‍Introduction

Assessments and screening tools are utilized by therapists as well as researchers. These measures assist in diagnosis and treatment planning for clients by operationalizing DSM-5 criteria and providing quantifiable goals for therapeutic interventions. For example, a client may enter therapy and describe feeling anxious. Screening data can differentiate whether the client is experiencing a panic disorder or generalized anxiety disorder (GAD) by comparing scores from different screeners to see which has the strongest association with the client’s problems. In this article, we will be defining the term assessment and the term screener to clarify different data collecting strategies. We will also highlight one screener and describe how it can be implemented efficiently with Adhere.ly.

‍What is an assessment?

An assessment is a set of questions or observations to help define presenting problems, comprehend client history, or inform potential treatment goals. A screener is a specific category of assessment. Screening tools are a set of questions used to denote the presence of a specific mental-health problem through numerical scoring criteria [1]. For example, a psychosocial assessment grants a broad understanding of the client’s problem and environment, while the Beck Anxiety Inventory determines if the client empirically exhibits anxiety symptoms and tangibly clarifies which symptoms are more prominent.

Assessments are available in various formats. Some therapists appreciate the objectivity and efficiency of analyzing numerical data, while others prefer the depth of information gained from qualitative methods. Clinicians can engage in structured or semi-structured interviews with clients to obtain a detailed description of the presenting problem. An assessment can also self-report questionnaires that are scored and used to inform a diagnosis. Data from standardized surveys allow for convenient progress monitoring to measure treatment effectiveness. However, self-report screening tools are not always sufficient when assessing children as children often have a limited vocabulary for their mental health. Therefore, some tools rely on the caregiver or teacher’s report of symptoms, such as with the parent version of the Screen for Child Anxiety Related Disorders.

Not all anxiety assessments are based on self-reported data. Behavioral observations can be used to inform a client’s diagnosis, especially when working with children. For example, the Anxiety Dimensional Observation Scale involves a young child playing with their caregiver while incorporating mildly stressful stimuli [2]. A therapist observes the child’s behavior and codes for anxiety symptoms, such as hypervigilance [2]. Though there are many different types of assessments, their uses are not mutually exclusive. It is recommended that therapists utilize a combination of valid and reliable interviews and questionnaires when assessing anxiety to obtain a holistic understanding of the client [3].

‍Why are anxiety assessments important?

Assessments and screenings are crucial components of the therapeutic process. These metrics provide therapists an opportunity to build rapport and establish therapy as a collaborative process. When Gould et al. (2016) investigated the feasibility of the Geriatric Anxiety Inventory with 50 veterans, they found that one of the benefits of assessment was identifying the most distressing symptoms and initiating conversations about treatment options [4]. Without the use of a screener, the client’s description of symptoms may be too ambiguous to establish a diagnosis or formulate a treatment plan.

The importance of assessments extends beyond the intimate therapeutic relationship since they also help the general population. For example, in a brief literature review of 27 anxiety instruments for women and adolescent girls, researchers concluded easily accessible assessments promote preventative mental healthcare by increasing access to mental health treatment and strengthening prevalence data [5]. Furthermore, an evaluation of the Brief FRIEDBEN Test Anxiety Scale by von der Embse et al. (2013) found that assessments are vital for identifying at-risk populations and formulating targeted interventions to alleviate severe anxiety [6]. Without assessments, it is unclear which therapeutic exercises will be most effective for the client. Empirical measures provide indicators that the interventions being applied are fostering client growth.

‍Example: The Generalized Anxiety Disorder Screener (GAD-7)

