Measuring adherence to depression treatment guidelines in a VA primary care clinic

The primary objectives of this pilot study were to develop a measure of adherence for depression practice guidelines and to assess the degree to which providers and patients adhere to guidelines in a VA primary care setting. The Depression Guideline Measure (DGM) is based on three national guidelines. The DGM was used to review medical records of 111 patients with Patient Health Questionnaire (PHQ) scores >or=10. Interrater reliability for 15 of 19 DGM checklist items was excellent (kappa > 0.75). There was a broad range of adherence to guideline criteria: only 13.5% of patients were contacted for follow-up within 2 weeks, while 100% of providers documented follow-up plans. Forty percent of patients saw mental health providers, and 63% were prescribed antidepressants. A secondary objective of the study was to explore the relationship between guideline adherence and changes in PHQ scores. Among 51 patients who completed follow-up PHQs, no associations were detected. The results suggest that the DGM shows promise as a reliable measure of guideline adherence and that guideline criteria are frequently not met in busy primary care clinics. More research is needed to determine the validity of the DGM and the impact of guideline adherence on depression outcomes.     

Guidelines for psychosocial interventions in dementia care: a European survey and comparison

Objective

The effectiveness of psychosocial interventions in treating people with dementia and their carers is increasingly emphasised in the literature. Dementia guidelines should summarise the scientific evidence and best practice that is currently available, therefore, it should include recommendations for psychosocial interventions. The aims of our study were (1) to collate dementia guidelines from countries across Europe and to check whether they included sections about psychosocial interventions, and (2) to compare the methodological quality and the recommendations for specific psychosocial interventions in these guidelines.

Methods

The European dementia guidelines were inventoried. The methodological quality of the guideline sections for psychosocial interventions was assessed with the (AGREE) Appraisal of Guidelines Research and Evaluation instrument. The recommendations for specific psychosocial interventions were extracted from each of these guidelines and compared.

Results

Guidelines for psychosocial interventions were found in five of 12 countries. Guideline developers, methodological quality and appreciation of available evidence influenced the inclusion of psychosocial interventions in dementia guidelines from Germany, Italy, the Netherlands, Spain and the UK. The UK NICE SCIE guideline had the best methodological quality and included the most recommendations for psychosocial interventions. Physical activity and carer interventions were recommended the most across all guidelines.

Conclusion

The inclusion of psychosocial interventions in dementia guidelines is limited across Europe. High‐quality guidelines that include psychosocial interventions and are kept up to date with the emerging evidence are needed. Throughout Europe, special attention to the implementation of evidence‐based psychosocial care is needed in the next few years. Copyright © 2011 John Wiley & Sons, Ltd.     

UK art therapy practice-based guidelines for children and adults with learning disabilities

ABSTRACT

Art therapy is a form of psychotherapy that uses art media as its primary mode of communication. Having skill and experience in art is not a pre-requirement for people to benefit from art therapy. Making art work can offer the opportunity for expression and communication within a psychological therapy for people who find it difficult to express their thoughts and feelings verbally, and it is an accessible approach for children and adults with learning disabilities. An estimated 20% of art therapists working in the UK have some involvement with children or adults who have learning disabilities. These clinical practice guidelines were devised within the UK by the British Association of Art Therapists. A guideline development group was formed by the Learning Disability Special Interest Group and a national consultation was carried out among its membership. Ten overarching guideline recommendations for clinical practice were identified, namely ‘working relationships’, ‘communication’, ‘support networks’, ‘managing risk and vulnerability’, ‘establishing therapy agreements’, ‘assessment, formulation, and therapeutic goals’, ‘working creatively and flexibly’, ‘working psychotherapeutically’, ‘monitoring progress’ and ‘professional responsibilities and self-care’. The published art therapy practice-based guidelines for children and adults with learning disabilities are an example of a clinical consensus on current best practice in the UK.     

Reliability and validity of the DBT-VLCS: A measure to code validation strategies in dialectical behavior therapy sessions

Objective: There are six strategies or validation levels in dialectical behavior therapy (DBT), yet there are no measures designed to code for them. This absence limits our understanding of the relationship between validation strategies and treatment outcome. The DBT-Validation Level Coding Scale (DBT-VLCS) was developed to overcome this limitation. Method: This research reports on the interrater reliability and content validity for the DBT-VLCS. Results: Overall, interrater reliability was excellent for all items, with the exception of two items that demonstrated good reliability. Good content validity was demonstrated for six of the seven items. Conclusions: This preliminary study suggests that the DBT-VLCS is a reliable and valid measure to code the presence of validation in DBT. This measure creates the opportunity for research that has not previously been possible.     

