Wednesday, October 24, 2012

Rating Scale of Communication in Cognitive Decline

The Rating Scale of Communication in Cognitive Decline (RSCCD) is designed to evaluate progressive dementia patients' communication skills. It assesses verbal and nonverbal skills in patients who have been diagnosed with dementia previously. Furthermore, it addresses communication ability as it pertains to ongoing patient management, especially by caregivers (Albanese, 1991). In essence, it assists caregivers in their ability to observe and determine the evolving needs of dementia patients (D'Costa, 1991). This rating scale categorizes individuals into 10 levels of communication ability. Additionally it suggests various ways of communicating at each level. The goal of the test is to remedy communication difficulties, which is one of the most common challenges when caregivers must contend with a family member's cognitive decline as a result of Alzheimer's disease or other forms of dementia.

The general information included in the review is similar to to what is provided for various assessments in the MMY, and the language is similar as well. The rating scale test discusses the various forms, populations for whom the test was designed, administration time, prices, manual description, stated purpose, and scoring procedures. The review discusses reliability and validity as well. Regarding reliability data, the review for the rating scale test describes the norming sample as well as the methods by which reliability was determined.

Specific to assessing scales was the term outcome measurement, which is different than the assessment standards for other instruments that measure depression, suicidal intention, or other constructs. Scales are designed to gauge the severity of symptoms as a baseline and how the severity changes over time. In counseling, scales might be used to determine the overall effectiveness of the intervention. So, for example, an assessment scale may be used during the initial intake interview, and again after four or five sessions. This would give the counselor and the client a reasonable idea of the therapy's effectiveness (Lambert & Hawkins, 2004). Scales may also be used to measure pain or patient satisfaction.

The primary features of outcome measures may include "content, source, method of data collection, and the time orientation of each instrument (Lambert & Hawkins, 2004). Additionally, outcome measures are concerned with sensitivity to change. For example, when using a scale in counseling, it is important for the scale to indicate change as an effect of the treatment, not simply as a result of time. In determining sensitivity to change, a scale must be able to distinguish change accurately (Lambert & Hawkins, 2004). If an untreated patient responds similarly to a treated patient, then either the scale is not measuring change accurately, or the treatment is not working. The former would be an indication that the scale is an invalid measurement. Another important feature of outcome measurements is practicality (Lambert & Hawkins, 2004). For example, if a counselor uses a scale that must be sent away for the scoring process, it would be somewhat impractical because of the expense and the time factor and lack of immediacy in its practical use.

Specific to the rating scales is the description of the raters, which typically lists their experience and the number of years of experience. As a consequence of having raters as a part of determining reliability, the review discusses interrater reliability which describes how similar the raters rated the sample of patients. Observers, or raters, create a different aspect of reliability for scales. For example, central tendency errors and leniency and halo effects must be taken into account when using observers or raters to evaluate a patient or even when the client rates themselves (Whiston, 2009). The best case is to have both raters observe and rate the same client similarly. The closer their ratings, the higher the interrater reliability (D'Costa, 1991).

Construct validity is determined similar to assessments - that is, the scale is compared to tests, data that measures the same construct, literature on the subject, or research. Correlations are made between the responses to the scale in question and the alternative data. In this way, validity is established. For example, this rating scale was validated by comparisons to the Mini-Mental State Examination (D'Costa, 1991).

Generalizability is similar to evaluating other types of assessments. Although not mentioned in either of the reviews for the RSCCD, any scale needs to be normed in various populations to discern its reliability and validity in those populations. Coefficients are used to describe consistency, and methods such as test-retest can be used to establish reliability. Different from other assessments, reliability is often established by interrater reliability coefficients. Standard errors of measurement are not reported for the RSCCD, although they were mentioned in the reviews of other scales (Miller, 1991).

Rating scales, such as the RSCCD, can be incorporated into the standard intake assessment, whether it is by completing a form, or embedded within the interview itself. Either way, Whiston (2009) noted the importance of such evaluations in counseling because of clinician bias. Utilizing assessments and their valuable yield in counseling provides quality information to guide treatment design and ongoing therapeutic decisions (Whiston, 2009). Rating scales help the client or an observer rate symptoms, and over time, progress. In counseling, using outcome measurements frequently during the therapeutic process can be helpful, especially in determining the change that is normal early in therapy (Lambert & Hawkins, 2004). In effect, rating scales help counselors in treatment planning, gauging ongoing results, and realizing the need for alternative interventions (Lamber & Hawkins, 2004). Outcomes assessments increase the quality of care counselors bring to the therapeutic relationship and the intervention (Sederer, Dickey, & Eisen, 1997).

Albanese, M. (1991). Review of the Rating Scale of Communication in Cognitive Decline. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The twelfth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from

D'Costa, A. (1991). Review of the Rating Scale of Communication in Cognitive Decline. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The twelfth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from

Lambert, M. J., & Hawkins, E. J. (2004). Measuring Outcome in Professional Practice: Considerations in Selecting and Using Brief Outcome Instruments. Professional Psychology: Research and Practice, 35(5), 492-499. doi: 10.1037/0735-7028.35.5.492

Miller, R. J. (1991). Review of the ADD-H: Comprehensive Teacher's Rating Scale, Second Edition. In B.S. Plake, J.C. Impara, & R.A. Spies (Eds.), The twelfth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from

Sederer, L. I., Dickey, B., & Eisen, S. V. (1997). Assessing outcomes in clinical practice. Psychiatric Quarterly, 68(4), 311-325.

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