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Outcomes and Assessment: Towards Best Practices

Outcomes and Assessment: Towards Best Practices. Keith Owen Yeates, Ph.D, ABPP/CN Professor of Pediatrics and Psychology The Ohio State University Director, Center for Biobehavioral Health Columbus Children's Research Institute Director, Department of Psychology

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Outcomes and Assessment: Towards Best Practices

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  1. Outcomes and Assessment: Towards Best Practices Keith Owen Yeates, Ph.D, ABPP/CN Professor of Pediatrics and Psychology The Ohio State University Director, Center for Biobehavioral Health Columbus Children's Research Institute Director, Department of Psychology Columbus Children's Hospital

  2. Foundational principles • Adaptation • Brain and behavior • Context • Development

  3. A is for...Adaptation • Goal is to promote children’s adaptation • Adaptation involves interactions between children and environments • Adaptation encompasses academic, work, social, and psychological domains • Adaptation is both an immediate and long-term process • Assessment must be ecologically valid

  4. B is for...Brain and Behavior • Analysis of brain-behavior relationships provides insights into adaptation • Any complex behavior is likely to reflect multiple brain systems • Traumatic brain injury can engender an array of functional impairments • Assessment must acknowledge brain bases of behavior

  5. C is for...Context • Adaptation is a joint function of person and context • Brain-behavior relationships are moderated by context • The expression of brain impairment is context specific • Knowledge base regarding environmental influences is crucial • Assessment must include evaluation of multiple contexts

  6. D is for...Development • Developmental trajectories characterize both persons and contexts • Adaptation reflects interplay of developmental trajectories • Failures in adaptation results from a clash of developmental timetables and a lack of fit between individuals and their environments • Assessment must be developmentally referenced

  7. Questions to ask about outcomes • What?—range of outcomes • Why?—goals • When?—timing • Who?—target & respondent • Where?—contexts and settings • How?—methods

  8. What outcomes should be assessed? • Multiple levels of analysis • Biological • Psychological • Social • Cultural

  9. WHO International Classification of Functioning, Disability, and Health Health condition Structure & function Personal factors Environmental factors Activity Participation

  10. Why assess specific outcomes? • Many possible goals • Detecting impairment in brain function • Documenting functional deficits • Assessing environmental obstacles/supports • Assessing personal risk/resilience factors • Predicting course of recovery • Determining need for intervention • Assessing response to intervention • Helps to have theory as guide

  11. When should outcomes be assessed? • Recovery is a process of change • Goals change over time • Acute injury  Structure/function • Post-acute rehabilitation  Activity • Community re-entry  Participation • Target of assessment varies as a function of time post-injury

  12. Who should be assessed? • Multiple participants • Children • Caregivers • Extended family • Care providers • School personnel • Targets vs. respondents

  13. Where should we assess outcomes? • Multiple contexts • Hospital • Rehabilitation • Home • School • Work

  14. How should we assess outcomes? • Multiple methods • Questionnaires/rating scales • Direct observations • Standardized tests • Qualitative interviews

  15. Social development as a key outcome • Why assess social development in TBI? • Behavioral and social problems are most troubling to families • Social development predicts many other important outcomes • Psychological adjustment • Academic performance • Health status

  16. Evidence for likely effects of TBI • Children with chronic health conditions • Rated less socially accepted and less socially competent • Research on neural substrates of social cognition • Implicates fronto-temporal regions vulnerable in TBI • Previous studies of childhood TBI • Rated less socially competent and more lonely

  17. Conceptual distinctions • Levels of analysis • Social skills & individual characteristics  Structure/function • Social performance and interaction  Activity • Social relationships and adjustment  Participation

  18. ‘State of the art’ models & methods • Social neuroscience • Brain systems • Social information processing • Developmental psychology/psychopathology • Social problem-solving • Social interaction • Environmental influences

  19. Regional brain injury in TBI Anterior-posterior gradient Dorsolateral Orbital Ventromedial

  20. Neuroanatomy of social cognition Somatosensory cortices Cingulate cortex Amygdala Ventromedial frontal cortex From Adolphs, 2001

  21. Neuroscience of social cognition From Adolphs, 2003

  22. Models of social skills • Social problem-solving • Foundation processes • Executive functions • Pragmatic language • Linked to social behavior and adjustment From Guralnick, 1999

  23. An integrative, multi-level model Environmental risk Injury-related risk TBI severity Regional brain injury Parenting style Family functioning Socioeconomic status Affiliative Social-affectivefunctions Self perceptions Social problem-solving Aggressive Perceptions of others Cognitive-executivefunctions Withdrawn Social information processing Social interaction Social adjustment

  24. Measures of social skills • Cognitive-Executive Function • TEA-Ch • BRIEF • Social-Affective Function • Emotional and Emotive Communication Task • Emotion Regulation Checklist • Physical & Intentional Representation Task • Irony & Empathy Task • Test of Language Competence • Eyes Task • Social Problem Solving • Video Cues and Consequences

  25. Measures of social adjustment • Broad standardized/normed • Behavior Assessment System for Children • Child Behavior Checklist • Adaptive Behavior Assessment System • Vineland Adaptive Behavior Scales • Child Health Questionnaire • PedsQL • Focused research/experimental • Relational Provisions Questionnaire • Harter Social Acceptance Scale • Network of Relationships Inventory • Friendship Quality Questionnaire-Revised • Teacher Child Rating Scale • Classroom Peer Nominations • Child and Adolescent Scale of Participation

  26. Measures of family functioning • Family Assessment Device • Child-Rearing Practices Report • Family Burden of Injury Interview • Child and Adolescent Scale of Environment

  27. Questions to be answered • What factors (i.e., injury-related, personal, environmental) account for social outcomes? • Can we identify children at risk for poor social outcomes after TBI? • Can we intervene to prevent poor social outcomes or to ameliorate those that occur in children with TBI?

  28. Current best practices • Multiple levels of analysis • Theoretically grounded and guided • Time referenced • Developmentally referenced • Multiple frames of reference • Persons • Contexts • Methods

  29. Future needs • Better theories and models • Better standardization and norms • Better sensitivity to change and development • More ecological validity

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