Scoring the BBHI 2 Standardized Treatment Risk Scores

Transcription

1 Scoring the BBHI 2 Standardized Treatment Risk Scores 2013 by Daniel Bruns, PsyD and John Mark Disorbio, EdD v 9 Patient Name: Date: Referring Physician: Proposed Treatment: Risk Score Findings Raw Score Patient ile Chronic Pain ile (optional) Community ile (optional) Primary Risks Secondary Risks Clinical Findings Conclusions 1

2 Instructions 1. Beginning with the primary score worksheet, review the BBHI 2 scale profile. Note any relevant scale scores > 72 on the worksheet. Similarly, review the content scores; then the critical item scores and demographics and record positive findings. Note that the critical items only appear on the printout if there are positive findings. Score the risk factors 0 or 1, and then calculate the total raw score. Remember that each individual primary risk was seen in only 1% of the BHI 2 normative sample. 2. Record clinical findings resulting from the interview or chart review. For example, a defensive patient may deny substance abuse on the BBHI 2, but a chart review could reveal a positive drug test. Also note that the risk score criteria are psychometric scores, not diagnoses. Diagnostic information can be noted in the clinical findings. 3. Repeat the above using the secondary risk score criteria. Score the risk factors 0 or 1, and then calculate the total raw score. Remember that each individual secondary risk was seen in only 16% of the BBHI 2 normative sample (one standard deviation above the mean). 4. Using the tables, identify the primary and secondary risk score percentile ranks and record them above. In most patients, the primary risk raw score will be To interpret the meaning and limitations of these scores, review the following document: Bruns, D., & Disorbio, J. M. (2009). Assessment of Biopsychosocial Risk Factors For Medical Treatment: A Collaborative Approach. Journal of Clinical Psychology in Medical Settings, 16(2), Additional information can be gained by also calculating the community percentile rank. To understand the interpretation of double-normed scales, review the following document: 7. If the patient exhibits fake good testing profiles on the BBHI 2 or other tests, reported risk factors will likely be spuriously low. Under these circumstances, patient history and clinical observations regarding the presence of these risk factors should be carefully weighed. 8. Caveat: The selection of patients for medical treatment is a complex clinical decision-making process. Ultimately, the decision about whether or not to perform medical treatments should be made by the physician, with consideration for the assessment of psychosocial risks performed by appropriately-trained mental health professionals, as appropriate. While these risk scores were derived from a review of the literature, and convergence of evidence and opinion about important factors to assess, this specific scoring algorithm has only been empirically tested in one study. This risk assessment method can serve as one means of assessing biopsychosocial risk, which can inform treating professionals. However, the risk scores themselves are not intended to substitute for the clinical opinion of a trained professional. The risk score ranks (High, Very High, etc) are based on their statistical distribution, not on outcome data, and can be used for statistically describing the number of risk factors that are present. 2

3 Type of Risk Affective Other Psychological Risks Social Biological Primary Risk Score Worksheet Adapted from Bruns and Disorbio, 2009 Primary Factors BBHI 2 Sign BBHI 2 or Clinical Risk (0 or 1) Active suicidal urges Suicidal Ideation** = A or SA 0 1 Active homicidal urges Severe depression Depression > Severe anxiety (generalized, panic, Anxiety > 72 PTSD, med. phobia/death fears, etc) 0 1 Severe anger Mood elevation/mania Psychosis/Delusions/Hallucinations Psychosis** = MP/BP 0 1 Active substance abuse Somatization Somatic Complaints > Pain focused somatoform disorder Pain Complaints > Severe personality disorder Extremely poor coping Severe social isolation, family dysfunction, or current severe abuse Home life problems** = SA 0 1 Litigation for pain and suffering, and pain-related treatment Has attorney for healthcare matters*** and Comp Focus** = SA 0 1 Intense Dr./patient conflict Anger with Physician** = SA 0 1 Pain Unusual pain reports Number body areas with pain = Dysfunctional pain cognitions Pain Fixation** = SA 0 1 Extreme, invariant pain Highest Pain =10 with Pain Range =0 0 1 Exam History Science Extreme pain sensitivity Pain Tolerance Index = Positive bias to information Defensiveness > Medically impossible symptoms Gross inconsistencies between objective findings, symptom reports, and patient behavior Falsifying information, malingering, or factitious symptoms Inability to cooperate with treatment due to cognitive or other problems Same treatment failed multiple times in past Abuse of prescription medications, violation of opioid contracts History of gross noncompliance EB guidelines conclude treatment is injurious or of no benefit Primary Risk Raw Score Total Observations and Findings * Content Area; ** Critical Item; *** Demographic variable; A=Agree; SA=Strongly Agree; BP =Big Problem; MP = Moderate Problem; VH =Very High 3

