It’s important for the clinic to continually measure their clients’ level of behavioral and physical health to determine whether the treatment offered is working for individuals and, when viewed in the aggregate, whether the program is working in general. Assessment tools, along with established criteria, may also be needed to identify those needing intervention as well as those no longer requiring it. Many of these measures can also double as periodic assessements of progress.
When deciding which measures to utilize, Dr. Andrew Bertagnolli of Kaiser Permanente suggests posing these questions:
- Can this measure result in actionable improvement efforts?
- Is there evidence supporting the relationship between the measure and the clinical outcome?
- Is the measure scientifically sound?
- Does it allow for differences in patient beliefs and preferences for care?
- Is it sensitive to change?
- Is it easily understood?
- Is it susceptible to being “gamed”?
- Is it easy to collect accross an episode of care?
- Is it reliable/complete in collection method and resulting data?
- Is it easy to retrieve from either EHR or paper records?
The Duke Health Profile
Popular among health and mental health researchers is the copyright-proctected Duke Health Profile, a 17 item self-report instrument, measuring both health and mental health status. Indices include mental health, social health, perceived physical health, objective health and self esteem. Among the scales measuring dysfunctional health are depression, anxiety, pain and disability. .
Functional Assessment Form
Integrated behavioral programs in Buncombe County, North Carolina use a simple rating scale, the Functional Assessment Form, to ascertain how their clients are dealing with stress. Like the many others, this form can double as both a screening instrument and as an outcome measure.
Rand Health Survey
Another self-administered quality-of-life measure “widely used for routine monitoring and assessment of care in adult patients”, the 36-item Health Survey developed by the Rand Corporation, is available for use contingent on meeting Rand’s stipulations.
Global Assessment Scale (GAS) and Global Assessment of Functioning Scale
Both the Global Assessment Scale (GAS) and the similar Global Assessment of Functioning Scale (GAF) are used to evaluate adult clients’ overall mental health status during a specified time period on a 100-point continuum ranging from severe impairment to superior functioning.
California Quality of Life Survey (CA-QOL)
This 18-item questionnaire, adapted from Dr. Anthony Lehman’s Quality of Life Interview by the State Department of Mental Health, asks respondents to rate their health, physical condition, living situation and emotional well-being. For more information about the Lehman Quality of Life Interview, contact Anthony Lehman, MD, Department of Psychiatry, University of Maryland Medical Center.
Mini Patient Health Survey
One of the clinics IBHP awarded a demonstration grant to, Sierra Family Health, has had success with this self-administered questionnaire in which an affirmative answer to a few basic questions trigger follow-up questions. Thus, if the initial responses are negative, the form can be completed with just a few checks.
Other global assessment instruments, as well as assorted outcome measures can be ordered at Wiley Reference Works.
For an assessment of the current status of process, quality and outcome measurement and that data systems that support integrated behavioral care delivery, see Integrated Policy Initiative: Behavioral Health Measurement Project(2011), prepared by Karen Linkins et al. for IBHP. Another excellent source is the AHRQ Academy for Integrating Behavioral Health and Primary Care. Their interactive Find a Measure Internet site gives measures by name, functional domain and recommendation.
IBHP demonstration clinics, in concert with IBHP consultants, have gathered outcome data using a combination of customized and standardized instruments, including The Duke Health Profile as a global assessment.