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Inspired
healing rests on a foundation of skillful assessment.
Tailoring the treatment to meet the needs of the client is the
cornerstone of Ericksonian therapy as well as competency-oriented and
outcome-informed therapies. Equally
important is the readiness of the therapist to be flexible and change the
direction of therapy whenever indicated.
Skillful assessment provides the knowledge that makes this type of
therapy possible. When the
clinician knows how to uncover information vital to understanding the client,
then opportunities for healing are better recognized.
For
more detailed information about SAS see below.
If you are a licensed mental health professional or a behavioral sciences researcher, then you may download a copy of the SAS forms free of charge for use in an individual agency, practice, or research project. These materials are protected by copy right and therefore may not be sold or distributed without the author's permission.
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Purpose The SAS is a fully
integrated set of assessment protocols designed to facilitate treatment
planning, progress monitoring, and the instantaneous benefits of
therapeutic assessment.
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Population The
terminology used in the SAS is appropriate for adolescents and
adults with a high school reading level or higher.
The forms listed at this web site are in English.
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Interpretation The SAS produces both
numerical and quantitative data that that are interpreted ideographically.
Normative data is not required for this approach.
The outcome information is derived without the need for statistical
manipulation. Item analysis is
the primary means of deriving narrative information from the patient
during the interpretation process.
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Time The average time for
SAS-A is 120 seconds. The
average time for SAS-B is 180 seconds.
The time required for SAS-C can range from 5 minutes to a process
that is continued across several sessions.
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Author Dan Short, Ph.D.
The Short Assessment
System–Alpha protocol (SAS-A) is a broad band measure comprised of nine
scales that measure subjective levels of distress.
Each scale represents a general domain in which distress or
suffering might be experienced. These
domains are: Pain, Behavior, Isolation, Sadness, Anxiety, Anger, Fear,
Threats, and Thinking. Measurements
are derived from a self-anchored scaling method that ranges from 0 to 10.
These scales are intended to measure the presence and degree of
subjective distress. Each
scale is described in narrative terms and responses are listed in a graph
format. The SAS-A is designed to assess mental health issues using a continuum that crosses categories of pathology. The measure is based on the postulate that if a psychological problem exists, then the individual will experience distress of some type. The device is a therapeutic assessment form of assessment as it promotes inspection, partitioning of problem areas, and self-monitoring activities. The patient’s responses to the SAS-A provide an immediate focus for therapeutic processes, independent of any particular theoretical bias. SAS-A
Scoring Each of the nine
categories of subjective experience corresponds to an 11 point scale
representing a continuum of distress.
Each category purports to describe a general affective, behavioral,
somatic, or cognitive manifestation associated with the experience of
distress. Numerical values
ranging from 0 to10 indicate possible differences in the degree of
distress. These values are
arranged in vertical columns that form a graph, once the data is recorded.
The interpretation is achieved through visual analysis and
qualitative data collected in the follow-up interview.
SAS-A
Validity When assessing the
validity of the SAS-A, the traditional concepts of validity and
reliability lack relevance. This
is an ideographic measure therefore its validity and reliability are not
determined by normative data but are instead assessed on a case by case
basis. The more relevant
question for this method of assessment is the probability of treatment
validity—the degree to which assessment results contribute to treatment
planning, implementation, and therapeutic benefit.
The SAS-A has not been tailored to a single treatment paradigm but
instead monitors the patient’s experience of progress or lack of.
When these results are analyzed within the context of the fully
integrated assessment system, then treatment is more easily tailored to
meet the individual needs of the patient.
Many elements of the SAS are therapeutic assessment techniques, in
other words the assessment protocol alone is likely to yield therapeutic
benefit. These combined
factors suggest high treatment validity. Experience indicates
that the content validity for the SAS-A is also high.
The nine scales evaluate a wide variety of human experiences that
represent most every type of symptom associated with psychological
dysfunction. A study by the
author, addressing concurrent validity, demonstrated evidence of a
positive correlation for all SAS-A clinical scales when compared to
comparable scales found on the SCL-90-R.
These coefficients are listed in the table below (N=70).
Results indicate that levels of distress detected by the SCL-90-R
will also register as distress when using the SAS-A.
It should be noted that although both instruments measure
subjective distress, the SAS-A was not intended to function as a
substitute for the SCL-90-R, nor is it designed to measure precisely the
same constructs. For this
reason, some of the scales have lower correlations.
The Short Assessment
System–Beta protocol (SAS-B) is a qualitative device that has some
quantitative elements. There
are seven domains of inquiry that assess the subjective impact of a
therapy session. Data is
collected using a sentence stem completion technique.
The response is further qualified using a numerical rating.
Each stem represents a different dimension from which the immediate
impact of therapy can be evaluated. These
dimensions include outcome expectations, rapport, resistance, and general
experience. Quantitative
measurements are derived from a three-point scale indicating the level of
subjective intensity for a given response.
This functions as a means of weighting responses.
These scales are intended to set a part replies motivated by social
correctness versus those that are deeply felt.
