreviated core protocol and an extended version that expands the scope of the evaluation. The guidelines emphasise the value of early risk identification, use of evidence-based assessment instruments, consideration of family and cultural preferences, and the importance of providing multidimensional community-based services to remediate risk.
Jones et al's review of the assessment and management of the neuropsychiatric manifestations of Parkinson's disease serves as a practical guide to clinicians. This commentary outlines some of the underlying neuroscience and psychological sequelae of this range of conditions, offering a takeaway message to the clinician with an interest in Parkinson's neuropsychiatry.
Reassurance seeking (RS) is motivated by perceived general and social/relational threats across disorders, yet is often under-recognized because it occurs in covert (i.e. subtle) and overt forms. Covert safety-seeking behaviour may maintain disorders by preventing corrective learning and is therefore important to identify effectively.
This study presents the validation and psychometric analyses of a novel measure of covert and overt, general and social/relational threat-related interpersonal RS.
An initial 30-item measure was administered to an undergraduate sample (N = 1626), as well as to samples of individuals diagnosed with obsessive compulsive disorder (OCD; n = 50), anxiety disorders (n = 60) and depression (n = 30). The data were subjected to exploratory and confirmatory factor analyses, and validation analyses.
An exploratory factor analysis using principal axis factoring with oblique rotation yielded five interpretable factors, after removing four complex items. The resulting 26-item measure, the Covert and Overt Reassurance Seeking Inventory (CORSI), evidenced good convergent and divergent validity and accounted for 54.99% of the total variance after extraction. Factor correlations ranged from r = .268 to .736, suggesting that they may be tapping into unique facets of RS behaviour. In comparison with undergraduate participants, all clinical groups had significantly higher total scores [t (51.80–840) = 3.92–5.84, p < .001]. The CFA confirmed the five-factor model with good fit following the addition of four covariance terms (goodness of fit index = .897, comparative fit index = .918, Tucker–Lewis index = .907, root mean square error approximation = .061).
The CORSI is a brief, yet comprehensive and psychometrically strong measure of problematic RS. With further validation, the CORSI has potential for use within clinical and research contexts.
Chapter 8 introduces the final component of our framework, the Revise phase. This phase of the framework provides recommendations for conducting assessment, both formative and summative, that will allow teachers and instructional designers to determine the extent to which students have met the learning outcomes of a course or unit. In keeping with the general orientation of the book, we encourage an approach to assessment that is authentic and task oriented. The assessment practices proposed align with the activities and tasks recommended in the Build phase and are consistent with the teaching practices described in the Teach phase. In addition to assessment at the course level, we propose a set of criteria to evaluate the overall performance and quality of a course.
Background: Dementia is a syndrome that affects multiple cognitive domains and causes functional decline. People with dementia (PwD) often experience pain, still could not report the symptom due to the decline in cognition that leads to communication problems. Therefore, pain in PwD is often underrecognized and undertreated. Many behavioral observation tools have been developed to help identify pain in PwD; the Pain Assessment in Advanced Dementia (PAINAD) scale is one of the recommended tools to evaluate pain in PwD. The PAINAD has been translated into many languages, yet not translated into Thai language. Since there is no pain assessment tool for PwD in Thailand.
Objective: This study aimed to assess the reliability"and validity of the PAINAD in Thai version (PAINAD-Th) for measuring pain in people with"PwD
Materials and Methods: The cross-cultural translation including forward translation and back-translation of PAINAD-Th were performed, then the content validity was assessed by the expert committee. Enrolled participants were inpatients aged 60 years or over, and had dementia with Functional Assessment Staging Test (FAST) of at least 6 which represented moderately severe stage. A research assistant recorded 5-minute videos of the participants, the first video was during the activity that could provoke the pain and the second video was at rest. Two trained nurses independently rated the pain of the participants by observing the videos using the PAINAD-Th to examine the inter-rater reliability and the concurrent validity of the test against the reference standard which was the numeric rating scale (NRS) rated by the expert committee. The same rating process was reproduced one week apart to explore the test-retest reliability.
Results: The content validity index of the PAINAD-Th was 1.00 and 0.93 (forward and back-translation, respectively)."The inter -rater and test-retest reliability showed an excellent intra-class correlation coefficient of"0.92 and 0.96, respectively. The concurrent validity was significantly correlated with the reference standard with an excellent intra-class correlation coefficient of"0.95.
