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. Scope

1.1. This instruction provides additional information on psychometric instruments that may be used by mental health professionals (psychologists, occupational therapists, registered nurses, and social workers) as part of the clinical assessment for Open Arms clients. This instruction should be read in conjunction with the Clinical Assessment and Treatment Planning Procedure (202-02).

2. Context

2.1. The foundation of Open Arms care planning is a thorough clinical assessment which includes a detailed history, exploration of presenting concerns, assessment of risk of harm, and examination of current mental state.

2.2. Open Arms requires clinicians to use an evidence-based approach to clinical assessment. Open Arms clinicians work within the boundaries of their professional competence, ensuring they have the necessary qualifications and experience to administer any psychometric instrument they use.

2.3. Psychometric instruments may be used in the data collection and assessment phase of counselling to inform case formulation and care planning, and also in the measurement of counselling outcomes. The National Psychology Board is developing a code of conduct[1] which will apply to all registered psychologists. Until this is released, compliance with the Australian Psychological Society Code of Ethics[2] is a requirement of registration as a psychologist in Australia, and all uses of psychometric instruments must be consistent with this code. Occupational therapists and medical practitioners must be compliant with their respective national board’s codes of conduct, and nurses must be compliant with their national board’s standards for practice. Social workers must be compliant with the Australian Association of Social Workers code of ethics.

3. Use of Psychometric Instruments

3.1. Open Arms administers the following assessment measurements for the purpose of screening and outcome monitoring:

  • Depression Anxiety and Stress Scale (DASS)
  • Alcohol Use Disorders Identification Test (AUDIT)
  • PTSD Check List (PCL-5) if a client presents with trauma.

3.2. These are intended as repeated measures, to be taken and recorded in VERA at the beginning of an episode of care and at intervals thereafter. Use of these screening assessments is expected, and a clinician may only omit administration if there is a valid, documented clinical reason to do so.

3.3. Clinicians may use additional psychometrics within the scope of their professional practice, training and competence in the context of assessment, formulation, treatment and review. A clinician using a psychometric instrument with an Open Arms client must:

  • comply with standardisation instructions unless there is a valid reason to deviate from administration instructions
  • protect restricted tests from public disclosure
  • ensure that the psychometric instrument is valid for the chosen use and appropriate given the culture and language of the client
  • use a psychometric instrument as one source of data in clinical assessment, based on sound theory, and not as an outcome in itself
  • be aware of personal biases and limitations in selection, interpretation and reporting results to clients
  • seek the informed consent of the client or legal guardian (see the Privacy and Confidentiality Procedure (101-02)), including a plain language explanation of:
  • the nature and purpose of the psychometric instrument(s) to be used
  • the reasonably foreseeable risks, adverse effects and possible disadvantages
  • how information will be collected and recorded, how long information will be stored, who will have access to the stored information, and limits to confidentiality
  • advise the client that they may participate, may decline to participate or may withdraw from methods or procedures proposed to them, and what the reasonably foreseeable consequences may be if they decline to participate or if they withdraw from the proposed procedures
  • only draw conclusions from psychometric instruments that can be supported by the evidence in the context of the whole clinical picture
  • weigh all components of the assessment, including data gathered from psychometric instruments, in case formulation and care planning

3.4. The Open Arms website has a number of resources for health professionals, including additional information on a range of psychometric instruments suited to common presenting issues to assist in working with clients.

4. General Assessment

4.1. The following are assessment tools which can provide additional information about a client’s current level of functioning. Tools in this category are diverse, and include mental state examinations, clinical interviews and brief scales.

4.2. A mental state examination is a structured interview designed to obtain information about a client’s mental experiences and behaviour at the time of the assessment. Structured interview forms vary in detail and complexity. Three examples are:

  • Mental State Examination (MSE)
  • Mini Mental State Examination (MMSE)
  • Modified Mini Mental State Examination (3MS).

4.3. There are a number of form-based assessments of mental health that have a sound evidence base. Two commonly used examples are:

  • Kessler Psychological Distress Scale (K10) – short
  • Mini International Neuropsychiatric Interview (MINI)[3] – long.

