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The Psychometric Properties of the Collaborative Assessment and Management of Suicidality Rating Scale

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The Psychometric Properties of the Collaborative Assessment and Management of Suicidality Rating Scale DOI: 10.1002/jclp.22699 RESEARCH ARTICLE The psychometric properties of the Collaborative Assessment and Management of Suicidality rating scale Christopher D. Corona1,2 | Peter M. Gutierrez3,4 | Barry M. Wagner5 | David A. Jobes5 1VISN 2 Center of Excellence for Suicide Prevention, Canandaigua VA Medical Center, Abstract Canandaigua, New York Objective: The CAMS Rating Scale (CRS) is an adherence 2Department of Psychiatry, University of measure for the Collaborative Assessment and Management Rochester Medical Center, Rochester, New York of Suicidality (CAMS), a suicide‐specific clinical intervention. 3Rocky Mountain Mental Illness Research, This study examined the ability of the CRS to assess Education, and Clinical Center, Denver VA Medical Center, Denver, Colorado adherence to CAMS. 4Department of Psychiatry, University of Methods: Video‐recorded therapy sessions of clinicians Colorado School of Medicine, Aurora, delivering either CAMS or Enhanced Care‐As‐Usual (E‐CAU) Colorado 5Department of Psychology, Catholic were rated with the CRS. These ratings (N = 98) were used to University of America, Washington, District of evaluate criterion validity, internal consistency, and factor Colombia structure. Correspondence Results: Criterion validity and factor analyses did not Christopher D. Corona, PhD, VISN 2 Center of Excellence for Suicide Prevention, support the organization of the CRS into its current Canandaigua VA Medical Center, 400 Fort subscales. Furthermore, the identified factor model and Hill Avenue, Canandaigua, NY 14424. ‐ Email: [email protected] item level statistics revealed weak CRS items. Finally, internal consistency was higher among CAMS clinicians Funding information ‐ Military Operational Medicine Research than among clinicians delivering E CAU. Program, Grant/Award Number: Conclusion: These results establish the CRS as a measure W81XWH‐11‐1‐0164 that can effectively assess the adherence to CAMS in its current form. Potential revisions to future iterations of the CRS are discussed. KEYWORDS adherence, CAMS, evidence‐based practice, psychometrics, suicide 190 | © 2018 Wiley Periodicals, Inc. wileyonlinelibrary.com/journal/jclp J. Clin. Psychol. 2019;75:190–201. CORONA ET AL. | 191 1 | INTRODUCTION Suicide currently ranks as the 10th leading cause of death in the United States and is a major public health concern both domestically and abroad (Drapeau & McIntosh, 2017). There were over 44,000 suicides in the United States in 2016, and over 800,000 suicides internationally in 2012 (World Health Organization, 2014). One continuing challenge in the effort to reduce the rate of suicide worldwide is the relative lack of randomized controlled trials (RCTs) that evaluate treatments designed specifically to target suicidal behavior (Comtois & Linehan, 2006; Leenaars, Pompili, & Tatarelli, 2011; Ward‐Ciesielski & Linehan, 2014). To date, only dialectical behavior therapy (DBT), two forms of suicide‐specific cognitive therapy (CT; i.e., CT for Suicide Prevention and Brief Cognitive Behavioral Therapy), and the Collaborative Assessment and Management of Suicidality (CAMS) have replicated positive outcomes in RCTs (G. K. Brown et al., 2005; Jobes, 2016; Linehan, 1993, 2015; Rudd et al., 2015; Wenzel, Brown, & Beck, 2009). CAMS is a therapeutic framework designed to be used by clinicians from a variety of training backgrounds on a short‐term basis (CAMS; Jobes et al., 2015; Jobes, 2016). The framework is characterized by initial and continued risk assessment, treatment planning, and suicide‐specific interventions. In addition to a sharp focus on clinical material relevant to suicide, a collaborative interaction style is a key component of CAMS that should frame all technical aspects of the intervention. Such an approach mitigates the adversarial therapeutic tone that can arise within discussions about suicide, and fosters a strong therapeutic alliance by enlisting the patient as the expert of their experience who can make valuable contributions to their own treatment (Jobes, 2016). Care within the CAMS framework is guided by the “Suicide Status Form” (SSF; Conrad et al., 2009; Jobes, Jacoby, Cimbolic, & Hustead, 1997), and begins with a thorough assessment of the risk factors related to suicide. This assessment entails having patients rate their experience of psychological pain, stress, agitation, hopelessness, and self‐hate using the SSF, as well as obtaining a relevant history from the patient (e.g., past suicidal ideation and behavior, substance use, sleep problems, relationship problems, etc.). The preliminary identification of patient‐ defined suicidal “drivers” (i.e., particular