Development of a Quality Measure for Adults with Post-Traumatic Stress Disorder. APPENDIX G: Summary of Item-Level Responses

05/01/2019

TABLE G.1. Summary of Item-Level Responses on the Clinician Survey
Item % Yes % No % Don't Remember % Missing
Did you set an agenda? 60.42% 37.50% 1.04% 1.04%
Did you go over the agenda with the client? 54.17% 43.75% 2.08% 0.00%
Did you provide background on the treatment rationales and concepts during this session (i.e., why you are asking the client to do something or explaining why something is occurring within the session)? 77.08% 20.83% 2.08% 0.00%
Did you discuss or check-in on the client's treatment expectations (i.e., what will happen, how treatment will progress, expectations for improvement)? 58.33% 38.54% 3.13% 0.00%
Did you and your client mutually set or check-in on goals for treatment? 66.67% 26.04% 7.29% 0.00%
Did you identify salient problem areas related to the trauma?
  • Problem areas might include self-blame, other blame, power and control issues, beliefs impacted by the trauma (e.g., the world is a dangerous place), self-esteem, safety, trust, intimacy, and perception of danger.
77.08% 21.88% 1.04% 0.00%
Did you use cognitive restructuring techniques (techniques to address cognitive issues such as negative thoughts, distortions, false beliefs or perceptions and replace them with accurate and more useful cognitions) to work on the identified problem areas? 63.54% 33.33% 3.13% 0.00%
Did you use a Socratic discussion method, that is, statements or questions designed for the client to examine their beliefs? For example:
  • How do you know this? Can you give me an example?
  • What are some other ways of viewing this? What are the pros and cons to your way of thinking about this?
  • How did you come to this conclusion? What evidence do you have to justify this?
62.50% 34.38% 3.13% 0.00%
Did you use any of the following techniques to deal with trauma related avoidance?
Did you facilitate the development of alternative hypotheses (i.e., alternative viewpoints or explanations) to problematic beliefs? Examples of alternative hypotheses to problematic thinking might include:
  1. Distortion: People in authority can't be trusted. More Helpful Thought: People in authority are individuals, and they don't all share the same strengths and weaknesses
  2. Distortion: Everyone is out to hurt me. I can't trust anyone. More Helpful Thought: There are some dangerous people out there, but not everyone is out to harm you
57.29% 37.50% 5.21% 0.00%
Did you identify areas of trauma related avoidance, where the trauma has shifted or restricted daily patterns of living (i.e., the trauma has influenced daily functioning)? For example, a client may avoid places with loud noises and lots of people. 59.38% 39.58% 1.04% 0.00%
Did you use techniques to systematically approach areas of trauma related avoidance, where the trauma has shifted daily patterns of living (i.e., the trauma has influenced daily functioning) from easier to more difficult situations? - For example, a person in a motor vehicle accident may be fearful of driving. An approach from easy to more difficult might look like:
  • Easy: Encouraging the client to ride in a car as a passenger for a short period of time.
  • Difficult: Encouraging the client to drive on street and then a freeway, etc.