Using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1) as a diagnostic interview providing dimensional measures: cross-national findings on the psychometric properties of psychopathology scales.

BackgroundThe Schedules for Clinical Assessment in Neuropsychiatry (SCAN) is a set of clinical assessment instruments developed under the auspices of WHO. In contrast to other structured diagnostic interviews, SCAN also provides possibilities for dimensional assessment of psychopathology. This paper reports cross-national findings on the psychometric properties of psychopathology scales derived from SCAN 2.1.MethodsWithin a randomized controlled trial, SCAN 2.1 was used in Dresden (Germany), Michalovce (Slovak Republic), Prague (Czech Republic), and Wrocław (Poland). Forty-seven items from Part I of SCAN 2.1, identified as qualifying for constructing dimensional measures, were, on the one hand, grouped according to their allocation to five specific SCAN 2.1 sections. On the other hand, principal component analyses were used to group the items according to their statistical relationship. To estimate the reliability of the scales, Cronbach's α was computed. To assess factor similarity across sites, Tucker's congruence coefficients were calculated. To appraise concurrent validity, mean scale scores were compared across different diagnostic groups.ResultsReliability was qualified as moderate to substantial for all generated scales. Factor-solutions differed across sites. Differences in mean scores supported the assumption that the scales might possess, in addition to face validity, concurrent validity.ConclusionsThis is the first cross-national study on the psychometric properties of psychopathology scales derived from SCAN 2.1, and findings are very encouraging concerning its use as a dimensional measure. However, further studies are needed to substantiate implementation of the scales established.     

The Scales of Psychological Capacities: Adaptation to an adolescent population

Abstract

Given the dearth of pediatric outcome measures, Wallerstein's “Scales of Psychological Capacities” (SPC), measuring psychotherapy changes with adults and reflecting shifts in character without specific adherence to a school of personality, was adapted to adolescents (Ad-SPC) and examined psychometrically. Twelve child psychoanalysts were consulted for content validity. Two investigators determined it to have high face validity after administering it to 40 adolescents. High inter-rater reliability was achieved for individual scale items. Construct validity was determined using Pearson correlations between multiple Ad-SPC items and co-administered validated measures of psychopathology. Preliminary psychometric properties support the Ad-SPC's potential for applicability in adolescent psychotherapy.     

Auditory arousal thresholds after selective slow-wave sleep deprivation.

OBJECTIVES: The aim of this study is to assess Auditory Arousal Thresholds (AATs) three times during an undisturbed baseline night and to compare them to AATs during the recovery night that follows two consecutive nights of selective SWS deprivation. The presence of a time-of-night effect on AATs will also be assessed. METHODS: Ten male Ss slept in the laboratory for 6 consecutive nights. The first two nights were undisturbed. The 3rd night was considered as baseline. During the 4th and 5th nights, selective SWS deprivation was obtained by means of acoustic stimulation. The 6th night was a recovery. In the last 4 nights Ss were awakened three times, after 2, 5 and 7.5 h of sleep, respectively. All the awakenings were carried out from stage 2 (after at least 5 consecutive min of stage 2), by means of 1000 Hz ascending tone series. The AAT determination was based on EEG-EMG criteria: at least 10-s of clear alpha rhythm and/or a 10 s movement arousal. RESULTS: During both deprivation nights, SWS amount was close to zero. In the ensuing recovery night a significant SWS rebound was found, accompanied by a significant increase of AATs with respect to the baseline. Furthermore, there was a significant linear decrease of AATs during the night. Finally, the individual correlations between AATs and SWS amount were significant in 4 out of 10 Ss. CONCLUSIONS: These results confirm that AATs are a reliable index of sleep depth by showing that the SWS rebound following selective SWS deprivation is paralleled by a significant AAT enhancement. The experimental paradigm also allows us to claim that AATs show a decreasing linear trend during the night, having excluded any procedural bias. Finally, AATs can be directly related to SWS amount that preceded the awakening, although the individual correlations between AATs and SWS have to be considered with caution, given the high inter-subject variability and the small number of observations.     