problems or issues that make suicide compelling) follows, along with the creation of both an outpatient safety plan as well as a general treatment plan focusing on problem‐drivers (e.g., beliefs about oneself). Ongoing sessions include continued assessment of suicide risk using the SSF, the use of optional instruments, which are designed to help the dyad further understand the patient’s unique relationship or attachment to suicide (e.g., the CAMS Therapeutic Worksheet), and clinical interventions aimed at patient‐defined problem‐drivers (e.g., CT targeting beliefs about oneself). Once suicide risk is satisfactorily mitigated as per ongoing assessment, the resolution phase of treatment is characterized by discussions of what has worked in treatment as well as a plan for addressing future suicidality (Schembari, Jobes, & Horgan, 2016). Evidence supporting CAMS as a suicide‐specific intervention is growing. Comtois et al. (2011) compared CAMS with treatment‐as‐usual care (TAU) in an outpatient setting and found that those receiving CAMS showed significantly greater increases in hope, as well as significantly greater reductions in suicidal ideation and overall symptom distress 12 months after treatment. Andreasson et al. (2016) also found that CAMS showed promise for treating self‐harm and suicide attempts when compared with DBT. Most recently, Jobes et al. (2017) compared CAMS with Enhanced Care‐As‐Usual (E‐CAU) among active‐duty U.S. soldiers and found that suicidal ideation had been eliminated 3 months after treatment among those receiving CAMS. These studies replicated and extended findings from previous correlational studies also suggesting positive outcomes related to CAMS (Arkov, Rosenbaum, Christiansen, Jønsson, & Münchow, 2008; Ellis, Green, Allen, Jobes, & Nadorff, 2012; Ellis, Rufino, Allen, Fowler, & Jobes, 2015; Jobes, Kahn‐Greene, Greene, & Goeke‐Morey, 2009; Jobes, Wong, Conrad, Drozd, & Neal‐Walden, 2005; Nielsen, Alberdi, & Rosenbaum, 2011). An important consideration related to RCTs evaluating psychotherapeutic interventions is treatment fidelity or the extent to which treatments being studied are delivered as intended. Comprising the construct of treatment fidelity are both differentiation (i.e., demonstrating distinct treatment groups throughout a study) as well as adherence (i.e., demonstrating that defining elements of intervention are being practiced; 192 | CORONA ET AL. Perepletchikova, Treat, & Kazdin, 2007). Thus, using effective methods for assessing adherence is integral to the process of developing and disseminating suicide‐specific, evidence‐based interventions such as CAMS. To date, CT is the only empirically supported treatment for suicidal behavior with a corresponding measure that has been psychometrically evaluated (Dobson, Shaw, & Vallis, 1985; Vallis, Shaw, & Dobson, 1986). Whereas, this measure has been used in trials evaluating CT within the context of suicidal behavior (G. K. Brown et al., 2005; Rudd et al., 2015); psychometric analyses have not been carried out with these data. Furthermore, no psychometric evaluations have been published pertaining to the DBT Global Rating Scale (Linehan, 2003). Whereas, an adherence measure for CAMS (i.e., the “CAMS Rating Scale”;CRS)hasbeen mentioned in the literature, its psychometric properties have not been extensively evaluated thus far (Comtois et al., 2011; Jobes, 2012). The CRS was initially developed for use within treatment studies evaluating the effectiveness of CAMS. Those with expert knowledge of the CAMS model adapted the CRS from the Cognitive Therapy Scale (Young & Beck, 1980). Further refinement of the measure was based on feedback provided by raters using the measure within earlier studies as well as consultation among CAMS experts (Comtois et al., 2011). No data have been published regarding the psychometric properties of earlier iterations of the CRS. Such properties speak the ability of the CRS to assess the delivery of CAMS in an effective manner, and have implications for the use of this measure within the contexts of research, treatment dissemination, and patient outcomes (Webb, DeRubeis, & Barber, 2010). Thus, the goal of the current study was to examine the psychometric properties of the CRS in an effort to determine its appropriateness as a measure assessing adherence to CAMS. 2 | MATERIALS AND METHODS 2.1 | Setting The current study is a retrospective analysis using data from measures that were included in the “Operation Worth Living” (OWL) study, an RCT evaluating the effectiveness of CAMS versus E‐CAU in a sample of army soldiers (Jobes et al., 2017). Data for the RCT were collected between September 2012 and March 2016 in both a pilot phase, as well as with an intent‐to‐treat sample. The site of both RCT phases was an army post in the southeastern United States, and the data were collected in health clinics on this post. 2.2
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