CiMH Palette of Measures

Evaluation Training: Revised Child

Anxiety and Depression Scale
(RCADS)
Cricket Mitchell, PhD
CIMH Evaluation Consultant
Palette of Measures Evaluation:
What You Will Need (slide 1 of 2)
• Palette of Measures Data Entry Shell v2 (Excel file)
– Developed by CiMH and customized for each
participating agency
– Holds all data for clients served thru the Palette of
Measures project
– Demographics, service delivery information, pre- and
post- outcome measure data
• Palette of Measures Data Dictionary v2 (Word
document)
– A guide for using the associated data entry shell
– Defines each column in the excel file

2
Palette of Measures Evaluation:
What You Will Need (slide 2 of 2)
• Outcome measures from the two-pronged
approach
– General Outcome Measure
– Target-Specific Outcome Measure(s)
– For example…
• Revised Child Anxiety and Depression
Scale (RCADS)
– In the public domain, no fee for use

3
Overview of Training
• Brief Overview of Palette of Measures evaluation
protocol
• Revised Child Anxiety and Depression Scale
(RCADS): Target-specific measure when the focus of
treatment is anxiety
– Administration
– Scoring
– Clinical Utility
• Instructions for Palette of Measures data entry and
data submissions
– Data entry: RCADS
– Data entry: Demographics & Services
– Data submissions to CiMH

4
 Brief Overview of Palette of
Measures Evaluation Protocol

5
Outcome Assessment
• Palette of Measures providers will track outcomes
using data from pre- and post- administrations of
standardized measures of functioning
• Pre- and Post- a “dose” of treatment / an
intervention interval
– General measure of youth mental health functioning
(e.g., YOQ/YOQ-SR, CANS, Ohio Scales)
– Target-specific measure linked to focus of
treatment/intervention (e.g., AQ, ECBI, PHQ-9,
PTSD-RI, RCADS)
• Providers may choose to administer mid-course
assessments as well
– e.g., at 3-month intervals in usual care

6
A note about the use of standardized
assessment measures… (slide 1 of 2)
• Assessment is the beginning of developing
a relationship with the child and family
– Demonstrates a desire to know what the child
and family are experiencing
– By incorporating standardized assessment
measures of functioning, the efficiency and
thoroughness of assessment is enhanced

7
A note about the use of standardized
assessment measures… (slide 2 of 2)
• Using standardized assessment measures
of functioning…
– Assists in initial clinical impressions
– Provides valuable information to guide
treatment/interventions
– Assesses sufficiency of treatment delivered
– Demonstrates treatment-related improvements
in child functioning

8
 Revised Child Anxiety and
Depression Scales (RCADS)

9
CIMH RCADS Training
• Information on the RCADS and RCADS-P was
obtained from:
– Psychometric properties of the Revised Child Anxiety and
Depression Scale in a Clinical Sample (Bruce Chorpita,
Catherine Moffitt, & Jennifer Gray; Behaviour Research
and Therapy, 2005)
– A psychometric analysis of the Revised Child Anxiety and
Depression Scale – Parent version in a clinical sample
(Chad Ebesutani, Adam Bernstein, Brad Nakamura, Bruce
Chorpita & John Weisz; Journal of Abnormal Child
Psychology, 2010)
– A psychometric analysis of the Revised Child Anxiety and
Depression Scale – Parent version in a school sample
(Chad Ebesutani, Bruce Chorpita, Charmaine Higa-
McMillan, Brad Nakamura, Jennifer Regan, & Roxanna
Lynch; Journal of Abnormal Child Psychology, 2010)

10
RCADS and RCADS-P
Please refer to the UCLA Child First
website periodically for updated
materials
– http://www.childfirst.ucla.edu/resources.html

– e.g., a User’s Manual was released and

posted on this website Feb 2, 2011

11
RCADS and RCADS-P Description
Descripti
• Target-specific measure when the focus of
treatment is anxiety
• Measures the current frequency of anxiety
symptoms (and depression)
– Parent/caregiver report for ages 6-18
– Child self-report for ages 6-18
• Valid and reliable
• Available in the public domain, provided to
partnering agencies by CiMH

12
RCADS and RCADS-P Description
Descripti
• Parallel versions of • Six Scale Scores
the same measure – Separation Anxiety
• 47 items – Generalized Anxiety
– Panic
• 4-point Likert scale – Social Phobia
response options – Obsessions/
– Never (0) Compulsions
– Sometimes (1) – Depression
– Often (2) • Total Anxiety Score
– Always (3) • Total Anxiety and
Depression Score