Presentation of the Multidisciplinary Guideline Medically Unexplained Physical Symptoms (MUPS) and Somatoform Disorder in the Netherlands: disease management according to risk profiles

ObjectiveJanuary 2011, the Dutch Multidisciplinary Guideline for Medically Unexplained Symptoms (MUPS) and Somatoform Disorder (SD) was published. The aim was to set a standard for multidisciplinary prevention, diagnosis and treatment of MUPS and SD.MethodsFirst, the Multidisciplinary Guideline group defined a conceptual approach for the guideline. After this, a systematic literature review, followed by consensus meetings in the Multidisciplinary working group, aimed to answer the following questions: 1) What evidence exists for preventive interventions, including the patient-doctor communication in MUPS and SD? 2) How can the diagnosis of MUPS be established? 3) What effective treatments of MUPS are available? 4) Which types of treatment are most effective for which patients?ResultsAs conceptual approach for the guideline, based on existing literature, in this guideline MUPS are considered a category of symptoms that have many common aspects and are best approached by one, generic approach. 1) Research for preventive interventions and the patient-doctor relationship in MUPS and SD is scanty. 2) To establish the diagnosis of MUPS or SD, the GP should follow a parallel somatic-psychosocial diagnostic step plan. 3) A Systematic Review identified Cognitive Behavioral Treatment (CBT), treatment of comorbid depressive and anxiety disorder, psychiatric consultation with a Consultation Letter to General Practitioners (GPs) and stepped care as evidence based interventions for MUPS and SD. 4) In order to apply the best fitting treatment to patients, patient risk profiles were formulated to guide stepped-care treatment that should start at an appropriate level and treatment setting. Three levels are discerned: Low risk patients need reassurement by the GP. Moderate risk patients suffer from comorbidity. They need case-management and generally can be treated by the GP as well, who can be supported by psychiatric consultation. High risk patients often have long term SD and a perturbed patient-doctor relationship with their GP. For this group, specialist mental health treatment is needed.ConclusionDisease-managament based on risk profiles, providing stepped care and case management by the GP, supported by psychiatric consultation with a consultation letter, and mental health in-patient multidisciplinary treatment for severe cases, is the recommended strategy of the Dutch Multidisciplinary Guideline for MUPS and SD.     

Korean Clinical Practice Guideline for the Diagnosis and Treatment of Insomnia in Adults

Objective We aim to present a clinical guideline for the diagnosis and treatment of insomnia in adults by reviewing and integrating existing clinical guidelines. The purpose of this guideline is to assist clinicians who perform evidence-based insomnia treatment. Methods We selected literature that may be appropriate for use in guideline development from evidence-based practice guidelines that have been issued by an academic or governmental institution within the last five years. The core question of this guideline was made in sentence form including Patient/Problem, Intervention, Comparison, Outcome (PICO) elements. After searching PubMed, EMBASE, and medical guideline issuing agencies, three guidelines were judged to be the most appropriately reviewed, up-to-date, and from trusted sources. Results The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool was used to evaluate the quality of the three clinical guidelines. The final outcome of the guideline development process is a total of 15 recommendations that report the strength of the recommendation, the quality of evidence, a summary of content, and considerations in applying the recommendation. Conclusion It is vital for clinical guidelines for insomnia to be developed and continually updated in order to provide more accurate evidence-based treatments to patients.     

A randomized controlled clinical trial comparing "guideline exposed" and "guideline naive" physicians in respect to dosage selection and treatment outcome with doxepin in depressive disorders

INTRODUCTION: Can prescribing of insufficient dosages and outcome of treatment with antidepressants in routine care be improved by guidelines? METHODS: 161 general practitioners and 162 psychiatrists in private practice documented 1319 patients, receiving doxepin for individual clinical reasons. Physicians were randomly divided into a guideline exposed and a control group. All physicians treated their patients according to individual clinical considerations. RESULTS: Average maximum daily dosage was 83 mg/d in the control and 95 mg/d in the intervention group (F=19.15; p<0). Only 3% of patients in both groups got the recommended dosage of 150 mg/d. Guideline exposure resulted in increased dosages preferably for milder forms of depression and in comparatively lower rates of improvement. CONCLUSION: Guideline exposure did not reach its goal in respect to the recommended dosage. It missed its goal in respect to improvement of outcome and even showed negative effects. Guidelines should be evidence-based not only by referring to literature reviews but by testing their clinical effects in controlled clinical trials.     