The GAD-7 is a brief screener originally designed for the diagnosis and treatment of Generalized Anxiety Disorder (GAD). The measure has seven statements of physical and psychological anxiety symptoms. Severity of specific symptoms is measured using Likert scale (0-3), with zero indicating the client experiences the symptom “not at all” and three indicating the client experiences the symptom “nearly every day.” The creators of the screener, Spitzer et al., recommend that a score of 10 out of 21 could warrant a provisional diagnosis of GAD [7]. When Rutter & Brown (2016) performed a psychometric evaluation of the GAD-7 in an outpatient setting, they found the measure achieved a high scale reliability and high concurrent validity with other established anxiety measures [8]. The GAD-7 is applicable to younger age groups as well, with high reliability and validity also being reported in the adolescent population [9]. Additionally, the measure is not limited to GAD. Beard & Björgvinsson (2014) assessed the GAD-7 for other anxiety disorders, such as social anxiety disorder and panic disorder, and found that the instrument was reliable and valid for assessing anxiety symptom severity [10]. A key strength of the GAD-7 is its brevity and simplicity. Therefore, its implementation will not monopolize session time or inconvenience clients, while still providing reliable data for tracking anxiety symptoms.

‍Assessing Anxiety with Adhere.ly

Adhere.ly makes assessing clients efficient and convenient. Providers can rest assured that these assessments are secure and confidential as Adhere.ly has gone through the process to be HIPAA compliant. With the Assess feature, clients receive reminders to complete the assessment right from their phone or web device, increasing adherence to treatment. Here is how to use the GAD-7 with Adhere.ly.

1.     Log in to your Adhere.ly account or sign up for free!

2.     Click “Select client” near the top left corner of the screen. Type the client’s name in the search bar, then click on their name. 

3.     Click Assess and select the measure you would like to use. 

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4.     Select the date, time, and method to remind your client to complete the measure.

5.     Hit confirm.

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6.     Review the results by clicking the “Review” tab and selecting “Assessments”

Now your client will receive a reminder to complete the GAD-7 and can answer the items directly from their device. Scoring the assessment is even more convenient since the results of the measure are clearly displayed in the Review tab.

‍Takeaways

Assessments are a set of questions and/or observations that assist in defining presenting problems and clarifying treatment plans. A screening tool identifies a specific mental health problem, typically through numerical scoring criteria. The assessment process is essential for building the therapeutic relationship by providing foundational information for interventions. Adhere.ly simplifies this process for therapists and clients by providing reminders to complete measures, an intuitive interface for responding to items, and an efficient review tab for analyzing data. Click the link below to sign up for free!

[1]    Screening and Assessment. In: Substance Abuse Treatment: Addressing the Specific Needs of Women. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2012. Available from: Here

[2]    Mian ND, Carter AS, Pine DS, Wakschlag LS, Briggs-Gowan MJ. Development of a novel observational measure for anxiety in young children: The Anxiety Dimensional Observation Scale. J Child Psychol Psychiatry. 2015;56: 1017–1025. Available from: Here

[3]   Spence SH. Assessing anxiety disorders in children and adolescents. Child Adolesc Ment Health. 2018;23: 266–282. Available from: Here

[4]   Gould CE, Beaudreau SA, Gullickson G, Tenover JL, Bauer EA, AGCNS-BC, et al. Implementation of a brief anxiety assessment and evaluation in a Department of Veterans Affairs geriatric primary care clinic. J Rehabil Res Dev. 2016;53: 335–344. Available from: Here

[5]   Leung TI, Cifu AS, Lee WW. Screening for Anxiety in Adolescent and Adult Women. JAMA. 2022;327: 976–977. Available from: Here

[6]   von der Embse NP, Kilgus SP, Segool N, Putwain D. Identification and validation of a brief test anxiety screening tool. Int J Sch Educ Psychol. 2013;1: 246–258. Available from: Here

[7]   Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166: 1092–1097. Available from: Here

[8]   Rutter LA, Brown TA. Psychometric Properties of the Generalized Anxiety Disorder Scale-7 (GAD-7) in Outpatients with Anxiety and Mood Disorders. J Psychopathol Behav Assess. 2017;39: 140–146. Available from: Here

[9]   Tiirikainen K, Haravuori H, Ranta K, Kaltiala-Heino R, Marttunen M. Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents. Psychiatry Res. 2019;272: 30–35. Available from: Here

[10] Beard C, Björgvinsson T. Beyond generalized anxiety disorder: psychometric properties of the GAD-7 in a heterogeneous psychiatric sample. J Anxiety Disord. 2014;28: 547–552. Available from: Here