13
RCADS and RCADS-P
Administration
• Administer pre- and post- a dose of
treatment, or an intervention interval
– RCADS completed by client
– RCADS-P completed by mother/mother figure
or father/father figure (when available)
• Both can be completed for clinical purposes;
however, only one should be entered for outcome
tracking purposes
– Select parent/caregiver who spends most time with client

14
Let’s take a look at the
RCADS...

15
RCADS and RCADS-P
Administration
• Approximately 5-10 minutes to complete
• Youth are asked to report how often each
item applies to them (“...how often each of
these things happen to you?”)
– Parents/caregivers are asked to report how
often each of these items applies to their child
• Can be read aloud if desired/necessary

16
RCADS and RCADS-P
Administration
• Encourage honest responses
– Informants can easily be influenced by the
attitude of the person administering the scale
– Let respondents know that this questionnaire
will help you, as a clinician, better understand
how they are doing and how you can best
help them
• There are no right or wrong answers
• Encourage responses on all items

17
RCADS and RCADS-P Scoring
• RCADS and RCADS-P Scoring Worksheet
– Appropriate for entire age range of 6-18
– For each Scale, transfer the values associated
with the child or parent’s responses next to the
appropriate Question #
• Sum the values to determine each Scale score
– To obtain the Total Anxiety Score:
• Sum the Separation Anxiety, Generalized Anxiety,
Panic, Social Phobia, and Obsessions/Compulsions
Scale Scores
– To obtain the Total Anxiety and Depression
Score:
• Sum all Scale scores

18
RCADS and RCADS-P Scoring
• Excel Scoring Programs
– Appropriate for children in grades 3-12
• Should not be used to score RCADS or RCADS-P
measures for children younger than grade 3
– Available from UCLA Child First website
• http://www.childfirst.ucla.edu/resources.html
– Enter the values associated with the child or
parent’s responses next to the appropriate
Question #
– Scale Scores and Total Scores will automatically
be calculated
• T Scores are also generated

19
RCADS and RCADS-P Score
Interpretation
• T Score Interpretation for children in grades
3-12
– T Scores are standardized scores that have a
mean (average) of 50 and standard deviation of
10
• Automatically generated by UCLA Child First excel
scoring programs; also available in User’s Manual
– RCADS and RCADS-P
• T Scores > 65 are borderline clinically significant
• T Scores > 70 are clinically significant

20
RCADS and RCADS-P Score
Interpretation
• Raw score interpretation for children younger
than grade 3
– **T Scores conversions have not yet been
developed for children younger than grade 3**
– Use clinical judgment in evaluating raw scores
• What is the possible range of scores for this particular
scale or total score?
– Is this child’s score closer to the high end of the range? Or
closer to the low end of the range?
• Out of the total number of items assessed on this scale
or within this total score, what proportion are endorsed
at a 2 (“often”) or 3 (“always”)?

21
Clinical Utility of the RCADS
• Provides both child self-report and
parent/caregiver report of the same set of
symptoms
– Whenever possible, gathering information on the
same construct from multiple informants is
recommended
– However, research has demonstrated little
concordance between child self-report and
parent-report (not specific to RCADS)
• Disagreement should be viewed as different, yet
equally valid perceptions of youth problems

22
Clinical Utility of the RCADS
• Explicitly designed to assess symptomotology
associated with current diagnostic systems
• Each scale includes items that correspond to
selected DSM-IV anxiety disorders
• Separation Anxiety Disorder
• Social Phobia
• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Panic Disorder
• Also includes a scale for DSM-IV Major Depression

23
Clinical Utility of the RCADS
• For children grades 3-12, T Scores at or
above the clinical threshold (70) or
borderline clinical threshold (65) indicate
that the child is experiencing anxiety-
related symptoms that are most similar to
children who meet diagnostic criteria for
that particular disorder or syndrome (e.g.,
social phobia, generalized anxiety)

24
Clinical Utility of the RCADS
• Assesses symptoms associated with a range
of DSM-IV anxiety diagnoses
• Assists in initial clinical impressions and
diagnostic formulations
• Provides valuable information to guide
treatment/interventions
• Comparisons of pre/post scores reveal
treatment-related improvement in child
anxiety
– e.g.,
• Does the severity of diagnostic-specific anxiety
symptoms decrease substantially?