Conclusions: The PAINAD-Th is a promising tool for pain evaluation in PwD as it provides an excellent concurrent validity against the reference standard. Also, it has excellent content validity, inter-rater, and test-retest reliability.
We examined whether intraindividual variability (IIV) across tests of executive functions (EF-IIV) is elevated in Veterans with a history of mild traumatic brain injury (mTBI) relative to military controls (MCs) without a history of mTBI. We also explored relationships among EF-IIV, white matter microstructure, and posttraumatic stress disorder (PTSD) symptoms.
A total of 77 Veterans (mTBI = 43, MCs = 34) completed neuropsychological testing, diffusion tensor imaging (DTI), and PTSD symptom ratings. EF-IIV was calculated as the standard deviation across six tests of EF, along with an EF-Mean composite. DSI Studio connectometry analysis identified white matter tracts significantly associated with EF-IIV according to generalized fractional anisotropy (GFA).
After adjusting for EF-Mean and PTSD symptoms, the mTBI group showed significantly higher EF-IIV than MCs. Groups did not differ on EF-Mean after adjusting for PTSD symptoms. Across groups, PTSD symptoms significantly negatively correlated with EF-Mean, but not with EF-IIV. EF-IIV significantly negatively correlated with GFA in multiple white matter pathways connecting frontal and more posterior regions.
Veterans with mTBI demonstrated significantly greater IIV across EF tests compared to MCs, even after adjusting for mean group differences on those measures as well as PTSD severity. Findings suggest that, in contrast to analyses that explore effects of mean performance across tests, discrepancy analyses may capture unique variance in neuropsychological performance and more sensitively capture cognitive disruption in Veterans with mTBI histories. Importantly, findings show that EF-IIV is negatively associated with the microstructure of white matter pathways interconnecting cortical regions that mediate executive function and attentional processes.
Standard depression rating scales like the Hamilton Depression Rating Scale and the Montgomery–Åsberg Depression Rating Scale were developed more than 40 years ago. They are mandatory in clinical trials but are for a variety of reasons seldom used in clinical practice. Moreover, most clinicians are less familiar with more recent trends or with some dilemmas in assessment tools for major depression.
Asssessment tools can be observer-rating or self-rating scales, disease-specific or non–disease-specific scales, subjective scales or objective lab assessments, standard questionnaires or experience sampling methods. An overarching question is to what degree current assessment methods really address the individual patient’s needs and treatment expectations.
The present paper aims to offer a framework for understanding the current trends in assessment tools that can orientate and guide the clinician.
In this chapter, we examine the theoretical underpinnings of bullying behavior and link bullying to related but distinct forms of aggression. Bullying prevention and intervention strategies are reviewed and the connection between school climate and bullying is reinforced. Prevention and intervention programs that address improving the school climate are necessary but insufficient to effectively reduce bullying. Given that bullying and targeted violence are typically seen as distinct behaviors, the authors suggest that promoting a holistic violence prevention model should replace the individual and often independent approaches for dealing with various forms of aggression and violence. Instead, a comprehensive and coordinated system of assessment, prevention, and intervention will lead to reductions in bullying and other forms of targeted violence. This will require students, teachers, parents, and community stakeholders (i.e., law enforcement, community leaders, politicians) to work together for the holistic health of schools and communities.
Although parents and educators have identified student social and emotional development as an important educational outcome, this domain has not received as much emphasis in educational policy or practice as academic achievement. Recognition of the contributions of social and emotional learning (SEL) to students’ social and academic success, however, has increased interest in promoting SEL in schools over the last decade. This chapter begins with a brief introduction to SEL constructs and definitions, followed by a synopsis of current SEL assessment and intervention practices. We also highlight the current state of empirical evidence for these practices and then turn to several important necessary future directions to advance school-based SEL practices.
Caring for a person with dementia is associated with poor mental, physical, and social health, which makes it important to consider how carers are best supported in their caring role to preserve both their and the person with dementia’s well-being. At present, a robust instrument to assess carers’ support needs does not exist. This study aimed to develop a self-reported questionnaire to assess the support needs of carers of people with dementia. The objectives were to: (1) generate items, (2) pilot test, and (3) field-test the questionnaire.
