Swedish Association of Child and Adolescent Psychiatry Annual meeting, Lund, 2 nd April 2008 Making life easier for ourselves and families: Using the online.

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]