4.4. In addition, examples of general psychological symptom assessments include:

  • Brief Psychiatric Rating Scale (BPRS)[4]
  • Symptom Checklist 90 Revised (SCL-90-R)[5] 
  • Brief Symptom Inventory (BSI).

5. Suicidal thoughts, suicidal behaviours and self-harm

5.1. Although the SafeSide framework is used in Open Arms to formulate and respond to risk, the following may be used to augment the framework:

  • Columbia Suicide Severity Rating Scale (C-SSRS)[6] 
  • Suicidal Ideation Attributes Scale (SIDAS)[7]  
  • Adapted version of the Brief Non-suicidal Self-Injury Assessment Tool (B-NSSI-AT).

6. Personality Assessments

6.1. There are a number of well-established and well-researched personality inventories commercially available. A selection of these is:

  • Minnesota Multiphasic Personality Inventory 2 (MMPI-2)
  • Personality Assessment Inventory (PAI)
  • Millon Clinical Multiaxial Inventory (MCMI-III)
  • Revised NEO Personality Inventory (NEO PI-R).

7. Depression

7.1. Widely used brief self-report inventories of depression include:

  • Beck Depression Inventory (BDI-II)[8] 
  • Depression Anxiety and Stress Scale (DASS) 
  • Hamilton Depression Rating Scale (HAM-D)[9] 
  • Zung Self-rating Depression Scale (SDS)
  • Edinburgh Post Natal Depression Scale
  • Patient Health Questionnaire-9.[10] 

8. Anxiety and Stress

8.1. Widely used brief self-report inventories of anxiety include:

  • Anxiety Sensitivity Index (ASI)
  • Beck Anxiety Inventory (BAI)[11] 
  • Depression Anxiety and Stress Scale (DASS)
  • Hamilton Rating Scale for Anxiety (HAM-A)
  • Penn State Worry Questionnaire PSWQ) 
  • State-Trait Anxiety Inventory (STAI)
  • Generalised Anxiety Disorder 7-item scale (GAD-7).[12]

9. Posttraumatic Stress Disorder (PTSD)

9.1. These are widely considered the gold standard for assessing PTSD:

  • Clinician Administered PTSD Scale (CAPS)[13] 
  • PTSD Check List (PCL-5).

9.2. Other measures that may also be considered include:

  • Davidson Trauma Scale (DTS)[14] 
  • PTSD Symptom Scale Interview (PSS-I)[15] 
  • PTSD Symptom Scale self-report version (PSS-SR)[16] 
  • Structured Interview for PTSD (SIP)[17]

9.3. Reference to the Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder[18] is highly recommended for guidance in both the assessment and treatment of PTSD.

10. Substance Use

10.1. Open Arms uses the Alcohol Use Disorders Identification Test (AUDIT) as standard practice during initial assessment. Substance use may further be measured using:

  • Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)[19]

11. Specific Symptoms

11.1. A number of measures may also be considered for a range of specific symptom assessments. Some examples are:

  • AAQ-II (Acceptance and Action Questionnaire – 2nd Edition)
  • Assertiveness Questionnaire
  • Clinical Dementia Rating (CDR)
  • Child Behaviour Checklist (CBCL)
  • Eating Disorder Questionnaire (EDQ)
  • Eating Disorder Inventory (EDI)
  • Fear Questionnaire (FQ)
  • Fear of Negative Evaluation Scale (FNE)
  • HCR-20 Violence Risk Assessment Scheme
  • Positive Beliefs about Rumination Scale (PBRS)
  • State-Trait Anger Expression Inventory (STAXI)
  • Dimension of Anger Scale (DAR-5)
  • World Health Organisation Quality of Life – Brief Form (WHOQOL-BREF)
  • Yale Brown Obsessive Compulsive Scale
  • Young Schema Questionnaire (YSQ)
  • Defense and Veterans Pain Rating Scale (DVPRS)[20] 
  • Pittsburgh Sleep Quality Index (PSQI)
  • Altman Self-Rating Mania Scale (ASRM)[21] 
  • Psychosis: Prodromal Questionnaire (PQ-16)[22] 
  • Physical Health: The International Physical Activity Questionnaire (IPAQ)[23] 
  • Social Connectedness: Spouse/ Partner Support Scale[24]

12. Relationship Measures

12.1. While there are numerous relationship measures, few have strong evidence to support them. Two have been identified that appear to be moderately supported by evidence:

  • Systemic Clinical Outcome and Routine Evaluation – 15-item version (SCORE-15)
  • Gottman Relationship Checkup.

