The Brief Adjustment Scale–6 (BASE-6) was recently developed for measuring general psychological functioning within measurement-based care (MBC). The present study further evaluated psychometric properties, generalizability to race/ethnic populations, and clinical utility of the BASE-6. Three adult samples, Sample 1: online community participants (n = 394); Sample 2: college students (n = 249); Sample 3: outpatient clinic clients (n = 80), were included. The results demonstrated a high level of internal consistency, good test–retest reliability, and convergent validity in all samples. The unidimensional structure of BASE-6 was confirmed and factorial invariance was established across groups. Finally, the BASE-6 captured change over time by demonstrating a large effect size of pre–post treatment changes and significant linear change in multilevel growth modeling. These results support the BASE-6 as a reliable and valid measure regardless of race/ethnicity and can sensitively detect clinical change over the course of the treatment. Thus, the BASE-6 appears to accurately monitor overall psychological adjustment.
AborayaA. (2009). Use of structured interviews by psychiatrists in real clinical settings: Results of an open-question survey. Psychiatry (Edgmont), 6(6), 24–28.
2.
AborayaA.NasrallahH. A.ElswickD. E.ElshazlyA.EstephanN.AborayaD.. . .DoharS. (2018). Measurement-based care in psychiatry: Past, present, and future. Innovations in Clinical Neuroscience, 15, 13–26.
3.
AchenbachT. M. (1991). Childhood behavior checklist. Department of Psychology, University of Vermont.
4.
AlegriaM.CaninoG.RíosR.VeraM.CalderónJ.RuschD.OrtegaA. N. (2002). Mental health care for Latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino Whites. Psychiatric Services, 53(12), 1547–1555. https://doi.org/10.1176/appi.ps.53.12.1547
5.
AntonyM. M.BielingP. J.CoxB. J.EnnsM. W.SwinsonR. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176.
6.
ArslanG.YıldırımM.ZangenehM. (2021). Coronavirus anxiety and psychological adjustment in college students: Exploring the role of college belongingness and social media addiction. International Journal of Mental Health and Addiction, 20(3), 1546–1559.
7.
BelandS.CousineauD.LoyeN. (2017). Using the McDonald’s omega coefficient instead of Cronbach’s alpha. McGill Journal of Education, 52(3), 791–804.
8.
BickmanL.KelleyS. D.BredaC.de AndradeA. R.RiemerM. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62(12), 1423–1429. https://doi.org/10.1176/appi.ps.002052011
9.
BlandJ. M.AltmanD. G. (1997). Statistics notes: Cronbach’s alpha. BMJ: British Medical Journal, 314(7080), Article 572. https://doi.org/10.1136/bmj.314.7080.572
10.
BoerS.DekkersO. M.le CessieS.CarlierI. V.van HemertA. M. (2019). Prediction of prolonged treatment course for depressive and anxiety disorders in an outpatient setting: The Leiden routine outcome monitoring study. Journal of Affective Disorders, 247, 81–87. https://doi.org/10.1016/j.jad.2018.12.035
11.
BoswellJ. F.KrausD. R.MillerS. D.LambertM. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25, 6–19. https://doi.org/10.1080/10503307.2013.817696
12.
BusnerJ.TargumS. D. (2007). The clinical global impressions scale: Applying a research tool in clinical practice. Psychiatry (Edgmont), 4(7), 28.
13.
CarlierI. V.MeuldijkD.Van VlietI. M.Van FenemaE.Van der WeeN. J.ZitmanF. G. (2012). Routine outcome monitoring and feedback on physical or mental health status: Evidence and theory. Journal of Evaluation in Clinical Practice, 18, 104–110. https://doi.org/10.1111/j.1365-2753.2010.01543.x
14.
CaspiA.HoutsR. M.BelskyD. W.Goldman-MellorS. J.HarringtonH.IsraelS.. . .PoultonR. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders?Clinical Psychological Science, 2, 119–137. https://doi.org/10.1177/2167702613497473
15.