A systematic review of the effectiveness of art therapy delivered in school-based settings to children aged 5–12 years

ABSTRACT

Background: School-based art therapy aims to facilitate children's personal change and growth through the use of visual arts media, such as drawing, painting, sculpture, clay, or digital art.

Aims: To identify and synthesise the types of school-based art therapy interventions, and appraise the effectiveness for children aged 5-12.

Methods: Systematic searching through ten major electronic databases, grey literature, and contact with experts in the field.

Results: Six completed and two on-going studies were identified. Art therapy was delivered to children with asthma, behavioural disorders, oppositional defiant disorders, separation anxiety disorders, learning disorders, and disruptive behaviours. All interventions were delivered over 7-25 sessions, and lasted 40-60' per session. The sample sizes ranged between 20-109 participants, involving 247 participants in total.

Conclusions: Art therapy can be effective in improving children's quality of life; anxiety; self-concept; problem-solving skills, attitudes towards school; emotional and behavioural difficulties. The follow-up findings were also promising; though confirmatory evidence is needed.

Implications: The risk of bias was high and unclear, highlighting the importance of following standardised reporting guidelines. Future research needs to focus on the identification of primary outcomes and measures that are tailored to art therapy interventions, and explore the (cost-) effectiveness of shorter versus longer durations of treatment.

Plain-language summary

Art therapy is widely used in schools to alleviate and prevent children’s emotional difficulties. In contrast to talking therapies, art therapy aims to facilitate personal change and growth through the use of visual arts media, such as, drawing, painting, sculpture, clay, or digital art media.

This systematic review aims to summarise the results from school-based art therapy studies, and to appraise the effectiveness for children aged 5–12. Ten major electronic databases were systematically searched. Art therapy–specific journals and books were hand-searched, and contact was made with experts in the field.

From the 10,911 retrieved results, 623 results were duplicates and 9181 were excluded following title screening. Following abstract screening, 41 papers appeared to be relevant and the full text was requested. Six completed and two on-going studies met the inclusion criteria and were included in this review. Art therapy was delivered to children with asthma, behavioural disorders, oppositional defiant disorders, separation anxiety disorders, learning disorders, and disruptive behaviours. The sessions were delivered over 7–25 weeks, and lasted 40’–60’ per session. The number of children in individual studies ranged between 20–109 participants, providing this systematic review with data from 247 participants in total.

The results suggested that art therapy is effective in improving children’s quality of life; anxiety; self-concept; problem-solving skills, attitudes towards school; emotional and behavioural difficulties. The follow-up findings were also promising; though further research is needed to increase confidence. Most studies appeared to have questionable methodological quality. Therefore, the use of reporting guidelines is important to allow for a better understanding of the results. Future research is needed to identify common primary outcomes, and investigate the effectiveness and cost-effectiveness of shorter versus longer durations of treatment.     

Reporting Guidelines for Clinical Trial Protocols and Reports of Implantable Neurostimulation Devices: Protocol for the SPIRIT-iNeurostim and CONSORT-iNeurostim Extensions

ObjectivesSPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) statements have been shown to improve the quality of reporting of trial protocols and randomized controlled trials. Extensions to the SPIRIT and CONSORT statements specific to certain interventions have the potential to address methodological considerations that would otherwise be overlooked. The aim of this protocol is to describe the methods to develop reporting guidelines for clinical trial protocols and reports of implantable neurostimulation devices.Materials and MethodsThe SPIRIT-iNeurostim and CONSORT-iNeurostim extensions will be developed through a staged consensus process involving literature review and expert consultation. The initial list of candidate items will be informed by findings from previous systematic reviews and published protocols and clinical trials of implantable neurostimulation devices. The candidate items will be included in a two-round Delphi survey. In the first round, participants will be invited to vote on the importance of each item and to suggest additional relevant items. In the second round, participants will be invited to re-score the items considering feedback received and the suggested additional items. A consensus meeting will then take place to discuss the results of the Delphi survey and reach consensus on the items to include in the extensions.DiscussionDevelopment of the SPIRIT-iNeurostim and CONSORT-iNeurostim extensions has the potential to lead to improvements and increase in transparency of the reporting of clinical trial protocols and reports of implantable neurostimulation devices.     

