Clients can be divided into three groups according to their ESSA (Service)
(1) Clients who experienced reliable positive change. These are clients who have an ESSA that is greater than 0.8. They are clients who are significantly improved.
(2) A middle group who have not experienced reliable change that is significantly better or worse. This group have ESSA scores below 0.8 and above -0.8.
This middle group includes
(i). clients who may have experienced some positive change i.e. somewhat changed),
(ii). some who experienced no change i.e. are unchanged and
(iii). clients who may have experienced some negative change i.e. are somewhat worse.
(3) Clients who experienced reliable negative change. These are clients who have an ESSA that is less than -0.8. They are clients who are significantly worse.
1. Significantly improved
These are clients who have an ESSA that is greater than 0.8. This group can be further divided into those who have reliably improved and those who have reliably recovered.
Reliably improved (number and percentage) | Clients who have reliably improved, have an ESSA > 0.8 but their final ORS score has not exceeded the ORS clinical cut-off for their age range (25 for adults, 32 for children). | Reliable improvement can be used to describe the impact of treatment programmes for example in a weight loss service a reliable improvement may be a weight loss representing 5% of body weight. |
Reliably recovered
| Clients who have reliably recovered have ESSA > 0.8 AND a final ORS score that has exceeded the clinical cut-off score for their age range. (25 for adults, 32 for children). A change in ORS score from a score in the clinical range of scores to a score in the nonclinical range of scores is considered a “recovery” because it represents a person’s change that makes his or her score indistinguishable from a person in the community or non treatment-seeking population. | Reliable recovery can be used to describe the impact of treatment programmes for example in a weight loss service a reliable recovery would be a weight loss representing 5% of body weight and also the client’s weight moving from within the “obese” range of weight to the “normal weight” range. |
2. Somewhat changed
This middle group represents clients who have received treatment that did not have a statistically meaningful impact with regard to improving their outcomes. It represents clients who have not significantly improved or reliably worsened. This middle group includes clients who may have experienced some positive change (somewhat improved), some who have experienced no change and some who may have experienced some negative change (somewhat worse).
Somewhat improved
| These are clients who have an ESSA that is less than 0.8 but greater than 0.5. These are clients who have not experienced significant improvement but who are somewhat improved. | These are clients whose ESSA as a group are on average less than 0.8 but greater than 0.5. This indicates that this group on average have somewhat improved but not reliably improved or reliably recovered. |
No change
| These are clients who have an ESSA that is between 0.5 and -0.5. These are clients who have not experienced improvement. It represents the clients who have not significantly improved nor somewhat improved nor deteriorated. | This is the number and percentage of clients who experienced an amount of change that is within a range that might be expected from normal variation or “error” in scores. This may also include clients whose scores are above the clinical cut-off but who have not experienced an ESSA greater than 0.5 or less than -0.5. |
Somewhat worse | These are clients who are somewhat worse but have not experienced reliable deterioration. | These are clients whose negative ESSA as a group is not less than -0.8 but is less than -0.5. This indicates that this group on average have somewhat worsened but not reliably worsened or deteriorated. |
3. Significantly worse
Reliable Deterioration (RD)
This is the number and percentage of clients who experienced reliable negative change. This is described as reliable or significant deterioration or worsening. It is the percentage of clients whose negative ESSA as a group is less than -0.8. Significantly Worse % or Deterioration Rate is the percentage of people who are reliably worse while in treatment. On average, between 5 and 10% of clients deteriorate while in care. Clinicians once they establish a baseline should aim to reduce the number of clients who get significantly worse in treatment.