CerimeleJ. M.GoldbergS. B.MillerC. J.GabrielsonS. W.FortneyJ. C. (2019). Systematic review of symptom assessment measures for use in measurement-based care of bipolar disorders. Psychiatric Services, 70(5), 396–408. https://doi.org/10.1176/appi.ps.201800383
16.
CheungG. W.RensvoldR. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling: A Multidisciplinary Journal, 9(2), 233–255. https://doi.org/10.1207/S15328007SEM0902_5
17.
CohenB. H. (2008). Explaining psychological statistics. Wiley.
18.
CohenJ. (1988). The effect size index: d. Statistical Power Analysis for the Behavioral Sciences, 2, 77–83.
19.
CooperL. D.MurphyH. G.DelkL. A.FraireM. G.Van KirkN.SullivanC. P.. . .GattoA. (2021). Implementing routine outcome monitoring in a psychology training clinic: A case study of a process model. Training and Education in Professional Psychology, 15(2), 87–96. https://doi.org/10.1037/tep0000298
20.
CruzR. A.PetersonA. P.FaganC.BlackW.CooperL. (2020). Evaluation of the Brief Adjustment Scale–6 (BASE-6): A measure of general psychological adjustment for measurement-based care. Psychological Services, 17(3), 332–342. https://doi.org/10.1037/ser0000366
21.
CurranP. J.BollenK. A.ChenF.PaxtonP.KirbyJ. B. (2003). Finite sampling properties of the point estimates and confidence intervals of the RMSEA. Sociological Methods & Research, 32(2), 208–252. https://doi.org/10.1177/0049124103256130
22.
DerogatisL. R. (1977). SCL-90R (revised version) manual I. Johns Hopkins University School of Medicine.
23.
DerogatisL. R. (1994). SCL90-R: Administration, scoring and procedures manual. National Computer Systems.
24.
DeschênesS. S.DugasM. J. (2013). Sudden gains in the cognitive-behavioral treatment of generalized anxiety disorder. Cognitive Therapy and Research, 37(4), 805–811. https://doi.org/10.1007/s10608-012-9504-1
25.
DinakaranD.SreerajV. S.VenkatasubramanianG. (2020). Measurement based care in schizophrenia—Feasibility in routine clinical practice. Asian Journal of Psychiatry, 49, Article 101954. https://doi.org/10.1016/j.ajp.2020.101954
26.
DowrickC.LeydonG. M.McBrideA.HoweA.BurgessH.ClarkeP.. . .KendrickT. (2009). Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: Qualitative study. BMJ: British Medical Journal, 338, b663. https://doi.org/10.1136/bmj.b663
27.
DrasgowF.KanferR. (1985). Equivalence of psychological measurement in heterogeneous populations. Journal of Applied Psychology, 70(4), 662–680.
28.
FortneyJ. C.UnützerJ.WrennG.PyneJ. M.SmithG. R.SchoenbaumM.HarbinH. T. (2017). A tipping point for measurement-based care. Psychiatric Services, 68, 179–188. https://doi.org/10.1176/appi.ps.201500439
29.
GardnerW.MurphyM.ChildsG.KelleherK.PaganoM.JellinekM.. . .ChiappettaL. (1999). The PSC-17: A brief pediatric symptom checklist with psychosocial problem subscales. A report from PROS and ASPN. Ambulatory Child Health, 5, 225–225.
30.
GarlandA. F.KruseM.AaronsG. A. (2003). Clinicians and outcome measurement: What’s the use?The Journal of Behavioral Health Services & Research, 30, 393–405. https://doi.org/10.1007/BF02287427
31.
GleacherA. A.OlinS. S.NadeemE.PollockM.RingleV.BickmanL.. . .HoagwoodK. (2016). Implementing a measurement feedback system in community mental health clinics: A case study of multilevel barriers and facilitators. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 426–440. https://doi.org/10.1007/s10488-015-0642-0
32.
GoldbergS. B.RoweG.MalteC. A.RuanH.OwenJ. J.MillerS. D. (2020). Routine monitoring of therapeutic alliance to predict treatment engagement in a Veterans Affairs substance use disorders clinic. Psychological Services, 17(3), 291–299. https://doi.org/10.1037/ser0000337
33.