13. Cost-per-use Instruments

13.1. Psychometric instruments that have a cost per use must be approved by the Open Arms Director (or delegate). To be approved, psychometric instruments must meet scientific standards for reliability and validity and provide relevant clinical information.

13.2. Open Arms Directors may seek approval to add a pay-per-use psychometric instrument by submitting a business case for approval by the Assistant National Manager that:

  • outlines why the instrument is required and how it will be used
  • provides evidence of the instrument’s reliability and validity
  • describes restrictions, qualifications and training required for its use, including any purchaser conditions, and outlines how these will be met
  • describes why the test has been selected and how it is administered, scored and interpreted
  • describes how use of the instrument serves the interests of clients
  • can demonstrate the existence of counsellor proficiency to use the instrument, including a record of training and relevant experience.

13.3. Online versions of cost-per-use instruments are preferred, to allow for national access. A region may seek approval for a hard copy of a high-value instrument, such as WAIS or WISC, with an appropriate rationale outlined in the business case.

13.4. Open Arms bears the cost of any approved in-centre use of a psychometric instrument. Approved outreach program counsellor (OPC) use of a psychometric instrument (other than those instruments which Open Arms requires to be used) is at the OPC’s own expense.

13.5. The Open Arms Director may approve professional development and supervised practice to enable a centre-based clinician to develop sufficient expertise. Where that occurs, the nominated supervisor must have sufficient training and expertise in the use of the psychometric instrument to provide appropriate supervision. 

14. Recording Psychometric Results

14.1. Completed, or partially completed, psychometric records form part of the client’s clinical record. Psychometric test forms must be scanned and added to the client’s record in VERA, after which paper copies can be destroyed in accordance with the Client Information and Records Management Procedure (101-01).

14.2. Any interpretation of the results of a psychometric instrument noted in the client’s record must identify the limitations of interpretation.

14.3. The results of psychometric instruments and how they contribute to case formulation and care planning should be explained to the client in plain language, using clinical judgement, explaining any limitations and potential implications.

15. Releasing Psychometric Information

15.1. Releasing restricted test materials, such as completed test forms, is prohibited in most cases to protect the integrity of the psychometric instrument.

15.2. Where release of any raw test data has been legally requested, this must be referred for advice from the DVA Legal Services Branch.

15.3. Under no circumstances may an Open Arms worker release an instrument and/or raw data (pertaining to a client) without the approval of the National Manager (or delegate).

16. Storage and access to restricted test materials

16.1. Many psychological tests are restricted in their access to registered psychologists and probationary psychologists under the supervision of a registered psychologist. In some cases, access is only granted to psychologists who have relevant accreditation. 

16.2. Psychological test materials must be kept securely as psychologists have a responsibility to protect the intellectual property of test authors and publishers and also so that test administration, scoring and interpretation are not compromised. All restricted psychological test materials should be stored securely in a locked cupboard or cabinet (not in an area holding client records or other office materials and therefore accessible to non-psychologist staff) and accessed only by registered psychologists.

16.3. Outreach clinicians operate their practices independently, and manage their own professional arrangements. It is an expectation of outreach clinicians who are registered psychologists that they keep any restricted test materials under appropriate security.

17. Parent Procedure

202-02 Clinical Assessment and Treatment Planning Procedure

18. Related Templates

Nil


[1] The board estimates that this code of conduct will be implemented in late 2022.

[2] Australian Psychological Society (2007). Code of Ethics. Australian Psychological Society: Published online.

