From the place where we are right/Flowers will never grow/In the spring.
The place where we are right/Is hard and trampled/Like a yard.
But doubts and loves/Dig up the world/Like a mole, a plow/And a whisper will be heard in the place/Where the ruined/House once stood.
- Yehuda Amichai
The "Improving Access to Psychological Therapies" (IAPT) initiative is very ambitious and exciting. It states its principal aim is to support English Primary Care Trusts in implementing "National Institute for Health and Clinical Excellence" (NICE) guidelines for people suffering from depression and anxiety disorders. It comments "The Improving Access to Psychological Therapies (IAPT) programme began in 2008 and has transformed treatment of adult anxiety disorders and depression in England. Over 900,000 people now access IAPT services each year, and the 'five year forward view for mental health' committed to expanding services further, alongside improving quality."
One aspect of this carefully planned initiative is strong encouragement to assess and monitor the progress of those who are getting help. The emphasis is on good assessment measures that are free to use. See below:
Clarification of use of anxiety disorder specific measures - this is a helpful 2 page PDF clarifying how it is recommended specific anxiety disorder measures are used.
Depression, anxiety & phobia measures - IAPT recommends routine use of a combination of questionnaires, the PHQ-9 for depression, GAD-7 for anxiety, and three IAPT phobia scales (social, agoraphobia, and specific phobia (the IAPT Data Handbook suggests a score of 4 or above on any of these phobia scales be classified as 'clinical caseness'). These questionnaires appear on page 65 of the "toolkit" (see above). I've produced a downloadable handout of this depression/anxiety/phobia measure that may allow easier further adaptation and printing out. Click here for a 7 page PDF giving more background information about the PHQ-9 and GAD-7 - including helpful scoring information.
Work & social adjustment scale (W&SAS) - this is another IAPT measure that's recommended for regular use. It assesses problems in functioning with work, home management, social leisure activities, private leisure activities, and family & relationships (all on 0 to 8 scales). The measure (along with other details) appears on page 66 of the "toolkit". Again I've produced a downloadable handout as a Word doc & as a PDF file with associated scoring suggestions, again as a Word doc or a PDF file.
IAPT recommends that, when appropriate, a disorder-specific assessment questionnaire is also used. They specifically mention:
Social Phobia - the Social Phobia Inventory (SPIN). Here is a two page handout of the SPIN with some scoring information.
Obsessive-compulsive inventory (OCI) - here is a Word version with each question 'tagged' to indicate which subscale it refers to (the hoarding subscale is probably the least helpful). The UK Institute of Psychiatry website provides a PDF version of the scale and see too pages 22-23 of their booklet for more details on OCI scoring, including typical scores for OCD sufferers and a 'normal' control group. It is suggested too that a total score of 40 or more suggests probable "caseness". Note both versions of the OCI given above just assess distress, not frequency, of symptoms.
Post-traumatic Stress Disorder - the Impact of Event Scale - revised (IES-R) - the 1995 Revised Impact of Event Scale adds in a Hyperarousal assessment to the original IES. Unfortunately there is currently less data on typical scores for normal subjects and for those suffering from PTSD. The UK Institute of Psychiatry provides some useful information on pages 28-29 of their booklet.
Health anxiety inventory (HAI) - this is the 18 item (short form) HAI. The third page of the download gives typical scores for a Health Anxiety group, a more general anxiety group, a control group, and so on. The Centre for Anxiety Disorders and Trauma website also provides freely downloadable copies of the short form of the HAI scored for a week or a month and the long form of the HAI also scored for these two different time frames.
Panic/Agoraphobia, the Mobility Inventory - this version of the Chambless mobility inventory from the UK Institute of Psychiatry's Centre for Anxiety Disorders and Trauma site is scored on the basis of total ratings for being alone and being with other people. I think IAPT are making a mistake only recommending the Mobility Inventory as a disorder-specific measure for Panic/Agoraphobia. The Inventory just assesses agoraphobia. People can be tortured by panic attacks with little agoraphobia. See my post Handouts & questionnaires for improved assessment & monitoring of panic disorder for suggestions on how this situation can be improved.
Phobia, the Fear Questionnaire - advice on accessing this questionnaire is given on page 12 of the IAPT downloadable PDF which mentions the article by Cox, B.J., Parker, J.D., Swinson R.P. Confirmatory factor analysis of the Fear Questionnaire with social phobia patients. The British Journal of Psychiatry (1996) 168: 497-499. In fact the Fear Questionnaire is detailed in a still earlier article: Marks, I.M. and Matthews, A.M. Brief standard self-rating for phobic patients. Behavior Research and Therapy (1979) 17: 263-267. [Abstract/Full Text]
Anger - IAPT could identify no free measure. They recommend using the PHQ/GAD in conjunction with general measure of severity, frequency duration and impairment. I find this two question Anger Assessment Questionnaire helpful (scoring information on the second page).
Generalised Anxiety Disorder - the Penn State Worry Questionnaire (PSWQ). Here is a copy of the PSWQ with some scoring information on the third page. You may find an adapted "weekly" version of the PSWQ is easier to use when monitoring therapeutic progress. Here is the PSWQ-PW again with some scoring information on the third page of the download.