4 Type of Risk Affective Psychologi cal Vulnerabili ty Social Biological Depression Anger Secondary Factors Secondary Risk Score Worksheet Adapted from Bruns and Disorbio, 2009 BBHI 2 Sign Depression > 59 or Vegetative Depression**= SA BBHI 2 Or Clinical Risk 0 1 Anxiety (fears, phobias, PTSD, etc) Anxiety > 59, or Panic** = MP or BP 0 1 Hx substance abuse Substance Abuse = SD 0 1 Personality disorder Cognitive disorder or low education Years Ed < high school graduate *** 0 1 Poor coping Diffuse somatic complaints Somatic Complaints > Conflict with Physicians Doctor Dissatisfaction** = A or SA 0 1 Job dissatisfaction Family dysfunction Home life problems** = SA 0 1 Hx abuse Worker compensation Worker Compensation*** 0 1 Compensation focus Compensation Focus** = SA 0 1 Represented by attorney Has attorney*** 0 1 Extreme pain Peak Pain = Dysfunct. Pain Pain Fixation** = A or SA 0 1 Pain & Disability Exam History Science Cognitions Pain sensitivity Pain Tolerance Index < Pain invariance Pain Range < Diffuse pain Pain Complaints > Pain > 2 years Demographic 0 1 Unexplained disability Functional Complaints > Biased information Defensiveness > 66 or < 34 = No medical necessity of procedure to preserve life or function Destructive/ high risk elective medical procedure Procedure specific risks: Smoking, diet, attitude towards implant, etc Similar procedure failed previously No response to any treatment History of nonadherence to conservative care No objective medical findings EB guidelines find inconclusive evidence of benefit Observations and Findings Secondary Risk Raw Score Total 4

5 Norms And Reliability of Risk Scores for Patients and Community Members Adapted from Bruns and Disorbio, 2009 Statistic BBHI 2 Primary Risk Score Norms Chronic Community Patient Community Secondary Risk Score Norms Patient Chronic Pain Pain N Mean Median Mode Standard Deviation Test-retest Reliability (N=82) Risk score range Moderately High (High for healthy person, high average for patients): Raw score equaling 84 th percentile (elevated one standard deviation) compared to community High: Raw score equaling 84 th percentile (elevated one standard deviation) compared to other patients in rehabilitation Very High: Raw score equaling 95 th percentile compared to other patients in rehabilitation Extremely High: Raw score equaling 99 th percentile compared to other patients in rehabilitation Raw Score Cutoffs For Benchmark Risk Levels Raw scores =

6 Raw Risk Score ile s Using Community Norms BBHI Primary Risk Factors ile BBHI Secondary Risk Factors ile * Total Missing Grand Total * Since all of the individual primary risk factors are extreme and relatively rare, the distribution of the primary risk score is highly skewed. Note that because 68.6% of patients have 0 primary risks, a score of 0 corresponds with a percentile rank of 68.6%. This percentile rank is somewhat misleading though, as it is also the lowest possible percentile rank on this measure. 6

7 Raw Risk Score ile s Using Patient Norms BBHI Primary Risk Scores ile BBHI Secondary Risk Scores ile Total Missing Grand Total

8 Raw Risk Score ile s Using Chronic Pain Norms BBHI Primary Risk Scores ile BBHI Secondary Risk Scores ile Total Missing Grand Total