Analysis of L-leucine amino acid transporter species activity and gene expression by human blood brain barrier hCMEC/D3 model reveal potential LAT1, LAT4, B0AT2 and y+LAT1 functional cooperation

In the CNS, amino acid (AA) neurotransmitters and neurotransmitter precursors are subject to tight homeostatic control mediated by blood-brain barrier (BBB) solute carrier amino acid transporters (AATs). Since the BBB is composed of multiple closely apposed cell types and opportunities for human in vivo studies are limited, we used in vitro and computational approaches to investigate human BBB AAT activity and regulation. Quantitative real-time PCR (qPCR) of the human BBB endothelial cell model hCMEC/D3 (D3) was used to determine expression of selected AAT, tight junction (TJ), and signal transduction (ST) genes under various culture conditions. L-leucine uptake data were interrogated with a computational model developed by our group for calculating AAT activity in complex cell cultures. This approach is potentially applicable to in vitro cell culture drug studies where multiple “receptors” may mediate observed responses. Of 7 Leu AAT genes expressed by D3 only the activity of SLC7A5-SLC3A2/LAT1-4F2HC (LAT1), SLC43A2/LAT4 (LAT4) and sodium-dependent AATs, SLC6A15/B⁰AT2 (B⁰AT2), and SLC7A7/y⁺LAT1 (y⁺LAT1) were calculated to be required for Leu uptake. Therefore, D3 Leu transport may be mediated by a potentially physiologically relevant functional cooperation between the known BBB AAT, LAT1 and obligatory exchange (y⁺LAT1), facilitative diffusion (LAT4), and sodium symporter (B⁰AT2) transporters.     

Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology

OBJECTIVE: To update the 1994 practice parameter for the diagnosis of dementia in the elderly. BACKGROUND: The AAN previously published a practice parameter on dementia in 1994. New research and clinical developments warrant an update of some aspects of diagnosis. METHODS: Studies published in English from 1985 through 1999 were identified that addressed four questions: 1) Are the current criteria for the diagnosis of dementia reliable? 2) Are the current diagnostic criteria able to establish a diagnosis for the prevalent dementias in the elderly? 3) Do laboratory tests improve the accuracy of the clinical diagnosis of dementing illness? 4) What comorbidities should be evaluated in elderly patients undergoing an initial assessment for dementia? RECOMMENDATIONS: Based on evidence in the literature, the following recommendations are made. 1) The DSM-III-R definition of dementia is reliable and should be used (Guideline). 2) The National Institute of Neurologic, Communicative Disorders and Stroke--AD and Related Disorders Association (NINCDS-ADRDA) or the Diagnostic and Statistical Manual, 3rd edition, revised (DSM-IIIR) diagnostic criteria for AD and clinical criteria for Creutzfeldt--Jakob disease (CJD) have sufficient reliability and validity and should be used (Guideline). Diagnostic criteria for vascular dementia, dementia with Lewy bodies, and frontotemporal dementia may be of use in clinical practice (Option) but have imperfect reliability and validity. 3) Structural neuroimaging with either a noncontrast CT or MR scan in the initial evaluation of patients with dementia is appropriate. Because of insufficient data on validity, no other imaging procedure is recommended (Guideline). There are currently no genetic markers recommended for routine diagnostic purposes (Guideline). The CSF 14-3-3 protein is useful for confirming or rejecting the diagnosis of CJD (Guideline). 4) Screening for depression, B(12) deficiency, and hypothyroidism should be performed (Guideline). Screening for syphilis in patients with dementia is not justified unless clinical suspicion for neurosyphilis is present (Guideline). CONCLUSIONS: Diagnostic criteria for dementia have improved since the 1994 practice parameter. Further research is needed to improve clinical definitions of dementia and its subtypes, as well as to determine the utility of various instruments of neuroimaging, biomarkers, and genetic testing in increasing diagnostic accuracy.     

