swedish association of child and adolescent psychiatry annual meeting, lund, 2 nd april 2008 making...
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Swedish Association of Child and Adolescent PsychiatryAnnual meeting, Lund, 2nd April 2008
Making life easier for ourselves and families:
Using the online DAWBA in Swedishto take some of the hard work out of detailed assessments
Robert Goodman
King’s College London Institute of Psychiatry
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Starting from first principles
Key ingredients of effective clinical work:
2) Thorough assessment of psychopathology and risk factors
3) Evidence based treatment
4) Routine monitoring of outcome
1) Motivated and courteous staff
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Additional principles from public health
5) Maximize cost-benefit ratio
6) Easy access to all potential beneficiaries
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Automation
In the long run this:
1) Increases wages
2) Makes products and services cheaper and therefore more widely available
The use of machines can greatly increase the productivity of workers
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Spinning
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Harvesting
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Washing clothes
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Adding up numbers
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Medical investigations
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Thorough assessment of psychopathology and risk factors
There are several options:
• Questionnaires and fully structured interviews
• Semi-structured interviews
• Hybrid measures
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Questionnaires and fully structured interviews (respondent-based)
The questions and response categories are fixed. These can be administered by a computer or an interviewer, but the interviewer’s job is really just to read the question, and not to modify the question or interpret the response.
e.g. the DISC
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Semi-structured interviews (investigator-based)
A highly trained interviewer uses flexible questioning to decide if each of the relevant symptoms is present or not. e.g. CAPA, K-SADS
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Fully structured Semi-structured
Quick +Cheap +Clinically convincing + + +
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For many fully and semi-structured interviews:
Answersto the interview
Fully automatic computer algorithm
Final diagnoses
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Development and Well-Being Assessment (DAWBA)
Computer or non-specialist interviewer administers two sorts of questions:
1) Fixed questions with fixed response options
2) Open-ended follow-on questions to elicit descriptions of problems in the respondents’ own words
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Answers to fixed question
Computer algorithm
Provisional diagnosis
Answers to open-ended questions
Summaries
Experienced clinical rater makes final diagnoses
Additional clinical interview
10,000 : 300 : 3
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The DAWBA clinical raters deal with 3 key questions:
1) Did the respondents understand the questions?
2) How should conflicting information be resolved?
3) Assign a non-operationalised diagnosis?
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The validity of the DAWBA has been demonstrated in British, Brazilian, Bangladeshi and Yemeni studies.
In addition:
• It generates sensible results for prevalence and risk factors
• It is relatively quick and easy
• It works in difficult circumstances
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The DAWBA in Swedish
With particular thanks to :
Jan-Olov Larrson
Hans Smedje
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www.dawba.com
for a demonstration of the online DAWBA system
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To register your team for a free trial of the online DAWBA system:
www.dawba.net/user
Or email us with questions: [email protected]