Gual-MontolioP.Martínez-BorbaV.Bretón-LópezJ. M.OsmaJ.Suso-RiberaC. (2020). How are information and communication technologies supporting routine outcome monitoring and measurement-based care in psychotherapy? A systematic review. International Journal of Environmental Research and Public Health, 17(9), Article 3170. https://doi.org/10.3390/ijerph17093170
34.
GuoT.XiangY. T.XiaoL. E.HuC. Q.ChiuH. F.UngvariG. S.. . .WangG. (2015). Measurement-based care versus standard care for major depression: A randomized controlled trial with blind raters. American Journal of Psychiatry, 172(10), 1004–1013. https://doi.org/10.1176/appi.ajp.2015.14050652
35.
GuyW. (1976). Clinical global impression. In GuyW. (Ed.), Assessment manual for psychopharmacology (pp. 217–222). National Institute of Mental Health.
36.
HardingK. J. K.RushA. J.ArbuckleM.TrivediM. H.PincusH. A. (2011). Measurement-based care in psychiatric practice: A policy framework for implementation. The Journal of Clinical Psychiatry, 72, 1136–1143. https://doi.org/10.4088/JCP.10r06282whi
37.
HatfieldD. R.OglesB. M. (2004). The use of outcome measures by psychologists in clinical practice. Professional Psychology, 35, 485–491. https://doi.org/10.1037/0735-7028.35.5.485
38.
HatfieldD. R.OglesB. M. (2007). Why some clinicians use outcome measures and others do not. Administration and Policy in Mental Health and Mental Health Services Research, 34, 283–291. https://doi.org/10.1007/s10488-006-0110-y
39.
HenryJ. D.CrawfordJ. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44(2), 227–239. https://doi.org/10.1348/014466505X29657
40.
HolmanE. A.ThompsonR. R.GarfinD. R.SilverR. C. (2020). The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States. Science Advances, 6(42), eabd5390. https://doi.org/10.1126/sciadv.abd5390
41.
HorigianV. E.SchmidtR. D.FeasterD. J. (2021). Loneliness, mental health, and substance use among US young adults during COVID-19. Journal of Psychoactive Drugs, 53(1), 1–9. https://doi.org/10.1080/02791072.2020.1836435
42.
HuL. T.BentlerP. M. (1998). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424–453. https://doi.org/10.1037/1082-989X.3.4.424
43.
IslamMd. S.TasnimR.SujanMd. S. H.Ferdous MostZ.SikderMd. T.MasudJ. H. B. . . . Md GriffithsM. D. (2021). Depressive symptoms associated with COVID-19 preventive practice measures, daily activities in home quarantine and suicidal behaviors: Findings from a large-scale online survey in Bangladesh. BMC Psychiatry, 21(1), Article 273. https://doi.org/10.1186/s12888-021-03246-7
44.
KablingerA. S.GattoA. J.O’BrienV. C.KoH.JonesS.McNamaraR. S.. . .CooperL. D. (2022). Effects of COVID-19 on patients in adult ambulatory psychiatry: Using patient-rated outcome measures and telemedicine. Telemedicine and e-Health. Advance online publication. https://doi.org/10.1089/tmj.2021.0642
45.
KazdinA. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146–159. https://doi.org/10.1037/0003-066X.63.3.146
46.
KendrickT.DowrickC.McBrideA.HoweA.ClarkeP.MaiseyS.. . .SmithP. W. (2009). Management of depression in UK general practice in relation to scores on depression severity questionnaires: Analysis of medical record data. BMJ: British Medical Journal, 338, Article 750. https://doi.org/10.1136/bmj.b750
47.
KennyD. A.KaniskanB.McCoachD. B. (2015). The performance of RMSEA in models with small degrees of freedom. Sociological Methods & Research, 44(3), 486–507. https://doi.org/10.1177/0049124114543236
48.
KniffinK. M.NarayananJ.AnseelF.AntonakisJ.AshfordS. P.BakkerA. B.. . .VugtM. V. (2021). COVID-19 and the workplace: Implications, issues, and insights for future research and action. American Psychologist, 76(1), 63–77. https://doi.org/10.1037/amp0000716
49.