儿童病毒性脑炎药物治疗循证指南的系统评价

目的系统评价儿童病毒性脑炎的相关指南,为临床循证用药提供参考。方法计算机检索Pub Med、EMbase、CBM、万方、CNKI、维普等数据库;以及NGC、GIN、TRIP等指南数据库和各大医学行业机构网站如CDC、IDSA、AAP、WHO、中国卫生和计划生育委员会、中国临床指南文库和中国临床指南协作网。检索时限从建库或建网至2014年10月。2位研究者依纳入与排除标准独立筛选文献,采用指南研究与评价的评审工具Ⅱ(AGREEⅡ)评价指南质量,使用组内相关系数(ICC)进行一致性检验。结果最终纳入3部指南,均为近5年发布,分别来自英国、美国和欧洲。指南最终推荐均为B级,在AGREEⅡ6个领域中"范围和目的 "得分最高,平均68.54%。得分较低的是"应用性"和"编辑的独立性"。对疑似患儿应尽早经验予阿昔洛韦治疗。确诊为单纯疱疹和水痘带状疱疹病毒性脑炎,亦推荐使用阿昔洛韦。但推荐级别不同,前者为强推荐,后者推荐强度降低。此外,单纯疱疹病毒性脑炎患儿暂不推荐使用糖皮质激素;而水痘带状疱疹,可使用激素作为备选治疗,但证据尚不充分。对于巨细胞病毒脑炎推荐更昔洛韦联合膦甲酸,不建议使用西多福韦;肠病毒脑炎可以使用普拉康纳利。结论各指南推荐的治疗病毒性脑炎的药物基本一致,但制定循证指南在编辑的独立性以及应用性上要进一步加强。     

Art therapy in the Israeli education system – a qualitative meta-analysis

ABSTRACT

Nine studies involving 131 interviews were conducted between 2013 and 2015 with female art therapists, supervisors, counsellors, teachers and school principals in the Arab and Jewish educational systems on the state of art therapy in the Israeli school system. This article presents a qualitative meta-analysis of these studies to provide an up-to-date comprehensive picture of the integration of art therapy in the Israeli education system. It also addresses zones of conflict between the therapeutic and educational approaches. The advantages and disadvantages of integrating art therapy into the education system are discussed in parts 1 and 2. Part 3 details the recommendations emerging from the interviews. Part 4 summarises the problems and conflicts. The discussion examines these findings in the light of the Guidelines for Teaching Staff From the Health Professions and Creative Arts Therapists Who Work in the Education System, published by the Israel Ministry of Education in 2015.     

Are competence frameworks fit for practice? Examining the validity of competence frameworks for CBT,psychodynamic, and humanistic therapies

Abstract

Practitioners transporting psychological therapies from a research context to clinical settings need to know what competences they should demonstrate to maintain congruence with the evidence base. This study explores the validity of a suite of competence frameworks for cognitive behavior therapy (CBT), humanistic, and psychodynamic therapies developed to aid the transportation process. Experienced psychological therapists (N = 111) undertook a Q-sort of 100 items, drawn from frameworks representing each of the modalities and including a set of pantheoretical generic competences, rating items as characteristic or uncharacteristic of their orientation. There were significant differences in the way competences were assigned, with practitioners strongly favoring items from their own modality framework and eschewing items from the others. These results confirm the validity of the items within the frameworks; their utility and application is discussed.     

Reaching a UK consensus on art therapy for people with a diagnosis of a psychotic disorder using the Delphi method

Some authors have suggested that there is low consensus about art therapy practice for people with a diagnosis of a psychotic disorder. This study used the Delphi survey method to seek consensus among UK art therapists. In the Round 1 online survey, 24 UK art therapists working with the client group provided statements describing their practice. These were analysed using content analysis along with statements from relevant art therapy literature and from 32 service users. The resulting list of 713 statements grouped into 13 themes was then sorted by a core group of five art therapists with extensive experience with the client group, producing 111 statements that were then rated by an augmented national UK panel of 30 art therapists in the Round 2 Delphi survey. Rating was according to perceived importance of each element of practice, and 80 items each reached 80% consensus as highly important. In Round 3, 11 items that reached high but not 80% consensus were re-rated by 26 of the panel of 30, and all but two reached 80% consensus. The final list of 89 statements is the first UK national consensus on art therapy practice with people with a diagnosis of a psychotic disorder.     

Two short forms of the Agnew Relationship Measure: The ARM-5 and ARM-12

Abstract

This article reports the development and psychometric properties of two short forms of the 28-item Agnew Relationship Measure, the ARM-12 and ARM-5. For the ARM-12, results of previous research were used together with conceptual considerations to select three items to represent each of four ARM subscales: Bond, Partnership, Confidence, and Openness. For the ARM-5, item-analytic principles were used to select five items to represent overall alliance. In all three ARMs, client and therapist versions were constructed to contain parallel items. We drew data to assess reliability and validity from three UK trials of brief therapy for depression. Results indicated that the two short ARMs have acceptable psychometric properties and that they converged with each other and with the full ARM.