35.42% 63.54% 1.04% 0.00%
a. Ask the client to imagine their traumatic experience for longer than 10 minutes 14.58% 84.38% 1.04% 0.00%
b. Ask the client to write about their traumatic experience 21.88% 75.00% 3.13% 0.00%
c. Socratic discussion method (i.e., How do you know this? Can you give me an example?) 46.88% 50.00% 2.08% 1.04%
d. Real world experiments like visiting a place related to the traumatic experience with the client for longer than 10 minutes 10.42% 86.46% 3.13% 0.00%
Did you discuss and process the details of the client's recounting of the trauma, including the emotions surrounding the event? 45.83% 53.13% 1.04% 0.00%
Did you struggle to manage time for any of the reasons below:
  • Client talked incessantly or tangentially
  • Client had trouble keeping on task
  • Session time was abbreviated
  • You had trouble keeping the Client on task
31.25% 66.67% 2.08% 0.00%
Were you directive (i.e., followed the agenda or guided the client to relevant discussion) during this session? 88.54% 10.42% 1.04% 0.00%
Did you ask your client for feedback or input on their treatment (i.e., how is this working?; Are we working on things that you think are important?)? This would not include progress monitoring. 65.63% 30.21% 4.17% 0.00%
Did you ask your client for feedback on you? 29.17% 67.71% 3.13% 0.00%
Did you assign your client homework or practice assignments (to be completed by the next session) to deal with issues surrounding PTSD symptoms (i.e., avoidance, thought monitoring, problematic beliefs, anxiety) or issues related to the trauma? 63.54% 33.33% 3.13% 0.00%
Did you review the assignment instructions and verify the client has a thorough understanding of the homework for the next session? 47.92% 41.67% 9.38% 1.04%
Did you address difficulties or barriers related to completing of homework from the previous session? 28.13% 65.63% 6.25% 0.00%
Did you work with your client to come up with solutions to difficulties, barriers, or issues in completing the homework from the previous session? 31.25% 64.58% 4.17% 0.00%
Did you review and discuss your client's homework assigned during the previous session? 31.25% 63.54% 5.21% 0.00%
For question part a., please think about the overall course of treatment with this client. For question part b., focus on caregiven during this selecte+A32:A42d treatment
When reviewing the homework assigned from the previous session, did you encourage the client or provide them with constructive feedback? 30.21% 60.42% 7.29% 2.08%
a. Have you ever conducted a suicide risk assessment for this client? 83.33% 14.58% 1.04% 1.04%
b. Did you conduct suicide risk assessment during this session? 25.00% 70.83% 4.17% 0.00%
a. Have you ever used information from your suicide risk assessment to influence treatment or monitor progress for this client? 63.54% 35.42% 1.04% 0.00%
b. Did you use information from your suicide risk assessment to influence treatment or monitor progress during this session? 27.08% 70.83% 2.08% 0.00%
a. Have you ever used any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change? 35.42% 64.58% 0.00% 0.00%
b. Did you use any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change during this session? 9.38% 89.58% 0.00% 1.04%
a. Have you ever provided the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.)? 92.71% 6.25% 1.04% 0.00%
b. Did you provide the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.) during this session? 55.21% 42.71% 2.08% 0.00%
a. Have you ever provided the client with specific education on the nature of the traumatic event (i.e., changes in viewpoint or perception or facts about the type of trauma)?
  • For example, this might include education on the nature of acquaintance rape vs. stranger rape, how sexual assault generally influences view points and beliefs, or how a perpetrator may groom their victim before an assault.
67.71% 28.13% 3.13% 1.04%
b. Did you provide the client with specific education on the nature of the traumatic event (i.e., changes in viewpoint or perception or facts about the type of trauma) during this session?
  • For example, this might include education on the nature of acquaintance rape vs. stranger rape, or how sexual assault generally influences view points and beliefs, or how a perpetrator may groom their victim before an assault.
31.25% 64.58% 4.17% 0.00%
a. Have you ever provided the client with an outline or overview of the treatment process (i.e., what will happen over the course of treatment)? 82.29% 12.50% 3.13% 2.08%
b. Did you provide the client with an outline or overview of the treatment process (i.e., what will happen over the course of treatment) during this session? 36.46% 62.50% 1.04% 0.00%
  Mean (Range) Standard Deviation % Don't Remember % Missing
I am confident in my ability to help this client. 5.53 (3-7) 0.98 NA* 0.00%
I believe this client likes me as a therapist. 5.89 (4-7) 0.84 NA* 0.00%
This client and I have built mutual trust. 5.97 (3-7) 0.90 NA* 0.00%
* The 7-point Likert scale questions did not allow a "Don't Remember" option.

 

TABLE G.2. Summary of Item-Level Responses on the Supervisor Survey
Item % Yes % No % Don't Remember % Missing
Did you use any of the following techniques to deal with trauma related avoidance?
Did the therapist set an agenda? 50.00% 33.67% 15.31% 1.02%
Did the therapist go over the agenda with the client? 44.90% 35.71% 18.37% 1.02%
Did the therapist provide background on the treatment rationales and concepts during this session (i.e., why you are asking the client to do something or explaining why something is occurring within the session)? 52.04% 24.49% 22.45% 1.02%
Did the therapist discuss or check-in on the client's treatment expectations (i.e., what will happen, how treatment will progress, expectations for improvement)? 47.96% 28.57% 22.45% 1.02%
Did the therapist and his/her client mutually set or check-in on goals for treatment? 58.16% 22.45% 17.35% 2.04%
Did the therapist identify salient problem areas related to the trauma?