KrausD. R.SeligmanD. A.JordanJ. R. (2005). Validation of a behavioral health treatment outcome and assessment tool designed for naturalistic settings: The Treatment Outcome Package. Journal of Clinical Psychology, 61(3), 285–314. https://doi.org/10.1002/jclp.20084
LambertM. J. (2015). Progress feedback and the OQ-system: The past and the future. Psychotherapy, 52, 381–390. https://doi.org/10.1037/pst0000027
52.
LambertM. J.HarmonC.SladeK.WhippleJ. L.HawkinsE. J. (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61, 165–174. https://doi.org/10.1002/jclp.20113
53.
LambertM. J.WhippleJ. L.HawkinsE. J.VermeerschD. A.NielsenS. L.SmartD. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301.
54.
LambertM. J.WhippleJ. L.KleinstäuberM. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55, 520–537. https://doi.org/10.1037/pst0000167
55.
LeongF. T.GuptaA. R. P. A. N. A. (2008). Culture and race in counseling and psychotherapy: A critical review of the literature. In BrownS. D.LentR. W. (Eds.), Handbook of counseling psychology (pp. 320–337). Wiley.
56.
LevineJ. C.CruzR. A.CooperL. D.MurphyH. G.PetersonA. P.HurdL. E.FeldnerM. T. (2017). Integrating routine outcome monitoring into graduate training clinics to advance evidence-based practice. The Behavior Therapist, 40(1), 17–22.
57.
LewisC. C.BoydM.PuspitasariA.NavarroE.HowardJ.KassabH.KroenkeK. (2019). Implementing measurement-based care in behavioral health: A review. JAMA Psychiatry, 76, 324–335. https://doi.org/10.1001/jamapsychiatry.2018.3329
58.
LewisC. C.ScottK.MartiC. N.MarriottB. R.KroenkeK.PutzJ. W.. . .RutkowskiD. (2015). Implementing measurement-based care (iMBC) for depression in community mental health: A dynamic cluster randomized trial study protocol. Implementation Science, 10(1), 1–14. https://doi.org/10.1186/s13012-015-0313-2
59.
LovibondS.LovibondP. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335–343.
60.
LöweB.UnützerJ.CallahanC. M.PerkinsA. J.KroenkeK. (2004). Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Medical Care, 42(12), 1194–1201.
61.
MarshH. W. (1994). Confirmatory factor analysis models of factorial invariance: A multifaceted approach. Structural Equation Modeling: A Multidisciplinary Journal, 1(1), 5–34. https://doi.org/10.1080/10705519409539960
62.
McCallumR. C.BrowneM. W.SugawaraH. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149.
63.
McMillanD.GilbodyS.RichardsD. (2010). Defining successful treatment outcome in depression using the PHQ-9: A comparison of methods. Journal of Affective Disorders, 127(1–3), 122–129. https://doi.org/10.1016/j.jad.2010.04.030
MillerS. D.DuncanB. L.BrownJ.SparksJ. A.ClaudD. A. (2003). The outcome rating scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2(2), 91–100.
66.
MurphyL.EduljeeN. B.CroteauK. (2020). College student transition to synchronous virtual classes during the COVID-19 pandemic in Northeastern United States. Pedagogical Research, 5(4), Article em0078. https://doi.org/10.29333/pr/8485
67.
NasrallahH. A. (2009). Long overdue: Measurement-based psychiatric practice. Current Psychiatry, 8, 14–18.
68.
NewnhamE. A.HookeG. R.PageA. C. (2010). Progress monitoring and feedback in psychiatric care reduces depressive symptoms. Journal of Affective Disorders, 127(1–3), 139–146. https://doi.org/10.1016/j.jad.2010.05.003
69.
NgF.TrauerT.DoddS.CallalyT.CampbellS.BerkM. (2007). The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure. Acta Neuropsychiatrica, 19(5), 304–310. https://doi.org/10.1111/j.1601-5215.2007.00217.x
70.
NunnallyJ. C.BernsteinI. H. (1994). Validity. Psychometric Theory, 3(1), 99–132.
71.
