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Why measuring clinical change at the individual level is challenging but crucial

Why measuring clinical change at the individual level is challenging but crucial - commentary on Jensen and Corralejo (2017) by M. Wolpert in Child and Adolescent Mental Health

24 August 2017

Professor Wolpert responds to Jensen and Corralejo’s paper – ‘Why measuring clinical change at the individual lead is challenging but crucial.’

Jensen and Corralejo comment that reporting change in symptoms only at a group level makes it difficult to distinguish between different scenarios in terms of outcomes. They consider parent-reported outcomes for up to 24 children and highlight that individual-level findings tell a less positive story than group-level findings. They conclude with a call for more reporting of outcomes at an individual level. Professor Wolpert supports this, noting that this is why individual-level analysis was undertaken in the recent report on outcomes across child mental health services. Drawing on this report, other work and subsequent consultation, Professor Wolpert suggests that Jensen and Corralejo’s call should consider the following issues: 

  • What constitutes a good outcome? What counts as a good outcome in child mental health is an under-developed area. There is a lack of consensus on which outcome to prioritise, why it should be prioritised and whose perspectives should be taken into account. 
  • How to measure outcomes. The recent report on outcomes in child and adolescent mental health services used metrics which derived from the Adult Improving Access to Psychological Therapies programme: ‘recovered', 'reliably improved' and ‘moved towards goals’. However, following the report, consultation on terms produced the following: ‘symptom free’, ‘substantial improvement/deterioration’ and ‘movement towards achieving goals.’
  • Measurement issues. Jensen and Corralejo do not comment in detail on what their findings of different recovery rates for different measures may mean. However, the fact that different scales use different approaches to calculate thresholds should be taken into account. 

In light of the above, Professor Wolpert argues that, while she supports Jensen and Corralejo's proposal for more measurement at individual level, it is essential to consider what constitutes a good outcome, and which metrics should be used, particularly with regard to the views of children, young people and families.