Short Assessment System  

 
 For use by mental health professionals

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.
 

 ¯ SAS-A3  (Subjective Rating of Distress/Overview)  

 ¯ SAS-B  (Session Outcomes & Summary)  

 ¯ SAS-C  (Treatment Contract/Progress Monitoring)  

 ¯ SAS-F2 (Rating by parent or other family member)  

 ¯ SAS-M (Self-monitoring log for anger management)  

 ¯ SAS Training Manual

 

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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.

 ¯ 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.

 ¯ 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.

 ¯ 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.

 ¯ 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.

 ¯ Author

Dan Short, Ph.D. 


SAS-A Description

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.

SCL-90-R 

SAS-A

Pain Behavior Isolation Sadness Anxiety Anger Fear Threats Thinking
Somatization .61
Obsessive-Compulsive   .37
Interpersonal Sensitivity   .64
Depression .75
Anxiety .52
Hostility .63
Phobic Anxiety .47
Paranoid Ideation .47
Psychoticism .70

SAS-B Description

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.

SAS-C Description

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

 ¯ Short has provided case consultation for therapists from around
 country.  The objective is both increased wisdom (i.e., understanding
 the behavior of others) and enlightenment (i.e., a deeper
 understanding of one's self).  

 ¯ Appointments can be made for face-to-face office visits
 or a phone consultation can be arranged at the normal hourly rate. 
 For more information, contact Dan Short at 480-329-5359.

 


 

 


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Copyright (c) 2003-2015 Dan Short, Ph.D.
9855 E Larkspur Dr. | Scottsdale | Arizona | 85260 | E-Mail : hope@IamDrShort.com
Tel : 480.329.5359