Development and field-testing of a new questionnaire.
Primary and secondary health and social care of informal carers and people with dementia in nine municipalities and one dementia clinic in a hospital in Denmark.
Eight experts, 12 carers, and 7 digital users participated in pilot testing. 301 carers participated in field-testing.
Items for inclusion were generated based on interviews and literature review. An iterative process of data collection was applied to establish face and content validity of the Dementia Carer Assessment of Support Needs Tool (DeCANT) using Content Validity Index among experts and cognitive interviews with carers. Field-testing of DeCANT among carers included using the 12-item Short Form Health Survey, the Barthel-20 Index, and the Neuropsychiatric Inventory.
Initially, an item pool of 63 items was generated, and pilot testing reduced this to 42 items. Subsequent field-testing resulted in a 25-item version of DeCANT, and confirmatory factor analysis of three hypothesized models demonstrated a marginally better fit to a four-factor model with fit indices of: χ2 = 775.170 (p < 0.001), root mean square error of approximation = 0.073, Comparative Fit Index = 0.946, the Tucker-Lewis Index = 0.938, and weighted root mean residual (WRMR) = 1.265.
DeCANT is a 25-item carer-reported questionnaire that can be used to help identify their support needs when caring for a person with dementia to enable supportive interventions and improve carers’ health and well-being.
Hoarding disorder (HD) is characterised by difficulties in discharging or parting with possessions irrespective of their actual value, urges to save and acquire new items and excessive clutter in living areas. There is an urgent need to advance the understanding of HD in child and adolescent populations. The aim of this paper is to cover the assessment, treatment strategies and tools currently available. In general, data on assessment of paediatric HD are scant. Only one psychometrically sound scale, the Child Savings Inventory, which is a parent-rated scale used to assess the severity of hoarding symptoms, was found. However, this scale is not sufficient to produce a diagnosis of HD. Regarding treatment, there was only a limited number of case studies suggesting the effectiveness of cognitive behavioural therapy that includes exposure to discarding and not collecting new items, using contingency management for exposure and oppositional behaviour, cognitive training and instructing parents to assist with home-based exposures. In conclusion, there is an urgent need for properly validated Diagnostic and Statistical Manual of Mental Disorders assessment tools, and we encourage practitioners and researchers to develop and test a Cognitive behavioral therapy (CBT) protocol for paediatric HD based on the aforementioned components.
Assessing intercultural communicative competence can be challenging for a number of reasons. First, there is little consensus regarding the precise definitions of subcomponents of intercultural competence, making it difficult to identify specific constructs to assess. Second, intercultural competence is locally situated, so the “same behavior or skill may be perceived as competent in one context but not another or one perceiver but not another, and thus no particular skill or ability is likely to ever be universally ‘competent’” (Spitzberg & Changnon, 2009, p. 6). Third, in a related vein, some aspects of intercultural communicative competence might not be suitable for classroom assessment, an issue that is addressed at the end of this chapter. In spite of these challenges, for personal and institutional purposes, assessing learners’ progress in intercultural communicative competence remains an important educational objective. Thus, in this chapter, I review several relevant concepts in L2/Lx assessment, then explore how they relate to understanding intercultural communicative competence, illustrating the theory with three case studies.
This article considers the role that assessment of suicidal ideation may have in short-term prediction of suicide. Suicide risk assessment is a multifactorial process and it is assumed that assessment of suicidal ideation is one component. Denial that suicidal ideation has any useful role in risk assessment fails to allow for the marked ongoing short-term variability in severity of intent, which is a common feature of the suicidal state of mind. It is concluded that the assessment of suicidal ideation, provided it is carried out correctly and applied appropriately, should continue to be regarded as a central component of the overall prediction process. A ‘two-take’ approach to short-term risk assessment and mitigation is proposed that takes variability in severity of intent into account and includes anticipatory treatment planning for any problems that may occur in the near future.
Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors.
To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups.
The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered.
The six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value.
The Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.
The coronavirus disease 2019 (COVID-19) pandemic may cause psychological distress in the general population and has the potential to cause anxiety regarding COVID-19. No validated questionnaires exist for the measurement of specific COVID-19 anxiety. We modified the DSM 5 – Severity Measure for Specific Phobia–Adult scale specifically for anxiety regarding COVID-19, and report the psychometric properties from an online study with 6262 participants from the general population in Germany. We analysed internal consistency as well as concordant validity. The scale showed good internal consistency (α = 0.86) and good concordant validity (rs = 0.60) with the 2-item Generalized Anxiety Disorder measure and rs = 0.61 with self-rating of limitations in daily life caused by COVID-19 anxiety.
