On 9 Apr 2003 at 12:44, VOGEL wrote:

> In this era of evidence-based practice, I am required by the local PCT
> to provide some sort of statistical evidence of the success or failure
> of the sessions I offer.   My first choice would be CORE but it has
> its drawbacks.  I have not the time to spend analysing the results
> myself and payment for analysis by the CORE team would have to come
> out of my own pocket so, frankly, I am not inclined to do that.
>
> So, this is a cry for help:  Does anyone use GHQ-12 routinely in their
> work?   What are the pro's and cons of it?   It seems rather a blunt
> instrument to me, and one which shows psychiatric 'caseness' rather
> than the nuances of distress or disturbance.   Are other people
> required to use questionnaire assessments in their work with clients?
> If so, what do you use?

Whoops -- been too busy to cope with the list for months, just
clearing out in my week of semi-work and couldn't resist responding
to this as one one of the designers of the CORE-OM (and to a lesser
extent the CORE-A).  Bear in mind that allegiance.

I do believe there's some argument, if we taking taxpayers' monies,
to show some interest in evaluating outcome of our work.  CORE was
designed to be just a core: not a whole, perhaps its greatest
advantage over most other measures, including all variants of the
GHQ, Beck's measures, the IIP (sadly), is that it's copyleft. That's
to say that we assert our copyrights on it and will sue someone
stealing it or changing it without our permission, however, we grant
anyone perfect right to copy it and use it as much as they like for
free provided that they don't change it or make a direct profit out
of copying it.

Surely the CORE-OM takes little more adding up (34 items) than the
GHQ-12?  Scores on the two are highly correlated with a little more
fine detail in the domain scores (problems, well-being, functioning,
and risk) on the CORE.  Leeds PTRC will process batches of CORE-A and
CORE-OM forms for people essentially at cost and CIMS (CORE
Information Management Systems) have written a PC based program to
handle data input and analysis from both CORE measures but again, at
a cost.  Currently CIMS are the only people licensed to implement the
CORE measures in software: no profit to us, the trustees of CORE
System Trust (CST) who hold the copyright, and negligible to John and
Alex and their associates in CIMS though their work does pay hunks of
their mortgages.  Useful, if rather CIMS oriented information on the
CORE system at:
        http://coreims.co.uk/
we're hoping to get a complementary site up for CST any month soon!

I'd strongly endorse sensible contributions about how most
counsellors and therapists will probably see impressive looking
improvements as the general run if they use any such measure and you
can usually then bring sensible funders into discussion with you
about the people who didn't improve and put more nuance in.

If you are, as some people are, keen to monitor therapy tightly by
such numerical measures then the point of the CORE, complementing
Paul's point, is that it is designed to be supplemented by measures
that might be particularly pertinent such as PTSD or eating disorder
measures.

> (PS:  Something inside me kicks against the requirement for
> assessments of this nature.  They  lack nuance, for one thing, and are
> too closely allied to the medical model - that quantifiable results
> are the only 'good thing' - for my comfort.  However, I have to feed
> this particular beast what it seems to want...)

I sympathise strongly and believe that it's crucial to emphasise to
any funding body the partial nature of the CORE picture and how vital
it is that it's complemented by the much richer picture that you and
the clients have of what happened.

Most conscientious medics think likewise even if "what" they're
treating, e.g. blood sugar level for a diabetic, or blood oxygen in a
life threatening asthmatic crisis, are much more readily measurable,
more clearly unidimensional, and central to treatment: all support by
one human of another is complex.

However, the things that doctors, therapists and counsellors have
done under the cloak of confidentiality, and the frequent contempt
all three groups show for having to argue their funding case, doesn't
do us any favours in the long term.  Anyone in private practice works
only to the laws of contract and their conscience, those of us who
work with others' money have it a bit more complex.

Well, back off my soap box and back to some semi-leave for a few more
days.

Chris

--
Chris Evans <[log in to unmask]>
Consultant Psychiatrist in Psychotherapy,
Rampton Hospital; Associate R&D Director,
Tavistock & Portman NHS Trust;
Hon. SL Institute of Psychiatry
*** My views are my own and not representative
of those institutions ***