[3] Sheehan, DV & Lecrubier, Y (2010). Mini International Neuropsychiatric Interview (M.I.N.I. 6.0.0), University of South Florida / Centre Hospitalier Sainte-Anne.

[4] Overall, JE & Gorham, DR (1962). The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.

[5] Both of these assessments are authored by LR Derogatis and published by Pearson Assessments.

[6] Posner, K, Brown, GK, Stanley, B, Brent, DA, Yershova, KV, Oquendo, MA, ... & Mann, JJ (2011). The Columbia–Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266–1277.

[7] Spijker, BA, Batterham, PJ, Calear, AL, Farrer, L, Christensen, H, Reynolds, J & Kerkhof, AJ (2014). The suicidal ideation attributes scale (SIDAS): community‐based validation study of a new scale for the measurement of suicidal ideation. Suicide and Life-Threatening Behavior, 44(4), 408–419.

[8] Beck, AT, Steer, RA & Brown, GK (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

[9] Although the validity and reliability of this scale has been questioned, for example in Bagby, RM, Ryder, AG, Schuller, DR & Marshall, MB (2004). The Hamilton Depression Rating Scale: Has the Gold Standard Become a Lead Weight? American Journal of Psychiatry, 161, 2163–2177.

[10] Kroenke, K, Spitzer, RL & Williams, JB (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

[11] Beck, AT & Steer, RA (1993). Beck Anxiety Inventory Manual. San Antonio: Harcourt Brace and Company.

[12] Prins, A, Bovin, MJ, Smolenski, DJ, Marx, B, Kimerling, R, Jenkins-Guarnieri, MA, ... & Tiet, QQ (2016). The primary care PTSD screen for DSM-5 (PC-PTSD-5): development and evaluation within a veteran primary care sample. Journal of General Internal Medicine, 31(10), 1206–1211.

[13] Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS & Keane, TM (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8, 75–90.

[14] Zlotnick, C, Davidson, J, Shea, MT & Pearlstein, T (1996). The validation of the Davidson Trauma Scale (DTS) in a sample of survivors of childhood sexual abuse. Journal of Nervous and Mental Disease, 184, 255–257.

[15] Foa, EB, Riggs, DS, Dancu, CV & Rothbaum, BO (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459­–473.

[16] Falsetti, SA, Resnick, HS, Resick, PA & Kilpatrick, D (1993). The Modified PTSD Symptom Scale: A brief self-report measure of posttraumatic stress disorder. The Behavioral Therapist, 16, 161–162.

[17] Davidson, JR, Book, S, Colket, J, Tupler, L et al. (1997). Assessment of a new self-rating scale for post-traumatic stress disorder. Psychological Medicine 27(1), 153–160.

[18] Phoenix Australia – Centre for Posttraumatic Mental Health (2013). Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder. PA-CPMH, Melbourne.

[19] WHO ASSIST Working Group (2002). The alcohol, smoking and substance involvement screening test (ASSIST): development, reliability and feasibility. Addiction, 97(9), 1183–1194.

[20] Buckenmaier, CC, Galloway, KT, Polomano, RC, McDuffie, M, Kwon, N & Gallagher, RM (2013). Preliminary validation of the Defense and Veterans Pain Rating Scale (DVPRS) in a military population. Pain Medicine, 14(1), 110–123.

[21] Altman, EG, Hedeker, D, Peterson, JL & Davis, JM (1997). The Altman self-rating mania scale. Biological Psychiatry, 42(10), 948–955.

[22] Ising, HK, Veling, W, Loewy, RL, Rietveld, MW, Rietdijk, J, Dragt, S ... & van der Gaag, M (2012). The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra-high risk of developing psychosis in the general help-seeking population. Schizophrenia Bulletin, 38(6), 1288–1296.

[23] Craig, CL, Marshall, AL, Sjorstrom, M, Bauman, AE, Booth, ML, Ainsworth, BE ... & Oja, P (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395.

[24] Schuster, TL, Kessler, RC & Aseltine, RH (1990). Supportive interactions, negative interactions, and depressed mood. American Journal of Community Psychology, 18(3), 423–438.




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