FFQ are one of the most widely used tools of research into nutritional epidemiology, and many studies have been conducted in several countries using this dietary assessment method. The present study aimed to evaluate the relative validity of FFQ, in comparison with other methods, in assessing dietary intake of children and adolescents, through a systematic review. Four electronic databases (Embase, PubMed, Scopus and Web of Science) found sixty-seven articles, which met the inclusion criteria (healthy children and adolescents from 3 to 18 years of age; journal articles written in English, Spanish and Portuguese between 1988 and March 2019; results showing the comparison between the FFQ with other methods of assessment of dietary intake). The articles were analysed by two independent reviewers. A meta-analysis was conducted using correlation coefficients as estimate effects between the FFQ and the reference standard method. Subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. In fifty-five of the sixty-seven studies, a single dietary assessment method was used to evaluate the FFQ; nine combined the two methods and three used three reference methods. The most widely used reference method was the 24-h recall, followed by the food record. The overall relative validity of the FFQ to estimate energy, macronutrient, certain micronutrient and certain food item intakes in children and adolescents may be considered weak. The study protocol was registered in PROSPERO under number CRD42016038706.
This study aims to generate country-specific norms for two episodic memory tasks and a verbal fluency test among middle-aged and older adults using nationally representative data from nine low-, middle-, and high-income countries.
Data from nine countries in Africa, Asia, Europe, and Latin America were analyzed (n = 42,116; aged 50 years or older). Episodic memory was assessed with the word list memory (three trials of immediate recall) and word list recall (delayed recall). Verbal fluency was measured through the animal naming task. Multiple linear regression models with country-specific adjustments for gender, age, education, and residential area were carried out.
Both age and education showed high influence on test performance (i.e. lower cognitive performance with increasing age and decreasing years of education, respectively), while the effect of sex and residential area on cognitive function was neither homogeneous across countries nor across cognitive tasks.
Our study provided sex-, age-, education-, and residential area-specific regression-based norms that were obtained from one of the largest normative study worldwide on verbal recall and fluency tests to date. Findings derived from this study will be especially useful for clinicians and researchers based at countries where cognitive norms are limited.
Nursing instruments have the potential for daily screening of delirium; however, they have not yet been evaluated. Therefore, after assessing the functional domains of the electronic Patient Assessment — Acute Care (ePA-AC), this study evaluates the cognitive and associated domains.
In this prospective cohort study in the intensive care unit, 277 patients were assessed and 118 patients were delirious. The impacts of delirium on the cognitive domains, consciousness and cognition, communication and interaction, in addition to respiration, pain, and wounds were determined with simple logistic regressions and their respective odds ratios (ORs).
Delirium was associated with substantial impairment throughout the evaluated domains. Delirious patients were somnolent (OR 6), their orientation (OR 8.2–10.6) and ability to acquire knowledge (OR 5.5–11.6) were substantially impaired, they lost the competence to manage daily routines (OR 8.2–22.4), and their attention was compromised (OR 12.8). In addition, these patients received psychotropics (OR 3.8), were visually impaired (OR 1.8), unable to communicate their needs (OR 5.6–7.6), displayed reduced self-initiated activities (OR 6.5–6.9) and challenging behaviors (OR 6.2), as well as sleep–wake disturbances (OR 2.2–5), Furthermore, delirium was associated with mechanical ventilation, abdominal/thoracic injuries or operations (OR 4.2–4.4), and sensory perception impairment (OR 3.9–5.8).
Significance of results
Delirium caused substantial impairment in cognitive and associated domains. In addition to the previously described functional impairments, these findings will aid the implementation of nursing instruments in delirium screening.
Delirium is a state of global disturbance of cerebral function, and is common, affecting over 30% of inpatients. Readers are invited to explore the causes of delirium, how to assess patients with this condition and its initial management, including both pharmacological and nonpharmacological measures. The chapter includes advice on prescribing antipsychotics and benzodiazepines in this vulnerable group of patients.