Last updated on 2nd January 2009
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. IAPT go on to say that "At present, only a quarter of the 6 million people in the UK with these conditions are in treatment, with debilitating effects on society."
One aspect of this carefully planned initiative is strong encouragement to assess and monitor the progress of those who are getting help. Visiting the IAPT "Outcomes Toolkit and FAQ" web page provides access to several freely downloadable documents. The emphasis is on good assessment measures that are free to use. See below:
IAPT Outcomes Toolkit 2008/9 PDF - this 81 page 1.1Mb Adobe PDF is the September 08 version with amended IAPT Paper Based Data Set Questionnaires.
IAPT Outcomes Toolkit Word Document - this Word version of the toolkit (about 1.6Mb) has been provided to allow the included forms to be more readily accessible.
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). 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 - 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 of this 5 areas disability scale.
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.
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 about this on pages 28-29 of their booklet.
Health anxiety inventory (HAI) - the 18 item (short form) HAI is the disorder specific scale recommended by the IAPT initiative. 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.
Mobility Inventory & Fear Questionnaire (both mentioned below) are detailed towards the end of this downloadable PDF.
Panic/Agoraphobia - the Mobility Inventory
Phobia - the Fear Questionnaire
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 page 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.