What’s in a name (1): scoring CORE measures

We may have caused a bit of confusion by introducing the term “Clinical score”.  Perhaps it’s not on the scale of the Capulet/Montague name tragedy (Shakespeare, 1591-1995?) but it may be worth explaining the scoring here as I do see mistakes and do get asked about this.

History

We started out scoring using the mean of the items and recommending pro-rating if not more than 10% of items were missing, i.e. using the mean of the remaining items.  That meant you could get a pro-rated mean overall score for the CORE-OM if as many as three items were missing, for the “non-risk” score if two of the non-risk items were missing, for the function and problems scores if one of their items was missing, and you couldn’t pro-rate if any items were missing for the well-being or risk scores.  You could get overall scores for the CORE-SF/A, CORE-SF/B if one of their items was missing (but not for domain scores as any missing item there means more than 10% of the items are missing).  Similarly, you could use a pro-rated score for the GP-CORE, the LD-CORE, the YP-CORE and the CORE-10 if one item was missing but pro-rating the CORE-5 was clearly impossible. 

All those scores had to lie between 0 and 4 by definition but they could be awkward looking numbers like 0.84 and over the early years we got feedback that many clinicians and managers didn’t like these “less than one and fractional” scores. 

“Clinical Scores”

With mixed feelings in the team, the idea of “Clinical Scores” came in: the item mean as above, but multiplied by 10 to get a score that in clinical samples would pretty much always be a x.y sort of number with x >= 1 and scores ranging between 0 and 40. The same rules about pro-rating were retained.  This “x10 = Clinical Score” gives that rather easy scoring for a complete CORE-10 or complete YP-CORE that the “Clinical Score” is just the sum of the 10 items completed (but if one item is omitted you still have to find the mean of the nine completed items and multiply that by 10).   For a completed  CORE-5 the route to the “Clinical Score” is almost equally easy: the Clinical Score is twice (2x) the sum of the five items’ scores.

We sometimes see people reporting the sum of the items: please don’t do that, we’ve never recommended that anywhere.  We also see people not saying explicitly that they’re using the original “mean item score” or the “Clinical Score”, please do say which you used even if it seems very obvious.  Finally, we encourage people always to be explicit about having used pro-rating (if you have) and to be explicit about numbers of incomplete questionnaires and numbers of items missed. This all maximise comparability of reports.  Non-comparable scoring may not be as lethal as Mantua family feud was to Romeo, Juliet and Mercutio, but it’s definitely to be avoided!

Reference

Shakespeare, W. (1591-1595, exact date uncertain) “Romeo and Juliet” available in many versions as the peer-reviewed format hadn’t been invented: quarto 1, quarto 2, first folio and later versions.  However, the fatal name issue is consistent in all.

New CORE publications

Welcome to 2015 and to the new CORE System Trust website.

One of the many aims of this collective blog is to flag up work that is relevant or cognate to CORE. Two journals that are very good resources for psychotherapy research and for CORE in particular are Psychotherapy Research, the journal of the Society for Psychotherapy Research (SPR), and Counselling and Psychotherapy Research, which is the research journal of the British Association for Counselling and Psychotherapy (BACP). While they are both worth scanning regularly, each has a special issue/section that might be of special interest to readers.

The first issue of Psychotherapy Research in 2015 carries a special issue on Building collaboration and communication between researchers and clinicians edited by Louis G Castonguay and Christopher Muran. This enterprise is one that captures the philosophy of CORE and so it is good to have CORE represented in the special issue.

I recall Louis first raising the possibility of contributing an article in this special issue when we were heading down from Sheffield to the Savoy Conference in London in early December 2010. It was in the midst of one of the worst winters and Sheffield was virtually cut off by snow. Louis, Bill and Sue Stiles, and I waded knee-deep through snow from the Kenwood Hotel to Sheffield Station and were fortunate to get one of the few trains out of Sheffield, eventually arriving somewhat late at the conference. As I recall, Louis’s talk was rescheduled to the afternoon but had kept very well on ice and was as good as ever.

In any event, it’s clearly been a long gestation period for this special issue to arrive but there is plenty for folk to assimilate. Specifically, the 2nd article in the special issue focuses on CORE and, in particular, on issues arising from its implementation in Sweden and the UK:

  • Holmqvist, R., Philips, B., & Barkham, M. (2015). Developing and delivering practice-based evidence: Observations, tensions, and challenges. Psychotherapy Research, 25, 20-31. DOI: 1080/10503307.2013.861093

The article is freely available to members of the Society for Psychotherapy Research (SPR) or through university libraries that carry a subscription. If these fail, email me (m.barkham@sheffield.ac.uk) and I will forward a copy.

On a similar theme, the September 2014 issue of Counselling and Psychotherapy Research carried a special section on Practice-based Research Networks. There is a small collection of 5 articles that includes a brief overview of practice-based research networks. As an aside, in researching the introduction to this special section I discovered the pioneering work of Will Pickles – check him out – absolutely fascinating.

Anyway, there are two articles in the section that incorporate work using different versions of CORE. One is an article on individualized patient progress system incorporating CORE-5:

  • Sales, C.M.D., Alves, P.C.G., Evans, C., Elliott, R., & On Behalf of Ipha Group (2014) The Individualised Patient-Progress System: A decade of international collaborative networking. Counselling and Psychotherapy Research, 14, 181-191, DOI: 10.1080/14733145.2014.929417

The other is an article using the YP-CORE in schools:

  • Cooper, M., Mcginnis, S., & Carrick, L (2014) School-based humanistic counselling for psychological distress in young people: A practice research network to address the attrition problem. Counselling and Psychotherapy Research, 14, 201-211, DOI: 1080/14733145.2014.929415

Have a read and, again, if you have difficulties accessing the articles, email me (m.barkham@sheffield.ac.uk).

Happy reading and Happy 2015. With Tottenham beating Chelsea 5-3 on New Year’s Day, the signs are already promising!

Michael