  • Problem areas might include self-blame, other blame, power and control issues, beliefs impacted by the trauma (e.g., the world is a dangerous place), self-esteem, safety, trust, intimacy, and perception of danger.
74.49% 22.45% 2.04% 1.02%
Did the therapist use cognitive restructuring techniques (techniques to address cognitive issues such as negative thoughts, distortions, false beliefs or perceptions and replace them with accurate and more useful cognitions) to work on the identified problem areas? 70.41% 21.43% 7.14% 1.02%
Did the therapist use a Socratic discussion method, that is, statements or questions designed for the client to examine their beliefs?
  • How do you know this? Can you give me an example?
  • What are some other ways of viewing this? What are the pros and cons to your way of thinking about this?
  • How did you come to this conclusion? What evidence do you have to justify this?
67.35% 16.33% 15.31% 1.02%
Did the therapist facilitate the development of alternative hypotheses (i.e., alternative viewpoints or explanations) to problematic beliefs? Examples of alternative hypotheses to problematic thinking might include:
  1. Distortion: People in authority can't be trusted. (More Helpful Thought: People in authority are individuals, and they don't all share the same strengths and weaknesses)
  2. Distortion: Everyone is out to hurt me. I can't trust anyone (More Helpful Thought: There are some dangerous people out there, but not everyone is out to harm you)
61.22% 17.35% 20.41% 1.02%
Did the therapist identify areas of trauma related avoidance, where the trauma has shifted or restricted daily patterns of living (i.e., the trauma has influenced daily functioning)? For example, a client may avoid places with loud noises and lots of people. 50.00% 36.73% 11.22% 2.04%
Did the therapist use techniques to systematically approach areas of trauma related avoidance, where the trauma has shifted daily patterns of living (i.e., the trauma has influenced daily functioning) from easier to more difficult situations?
For example, a person in a motor vehicle accident may be fearful of driving. An approach from easy to more difficult might look like:
  • Easy: Encouraging the client to ride in a car as a passenger for a short period of time.
  • Difficult: Encouraging the client to drive on street and then a freeway, etc.
33.67% 59.18% 6.12% 1.02%
a. Ask the client to imagine their traumatic experience for longer than 10 minutes 11.22% 80.61% 8.16% 0.00%
b. Ask the client to write about their traumatic experience 19.39% 71.43% 7.14% 2.04%
c. Socratic discussion method (i.e., How do you know this? Can you give me an example?) 47.96% 42.86% 6.12% 3.06%
d. Real world experiments like visiting a place related to the traumatic experience with the client for longer than 10 minutes 14.29% 78.57% 5.10% 2.04%
Did the therapist discuss and process the details of the client's recounting of the trauma, including the emotions surrounding the event? 41.84% 52.04% 4.08% 2.04%
Did the therapist struggle to manage time for any of the reasons below:
  • Client talked incessantly or tangentially
  • Client had trouble keeping on task
  • Session time was abbreviated
  • You had trouble keeping the Client on task
13.27% 71.43% 13.27% 2.04%
Was the therapist directive (i.e., followed the agenda or guided the client to relevant discussion) during this session? 79.59% 10.20% 10.20% 0.00%
Did the therapist ask his/her client for feedback or input on their treatment (i.e., how is this working?; Are we working on things that you think are important?)? This would not include progress monitoring. 57.14% 27.55% 13.27% 2.04%
Did the therapist ask your client for feedback on himself/herself? 26.53% 55.10% 18.37% 0.00%
Did the therapist assign his/her client homework or practice assignments (to be completed by the next session) to deal with issues surrounding PTSD symptoms (i.e., avoidance, thought monitoring, problematic beliefs, anxiety) or issues related to the trauma? 48.98% 47.96% 3.06% 0.00%
Did the therapist review the assignment instructions and verify the client has a thorough understanding of the homework for the next session? 39.80% 45.92% 12.24% 2.04%
Did the therapist address difficulties or barriers related to completing of homework from the previous session? 18.37% 72.45% 8.16% 1.02%
Did the therapist work with his/her client to come up with solutions to difficulties, barriers, or issues in completing the homework from the previous session? 14.29% 75.51% 9.18% 1.02%
Did the therapist review and discuss the client's homework assigned during the previous session? 22.45% 64.29% 11.22% 2.04%
When reviewing the homework assigned from the previous session, did the therapist encourage the client or provide him/her with constructive feedback? 15.31% 68.37% 16.33% 0.00%
For question part a., please think about the overall course of treatment with this client. For question part b., focus on caregiving given during this selected treatment session.