25
Palette of Measures Data Entry and
Data Submissions

26
Palette of Measures Data Entry
Shell
• There is a separate spreadsheet in the excel
workbook (aka database) for each type of
data:
– Demographics & Services
– Pre- General outcome measure
– Post- General outcome measure
– Pre- Target-specific measure(s)
– Post- Target-specific outcome measure(s)
• Specific outcome measure spreadsheets included in
each agency’s database varies across Palette of
Measures project participants

27
Palette of Measures Data Entry
Shell
• In addition to the spreadsheets that hold
data...
– There is an Instructions spreadsheet
• Basic data entry instructions
• Contact information for T.A. (Cricket Mitchell)
– There is a Data Lists spreadsheet at the end
of the workbook that you will not use
• Data Lists populate the pull-down menus in other
spreadsheets

28
 Palette of Measures Data Entry:
RCADS
Pre-RCADS   PARENT/CAREGIVER REPORT: (ages 6-18)

  Date of RCADS-P (Raw Scale and Total Scores)

Client ID# Assessment P-Sep1 P-Gen1 P-Pan1 P-Soc1 P-OC1 P-Dep1 P-TotAnx1 P-TotAnxDep1
                   
                   
• There is a separate spreadsheet for Pre-RCADS data, Post-
RCADS data, and Mid-RCADS data
• In each spreadsheet, there is a separate field for each of the Raw
scores for all Scales, Total Anxiety, and Total Anxiety &
Depression for both informants
• In the event of missing data, please leave fields blank/empty

29
 Palette of Measures Data Entry:
RCADS
Mid-RCADS     PARENT/CAREGIVER REPORT: (ages 6-18)
  Date of Assessment RCADS-P (Raw Scale and Total Scores)
P- P- P- P- P- P- P- P-
Client ID# Assessment Interval SepM GenM PanM SocM OCM DepM TotAnxM TotAnxDepM

                     
                     

• For agencies who will conduct mid-treatment assessments,

indicate the Assessment Interval in the Mid-RCADS
spreadsheet by selecting from the available pull-down menu
• e.g., 1st mid-treatment assessment, 2nd mid-treatment
assessment

30
But, before you enter any
outcome data, you’ll enter
Demographics & Service
Delivery Information...

31
 Palette of Measures Data Entry:
Demographics & Services (1 of 2)
Client Information:           
        Primary (DSM-IV code) (DSM-IV code)  

Client ID# DOB Gender Ethnicity Language Primary Axis I Secondary Axis I Therapist ID

               

               

• Use a unique identifier for Client ID#

• Categorical variables will have pull-down menus from which
you’ll select an option (e.g., gender, ethnicity, language)
• Dates should be entered as xx/xx/xxxx
• Axis I diagnoses s/b the numeric DSM-IV code
• Therapist ID is optional

32
 Palette of Measures Data Entry:
Demographics & Services (2 of 2)
Focus 1 of Treatment  
(if Focus 1 not (if Services not
  Date of Date of Total # Completed completed) Completed completed)
First Last of
Focus1 Session Session Sessions Focus 1? Reason Services? Reason
               
• Select Focus from pull-down menu (e.g., anxiety, depression)
• The shell will hold data for up to 4 foci, or treatment targets
• Enter Date of First Session
• The remaining fields are to be completed at the end of treatment
targeting this particular focus (e.g., Date of Last, # Sessions)
• 2 levels of “Completed?”
• Treatment targeting this particular focus
• Overall service delivery

33
 Palette of Measures Data
Submissions (slide 1 of 3)
• Data submissions to CiMH will occur twice a year
throughout the duration of the project
– The end of each May (reflecting all clients served from the
initiation of the project through the end of that April)
– The end of each December (reflecting all clients served
from the initiation of the project through the end of that
November)
– Note that this is the anticipated schedule; actual data
submission dates may vary slightly
• An email notice will be sent to Palette of Measures
site leads approximately one month in advance of
each data submission deadline

34
 Data Submissions (slide 2 of 3)
• Providers may choose from among the following
methods for submitting their Palette of Measures
Excel databases to CiMH:
– Use YouSendIt, or another secure web-based transfer
site, to submit data electronically
• YouSendIt (www.YouSendIt.com) is a vendor that supports the
secure transfer of electronic data (encrypted and password-
protected)
– Mail a password-protected CD to CiMH and submit the
password separately (via email or phone)
– Email an encrypted, password-protected file(s) to CiMH
and submit the password separately (via email or phone)

35
 Data Submissions (slide 3 of 3)
• After data are submitted, sites continue to
enter new data into the same database
– Always reflects an ongoing, historical record of
clients served through the Palette of Measures
project
• Every effort is made to distribute reports
within two months of each data submission
– Aggregate and site/agency-specific reports

36
Questions

37
 The End
Contact Information
•Cricket Mitchell, PhD
•Email: cmitchell@cimh.org
•Cell phone: 858-220-6355

38