swedish association of child and adolescent psychiatry annual meeting, lund, 2 nd april 2008 making...
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Swedish Association of Child and Adolescent PsychiatryAnnual meeting, Lund, 2nd April 2008
Making life easier for ourselves and families:
Using the online DAWBA in Swedishto take some of the hard work out of detailed assessments
Robert Goodman
King’s College London Institute of Psychiatry
Starting from first principles
Key ingredients of effective clinical work:
2) Thorough assessment of psychopathology and risk factors
3) Evidence based treatment
4) Routine monitoring of outcome
1) Motivated and courteous staff
Additional principles from public health
5) Maximize cost-benefit ratio
6) Easy access to all potential beneficiaries
Automation
In the long run this:
1) Increases wages
2) Makes products and services cheaper and therefore more widely available
The use of machines can greatly increase the productivity of workers
Spinning
Harvesting
Washing clothes
Adding up numbers
Medical investigations
Thorough assessment of psychopathology and risk factors
There are several options:
• Questionnaires and fully structured interviews
• Semi-structured interviews
• Hybrid measures
Questionnaires and fully structured interviews (respondent-based)
The questions and response categories are fixed. These can be administered by a computer or an interviewer, but the interviewer’s job is really just to read the question, and not to modify the question or interpret the response.
e.g. the DISC
Semi-structured interviews (investigator-based)
A highly trained interviewer uses flexible questioning to decide if each of the relevant symptoms is present or not. e.g. CAPA, K-SADS
Fully structured Semi-structured
Quick +Cheap +Clinically convincing + + +
For many fully and semi-structured interviews:
Answersto the interview
Fully automatic computer algorithm
Final diagnoses
Development and Well-Being Assessment (DAWBA)
Computer or non-specialist interviewer administers two sorts of questions:
1) Fixed questions with fixed response options
2) Open-ended follow-on questions to elicit descriptions of problems in the respondents’ own words
Answers to fixed question
Computer algorithm
Provisional diagnosis
Answers to open-ended questions
Summaries
Experienced clinical rater makes final diagnoses
Additional clinical interview
10,000 : 300 : 3
The DAWBA clinical raters deal with 3 key questions:
1) Did the respondents understand the questions?
2) How should conflicting information be resolved?
3) Assign a non-operationalised diagnosis?
The validity of the DAWBA has been demonstrated in British, Brazilian, Bangladeshi and Yemeni studies.
In addition:
• It generates sensible results for prevalence and risk factors
• It is relatively quick and easy
• It works in difficult circumstances
The DAWBA in Swedish
With particular thanks to :
Jan-Olov Larrson
Hans Smedje
www.dawba.com
for a demonstration of the online DAWBA system
To register your team for a free trial of the online DAWBA system:
www.dawba.net/user
Or email us with questions: [email protected]