a. To your knowledge, has the therapist ever conducted a suicide risk assessment with this client? 88.78% 7.14% 2.04% 2.04%
b. Did the therapist conduct a suicide risk assessment during this session? 23.47% 71.43% 5.10% 0.00%
a. To your knowledge, has the therapist ever used information from your suicide risk assessment to influence treatment or monitor progress with this client? 71.43% 17.35% 11.22% 0.00%
b. Did the therapist use information from the suicide risk assessment to influence treatment or monitor progress during this session? 18.37% 72.45% 8.16% 1.02%
a. To your knowledge, has the therapist used any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change? 28.57% 61.22% 10.20% 0.00%
b. Did the therapist use any valid standardized instruments (e.g., The Revised PTSD Checklist) or psychometric scales to monitor PTSD symptoms and assess change during this session? 7.14% 84.69% 8.16% 0.00%
a. To your knowledge has the therapist ever provided the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.)? 83.67% 2.04% 13.27% 1.02%
b. Did the therapist provide the client with education on their symptoms (i.e., education on avoidance, flashbacks, etc.) during this session? 61.22% 32.65% 6.12% 0.00%
a. To your knowledge, has the therapist ever provided the client with specific education on the nature of the traumatic event (i.e., changes in viewpoint or perception or facts about the type of trauma)?
  • For example, this might include education on the nature of acquaintance rape vs. stranger rape, how sexual assault generally influences view points and beliefs, or how a perpetrator may groom their victim before an assault.
64.29% 14.29% 20.41% 1.02%
b. Did the therapist provide the client with specific education on the nature of the traumatic event (i.e., changes in viewpoint or perception or facts about the type of trauma) during this session?
  • For example, this might include education on the nature of acquaintance rape vs. stranger rape, or how sexual assault generally influences view points and beliefs, or how a perpetrator may groom their victim before an assault.
39.80% 52.04% 7.14% 1.02%
a. To your knowledge, has the therapist ever provided the client with an outline or overview of the treatment process (i.e., what will happen over the course of treatment)? 65.31% 13.27% 20.41% 1.02%
b. Did the therapist provide the client with an outline or overview of the treatment process (i.e., what will happen over the course of treatment) during this session? 33.67% 55.10% 10.20% 1.02%
  Mean (Range) Standard Deviation % Don't Remember % Missing
I am confident in the therapist's ability to help this client. 6.38 (3-7) 0.82 NA 0.00%
I believe this client likes the therapist. 6.18 (3-7) 0.74 NA 0.00%
This client and the therapist have built mutual trust. 6.23 (3-7) 0.74 NA 0.00%
* The 7-point Likert scale questions did not allow a "Don't Remember" option.

 

TABLE G.3. Summary of Item-Level Responses on the Client Survey
Question % Yes % No % Don't Remember % Missing
Did you and your therapist discuss an agenda or plan for your session? 89.74% 10.26% 0.00% 0.00%
Did your therapist talk about or check-in on your expectations of how therapy will go? 79.49% 15.38% 5.13% 0.00%
Did your therapist work with you to set goals you both agreed on? 91.03% 5.13% 0.00% 1.28%
Did your therapist help you become aware of or realize feelings, views or thoughts in your life that have been influenced by your traumatic experience?
  • These might include feelings, views, or thoughts about being safe in the world, the presence of danger, trust, and self-esteem.
92.31% 7.69% 0.00% 0.00%
Did your therapist ask you several direct questions to make you think critically about or examine your thoughts, feelings, or beliefs?
For example, your therapist might ask:
  • How do you know this? Can you give me an example?
  • What are some other ways of viewing this? What are the pros and cons to your way of thinking about this?
  • How did you come to this conclusion? What evidence do you have to justify this?
