COST

1. Advance Behavioral Center, Inc. COST The Clinical Outcome Screening Tool

2. Thought for the day A young man had been caught in a daring act of theft and had been condemned to be executed for it. He expressed his desire to see his Mother, and to speak with her before he was led to execution, and of course this was granted. When his Mother came to him he said: “I want to whisper to you,” and when she brought her ear near him, he nearly bit it off. All of the bystanders were horrified, and asked him what he could mean by such brutal and inhuman conduct. “It is to punish her,” he said. “When I was young I began with sealing little things, and brought them home to Mother. Instead of rebuking and punishing me, she laughed and said: “It will not be noticed.” It is because of her that I am here today.” Aesops’ moral: Train up a child in the way he should go; and when he is old he will not depart therefrom. 620-560 BC.

3. What is COST analysis? COST is a screening tool designed to evaluate and track four aspects of behavioral health care: Living in recovery (Recovery), Participating in the community (Community), Achieving therapeutic outcome (Outcome) and Reduced reliance on paid services and supports (Reliance.)

4. Why conduct COST analysis? COST is part of our Basic Assurances Monitoring Plan and provides essential information for certification by CQL and DMH.

5. How does COST work? There are several forms of COST. Some forms are completed by members and other forms are completed by staff. This this training introduces each form and instructs staff in the standardized evaluation process.

6. What is a Standardized Evaluation Process? In order to compare the results of COST from one member with another or results from the same person before and after treatment, it is important that each administration occurs in the same way. This allows comparisons that are reliable and valid. http://www.youtube.com/watch?v=C0LKN2lFWI4

7. What does Validity mean? What does Validity mean? Validity means that a measure actually measures what it is suppose to measure. For example, if a person has two different scores for Living in recovery (Recovery), then the scores should reflect greater or less success based on how high or low the score is. In order for a score to be valid it must be reliable. There are two kinds of validity, Internal and External. Validity means that a measure actually measures what it is suppose to measure. For example, if a person has two different scores for Living in recovery (Recovery), then the scores should reflect greater or less success based on how high or low the score is. In order for a score to be valid it must be reliable.

8. Internal Validity Internal Validity refers to the extent to which a causal conclusion based on a study is warranted.

9. External Validity External Validity is the extent to which the results of a study can be generalized to other situations and to other people

10. Threats to Validity • Items are not asked the same way each time. • Items are not asked the same way by different interviewers • The interviewer “leads” the interviewee • The members answers in a desired or inaccurate manner, rather than truthful manner. • Thinks the interviewer wants a specific answer • Would feel embarrassed if answered truthfully • Intentionally wants to hide a true response • Is delusional • Does not remember

11. What does Reliability mean? Reliability means COST is administered the same way every time. There are two types of reliability: Test-Retest and Inter-Rater reliability

12. Test-Retest Reliability When COST is given on two different occasions, if there has been no change in the members functioning the scores should be the same.

13. Inter-Rater Reliability If two different people give the COST, then their scores should be the same if the person answers them the same way.

18. <= 18

19. Full Name

20. LME ID

21. Your Name

22. Trial

23. Quarter

24. Date Completed

25. Office

26. Services

27. Cue

28. Question

29. Rating

30. Reported Observed

31. Adult

32. Full Name

33. LME ID

34. Your Name

35. Trial

36. Quarter

37. Date Completed

38. Office

39. Services

40. Cue

41. Question

42. Rating

43. Reported Observed

44. Parent Rating of their Child

45. Section Completed by Staff

46. Read statement with parent # 1 & 2

47. Model Circling Best Answer # 1 & 2

48. Parent Response Staff Corrected Response

49. Self Rating of Adult This form is completed like the Parent Rating of Child form

50. COST and active listening • COST is a Structured Interview completed using active listening techniques such as the following. • Paraphrase what the speaker is saying. • Listen for the underlying emotion. • Ask clarifying questions. • Encourage the speaker to keep talking by letting them know you are listening. • Approach the conversation with the belief that the speaker has the ability to solve the problem for themselves.