Graphs
Q: How do I make/view a client graph?
A: Check out this tutorial.
Q: What is the projected change (purple line)?
A: It is the expected change your client will experience if services are helpful. This line is determined using your client’s age, initial distress score, and the information from all the other clients that are in the CCI database.
Q: What goes into calculating the Global Distress Score (GDS)?
A: The GDS is a simple average of scores from questionnaire items in four domains which include: symptoms; functionality; social; and risk. In other words, it represents the client’s perspective on how distressed they are as represented by their individual answers on the ACORN.
To calculate GDS, each rated item in the symptom section is assigned a value from 0 to 4. The values of all the items (excluding substance use questions) are added up and then divided by the total number of questions. The resulting number is the GDS value. 0 represents no distress and 4 represents the maximum level of distress.
Q: What is the minimum number of ACORNS needed to show progress in treatment?
A: Two
Q: in what direction do I want my client’s scores to be going on the graph, up or down?
A: Higher scores on the ACORN graph mean that clients are reporting that their overall level of distress is getting worse. When services are effective, we would expect the distress scores to go down and the direction of the graph to go down as well. This means that if their graph is moving up/scores are getting higher, they are telling us that they are getting worse. In these cases we should see if changes to services or referral to a higher level of care is indicated.
Q: When I’m looking at the client graph page, is there anything that I should prioritize paying attention to?
A: The direction of change in Global Distress Score (if it’s going up it means the client is doing worse) and/or Self Harm score(s)
Q: What is the Clinical Boundary?
A: The clinical cutoff score ACORN uses was determined by Jacobson and Truax in a 1991 article where they compared a community sample to a clinical one. (https://content.apa.org/record/1991-16094-001)
It refers to a score that is presumed to represent the boundary between "normal" and the "clinical range" on an outcome measure. The article linked above describes a method for calculating the clinical cutoff score for outcome measures in psychotherapy research. The formula requires the mean and standard deviation of both a clinical and non-clinical sample, and estimates the score at which a subject has a greater probability of belonging to a clinical sample rather than a non-clinical sample.
Another frequently used definition of "normal" is a score that falls within 1 standard deviation of the mean for a non-clinical sample. Subjects scoring more than a standard deviation above the mean of a non-clinical sample (85th percentile) are said to be in the clinical range. In practice, both methods tend to arrive at very similar cutoff scores.
It is worth noting that published reports indicate that at least 25% of patients seeking mental health services have test scores below the clinical cutoff score at the start of treatment. Patients with test scores in the normal range tend to have change scores near 0 or even in a negative direction. See Brown et al (2001) for further discussion of this phenomenon.