89.74% 7.69% 0.00% 0.00%
Did your therapist offer other ways of thinking about your issues (e.g., problem areas or areas you want to work on) related to the trauma?
For example:
  • Thought: "I can't trust anyone."
  • Thought suggested by therapist: "Some people can't be trusted, but there are other people who are trustworthy."
91.03% 5.13% 3.85% 0.00%
Did you and your therapist discuss people, events, or places you now avoid or stay away from because of your traumatic experience? For example, someone in a car accident might avoid driving on the freeway. 82.05% 11.54% 6.41% 0.00%
Did your therapist do any of the following things to help you deal with fear, anxiety or things you now avoid because of your trauma?
  1. Ask you to imagine or retell your traumatic experience for longer than 10 minutes
  2. Ask you to write about your traumatic experience
  3. Ask you questions to make you think critically about or examine your thoughts, feelings, or beliefs related to your fear, anxiety, and avoidance of things (i.e., "How do you know this? Can you give me an example?")
  4. Ask you to do real world experiments like visiting a place related to the traumatic experience for longer than 10 minutes
70.51% 23.08% 2.56% 3.85%
After you described your traumatic experience, did you and your therapist discuss the details of what happened to you, how it impacted your life, or your emotions about the event? 83.33% 14.10% 2.56% 0.00%
Did your therapist make good use of your session time today? 97.44% 1.28% 0.00% 1.28%
Did your therapist ask for your opinion on how your treatment is going? 75.64% 19.23% 5.13% 0.00%
Did your therapist ask for feedback on how she/he is doing in helping you recover from your PTSD? 47.44% 35.90% 11.54% 5.13%
Did your therapist assign homework or practice assignments (to be completed by the next session) to work on your PTSD symptoms or problem areas? 60.26% 35.90% 2.56% 1.28%
Did your therapist make sure you understood how to complete your homework for the next session? 65.38% 29.49% 3.85% 1.28%
If you had problems completing your previously assigned homework, did your therapist work with you to come up with solutions to these problems? 62.82% 24.36% 8.97% 3.85%
Did your therapist review and discuss your homework from the previous session? 56.41% 29.49% 7.69% 6.41%
When reviewing the homework from the previous session, did your therapist encourage or provide you with constructive feedback? 57.69% 25.64% 11.54% 5.13%
a. Has your therapist ever asked you if have had thoughts about committing suicide? 88.46% 8.97% 1.28% 1.28%
b. During this session, did your therapist ask you if you had thoughts about committing suicide? 41.03% 52.56% 3.85% 2.56%
a. Has your therapist ever asked you to answer questions about your PTSD symptoms? This might include completing a form before or after therapy. 73.08% 15.38% 7.69% 3.85%
b. During this session, did your therapist ask you about your PTSD symptoms? This might include completing a form or survey before or after therapy. 65.38% 26.92% 5.13% 2.56%
a. Has your therapist ever provided information about PTSD and PTSD symptoms? 74.36% 15.38% 7.69% 2.56%
b. During this session, did your therapist provide information about PTSD and PTSD symptoms? 50.00% 41.03% 6.41% 2.56%
a. Has your therapist ever provided with specific education on the nature of the traumatic event (i.e., facts about the type of trauma)?
  • For example, this might include education on the nature of sexual assault, or how sexual assault generally influences your viewpoints and beliefs
70.51% 19.23% 8.97% 1.28%
b. During this session, did your therapist ever provide you with specific education on the nature of the traumatic event (i.e., facts about the type of trauma)?
  • For example, this might include education on the nature of sexual assault, or how sexual assault generally influences your view points and beliefs
52.56% 37.18% 7.69% 2.56%
a. Has your therapist ever explained how your particular treatment will work? 92.31% 3.85% 0.00% 3.85%
b. During this session, did your therapist explain how your particular treatment will work? 73.08% 16.67% 7.69% 2.56%
  Mean (Range) Standard Deviation % Don't Remember % Missing
My therapist and I have built mutual trust. 6.44 (2-7) 0.98 NA 1.28%
I am confident in my therapist's ability to help me. 6.29 (2-7) 1.17 NA 1.28%
I believe my therapist likes me as a person. 6.25 (2-7) 1.16 NA 1.28%