OkazakiS.SueS. (2016). Methodological issues in assessment research with ethnic minorities. In KazdinA. E. (Ed.), Methodological issues and strategies in clinical research (pp. 235–247). American Psychological Association. https://doi.org/10.1037/14805-015
72.
OveringtonL.IonitaG. (2012). Progress monitoring measures: A brief guide. Canadian Psychology, 53, 82–92. https://doi.org/10.1037/a0028017
73.
PetersonA. P.FaganC. (2017). Training the next generation in routine outcome monitoring: Current practices in psychology training clinics. Training and Education in Professional Psychology, 11(3), 182–189. https://doi.org/10.1037/tep0000148
74.
PierceM.HopeH.FordT.HatchS.HotopfM.JohnA.. . .AbelK. M. (2020). Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry, 7(10), 883–892. https://doi.org/10.1016/S2215-0366(20)30308-4
75.
RamírezM.FordM. E.StewartA. L. A.TeresiJ. (2005). Measurement issues in health disparities research. Health Services Research, 40(5p2), 1640–1657. https://doi.org/10.1111/j.1475-6773.2005.00450.x
76.
RaudenbushS. W.BrykA. S. (2002). Hierarchical linear models: Applications and data analysis methods (Vol. 1). SAGE.
77.
RaudenbushS. W.BrykA. S.CongdonR. (2013). HLM 7.01 for Windows [Computer software]. Scientific Software International.
78.
SapytaJ.RiemerM.BickmanL. (2005). Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology, 61, 145–153. https://doi.org/10.1002/jclp.20107
79.
SatorraA.BentlerP. M. (1994). Corrections to test statistics and standard errors in covariance structure analysis. In von EyeA.CloggC. C. (Eds.), Latent variable analysis: Applications for developmental research (pp. 399–419). SAGE.
80.
SerafiniG.ParmigianiB.AmerioA.AgugliaA.SherL.AmoreM. (2020). The psychological impact of COVID-19 on the mental health in the general population. QJM: An International Journal of Medicine, 113(8), 531–537. https://doi.org/10.1093/qjmed/hcaa201
81.
ShimokawaK.LambertM. J.SmartD. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298–311. https://doi.org/10.1037/a0019247
82.
SimonK. M.HarrisS. K.ShrierL. A.BuksteinO. G. (2020). Measurement-based care in the treatment of adolescents with substance use disorders. Child and Adolescent Psychiatric Clinics, 29(4), 675–690. https://doi.org/10.1016/j.chc.2020.06.006
83.
SnowdenL. R. (2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181–187.
84.
SonC.HegdeS.SmithA.WangX.SasangoharF. (2020). Effects of COVID-19 on college students’ mental health in the United States: Interview survey study. Journal of Medical Internet Research, 22(9), Article e21279. https://doi.org/10.2196/21279
85.
SpitzerR. L.KroenkeK.WilliamsJ. B.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.
86.
SueS.ChengJ. K. Y.SaadC. S.ChuJ. P. (2012). Asian American mental health: A call to action. American Psychologist, 67(7), 532–544. https://doi.org/10.1037/a0028900
87.
ToussaintA.HüsingP.GumzA.WingenfeldK.HärterM.SchrammE.LöweB. (2020). Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). Journal of Affective Disorders, 265, 395–401. https://doi.org/10.1016/j.jad.2020.01.032
88.
Van de VijverF.LeungK. (1997). Methods and data analysis of comparative research. In BerryJ. W.PoortingaY. H.PandeyJ. (Eds.), Handbook of cross-cultural psychology (pp. 257–300). Allyn & Bacon.
89.
WareJ. E.Jr.SherbourneC. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.
90.
YildirimM.SolmazF. (2021). Testing a Turkish adaption of the Brief Psychological Adjustment Scale and assessing the relation to mental health. Psikoloji Çalışmaları- Studies in Psychology, 41(1), 231–245. https://doi.org/10.26650/SP2020-0032
91.
ZimmermanM.McGlincheyJ. B.ChelminskiI. (2008). An inadequate community standard of care: Lack of measurement of outcome when treating depression in clinical practice. Primary Psychiatry, 15, 67–75.