SAS-B is designed to
assess the patient’s subject experience in response to therapy, while
simultaneously providing a vehicle for the patient to debrief and organize
his or her own thinking about topics covered during the session, and a
means of providing immediate feedback to help refine the clinician’s
approach. This provides a
formal channel through the patient can express concerns or objections
before leaving the office. The
measure is based on the postulate that if a clinician knows more about the
patient’s subject experiences during therapy, then he can do a better
job of tailoring therapy to meet the individual needs of the patient.
A second assumption is that if the patient is feeling resentful or
misunderstood it is better to have this communicated before the patient
leaves the office. SAS-B
Scoring Each of the seven
categories is self-explanatory. Stem
responses can be analyzed for underlying themes or implied messages,
however, a straight forward interpretation is recommended.
Numerical values ranging from 1 to 3 enable to respondent to weight
their responses, with high scores representing more strongly felt
responses. The interpretation
is achieved through visual analysis and additional qualitative data
collected using follow-up questions. SAS-B
Validity When assessing the
validity of the SAS-B, the traditional concepts of validity and
reliability lack relevance. This
is an ideographic measure therefore its validity and reliability are not
determined by normative data but are instead assessed on a case by case
basis. Once again, the more
relevant question for this method of assessment is the probability of
treatment validity—the degree to which assessment results contribute to
treatment planning, implementation, and therapeutic benefit.
The SAS-B provides information directly related to session outcomes
and treatment planning. Using
information collected on the SAS-B, the clinical approach is continually
refined to better meet the subjectively experienced needs of the patient.
The SAS-B contains therapeutic assessment techniques.
In other words, the assessment protocol alone is likely to yield
therapeutic benefit. These
combined factors suggest high treatment validity. The Short Assessment
System–Contract protocol (SAS-C) is a detailed treatment plan that
provides a means of estimating the number of sessions required for
treatment, the type of therapeutic methodology that will met with the
least resistance from the patient, the patient’s expectations for
treatment outcomes, and a formal declaration of the rights and
responsibilities of both the patient and the therapist.
This information is collected within the context of a
semi-structured interview that results in a written record that is signed
by both the patient and therapist. The SAS-C is designed
not only as a therapeutic assessment device, but it is also intended to
produce an interactive exchange so that the patient learns more about what
to expect in therapy as the therapist learns more of what to expect from
the patient. Each person’s
roles are defined within the context of a collaborative effort guided by
the patient’s goals for change. This
helps minimize confusion, misunderstanding, and resistance, while
increasing the probable level of motivation and commitment.
The patient’s responses to the SAS-C provide an immediate
starting point for therapy that can be revised as the therapy continues.
The robustness of the progress monitoring methodology is such that
earlier measurements, along with the projected aimline, remain relevant
even if the finer details of the therapeutic objective change over time.
This is important for the sake of continuity.
In addition to its
value as a tool of assessment and therapeutic intervention, the SAS-C also
provides clear documentation outlining the clinical decision making behind
treatment implementation. This
is important for purposes of accountability, so that there is less need to
challenge the decisions made by the therapist during treatment.
The signature of the patient on the contract further adds to its
credibility. SAS-C
Scoring Much of the information
collected on the SAS-C is narrative with the exception of the progress
monitoring graph. The Y-axis
of this device is calibrated to match the scales used on the SAS-A.
The X-axis contains 17 segments, each corresponding to a single
session. After determining the
number of sessions for which the patient will contract, a measurement is
taken indicating the level of distress that will be acceptable following
four months, or less, of counseling. In
the case of long-term counseling, a new contract is generated every four
months. After these
perimeters are established, a single scale from the SAS-A is chosen as
being most representative of the patient’s goals for therapy.
In other words, this is the area of distress that is most likely to
decrease as therapeutic goals are realized.
This single scale is used as a maker of progress throughout.
On the day that the contract is signed, the SAS-A data is recorded
and an Aimline is drawn to the projected end point.
This visual aid provides a means of evaluating progress and
determining when therapeutic goals or methods need to be revisited.
SAS-C
Validity When assessing the
validity of the SAS-C, the traditional concepts of validity and
reliability lack relevance. The
SAS-C is a behavioral intervention that simultaneously produces useful
assessment data. Of all the
SAS forms, the SAS-C contributes most directly to treatment planning,
implementation, and progress monitoring.
Although it incorporates a behavioral format, the SAS-C has not
been tailored to a single treatment paradigm.
This device provides a means of setting concrete goals, graphing
progress across time, and a collaborative framework for determining the
methodology to be used during treatment. Most
importantly, the SAS-C provides information about the patient’s
commitment to change. When
these results are analyzed within the context of the fully integrated
assessment system, then treatment is more easily tailored to meet the
individual needs of the patient. These
combined factors suggest high treatment validity. SAS
Suggested Uses The integrated
components of the SAS are recommended as an assessment protocol for all
clinical settings that involve the emotional well-being of the patient. The
SAS-A and SAS-B can be completed in a patient waiting area, without aid,
however, the interpretation of the results should be conducted by an
experienced clinician who has appropriate training with this system.
The SAS-C is completed during a collaborative effort between
clinician and patient. CONSULTATION & SUPERVISION
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Short has provided case consultation for
therapists from around
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Appointments can be made for face-to-face
office visits
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