What is the meaning of “meaningful change”? Helping social workers assess clinical change in the well-being of children in care

Summary: The use of systematic routines in social work incorporating valid and reliable outcome measures and empirically supported interventions to reduce the gap between children in care and their peers is becoming more widespread. However, one important element towards narrowing this gap is still largely missing: indicators of clinically meaningful change (CMC). Such indicators will enable social workers to assess the magnitude of change in their individual child clients more accurately and transparently. To demonstrate how such indicators can help social workers answer the question, ‘is the measured change meaningful?’, we present five indicators of CMC: Percent change, Crossing the clinical threshold, Standard deviation, Standard error of measurement and Reliable Change Index, and illustrate their use with made-up examples using Danish epidemiological data and the Strengths and Difficulties Questionnaire (SDQ).
Findings: The indicators of CMC each have their strengths and weaknesses, and roughly similar magnitudes of raw score changes in the SDQ Total Difficulties Score can represent different degrees of CMC depending on the baseline assessment and the magnitude of change in raw scores on the measured outcome.
Applications: The examples highlight the risks of using simple differences in raw scores to determine a child’s progress and the need for explicit yardsticks and awareness of measurement error in assessing whether change is clinically meaningful. Using such indicators of CMC will enable analysis of change at the individual level, thereby allowing social workers to harness their knowledge about the child and its context more effectively.