Clinical Outcomes in Routine Evaluation 10

What it measures?

• The Clinical Outcomes in Routine Evaluation 10 (CORE-10) is a 10-item assessment measure for common presentations of psychological distress, and is designed to be generic, short, and easy-to-use in primary care mental health settings (Barkham et al., 2013).
• The CORE-10 uses a selection of items from the greater 34-item CORE-OM (Evans et al., 2002), asking how a person has felt over the past week.
• The CORE-10 has six problem domain items, three functioning domain items and one risk item, although unlike the CORE-OM, it does not provide subscale scores for these domains. The total score indicates a persons' level of psychological distress, and can also indicate signs of depression (Barkham et al., 2013).

Who is it for?

* The CORE-10 is for people aged 17 and over. * There are other similar measures that can be used for other demographics: - For people aged 11-18, the YP-CORE (Twigg et al., 2010) - For people with learning disabilities, the LD-CORE-14 (Brooks et al., 2013) and LD-CORE-30 (Barrowcliff et al., 2018). * There is also a separate information gathering framework designed for use by practitioners in order to give context to CORE self-report measures, the CORE-A (Evans et al., 2003).

Instrument Quality

• While the CORE-OM is useful as an initial screening tool, the CORE-10 has been found to have better longitudinal psychometric properties (Rosenström et al, 2022), and so is recommended as a session-by-session monitoring tool, measuring patients’ improvement over time in response to psychotherapy.

Structure

• 10 items, drawn from the larger CORE-OM.
• 5-point Likert scale, between 0 and 4
• Respondents asked how frequently they have felt a certain way ranging from ‘not at all’ to ‘most or all of the time’ over the last week.

Scoring instructions

• If all items are completed: add together the item scores to get the Clinical Score.
• It is not recommended to compute a score if more than 1 item was omitted, but if 9 were completed: add together the item scores, divide by 9 to get the mean score, then multiply by 10 to get the Clinical Score.
• Total Clinical Scores range from 0 – 40.
• Note: Items 2 and 3 are reverse-scored (4 for ‘not at all’, 0 for ‘most or all of the time’)

Score Interpretation

What higher scores mean?

• A higher score indicates a higher level of psychological distress. Score can range from 0 to 40; a score of 11 or above is considered a clinical level of psychological distress, and a score of 13 or above can be indicative of depression (Connell & Barkham, 2007).

Identifying risk

A patient may be at risk if they endorse any of the following ‘red flag’ items. Further risk assessment should be undertaken.

Instrument developers

• Barkham, M., Bewick, B., Mullin, T., Gilbody, S., Connell, J., Cahill, J., Mellor-Clark, J., Richards, D., Unsworth, G., & Evans, C. (2013). The CORE-10: A short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research, 13(1), 3–13. https://doi.org/10.1080/14733145.2012.729069

Refrences

* Barkham, M., Bewick, B., Mullin, T., Gilbody, S., Connell, J., Cahill, J., Mellor-Clark, J., Richards, D., Unsworth, G., & Evans, C. (2013). The CORE-10: A short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research, 13(1), 3–13. https://doi.org/10.1080/14733145.2012.729069 ‌ *Barrowcliff, A. L., Oathamshaw, S. C., & Evans, C. (2018). Psychometric properties of the Clinical Outcome Routine Evaluation-Learning Disabilities 30-Item (CORE-LD30). Journal of Intellectual Disability Research, 62(11), 962–973. https://doi.org/10.1111/jir.12551 * Brooks, M., Davies, S., & Twigg, E. (2013). A measure for feelings - using inclusive research to develop a tool for evaluating psychological therapy (Clinical Outcomes in Routine Evaluation - Learning Disability). British Journal of Learning Disabilities, 41(4), 320–329. https://doi.org/10.1111/bld.12020 *Connell, J. & Barkham, M. (2007). CORE-10 User Manual, Version 1.1. CORE System Trust & CORE Information Management Systems Ltd. * Evans, C., Connell, J., Barkham, M., Margison, F., McGrath, G., Mellor-Clark, J., & Audin, K. (2002). Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE–OM. British Journal of Psychiatry, 180(1), 51–60. https://doi.org/10.1192/bjp.180.1.51 * Evans, C., Connell, J., Barkham, M., Marshall, C., & Mellor-Clark, J. (2003). Practice-based evidence: benchmarking NHS primary care counselling services at national and local levels. Clinical Psychology & Psychotherapy, 10(6), 374–388. https://doi.org/10.1002/cpp.384 * Rosenström, T. H., Mylläri, S., Malkki, V., & Saarni, S. E. (2022). Feasibility of generic, short, and easy-to-use assessment of psychological distress during psychotherapy: Longitudinal measurement invariance of CORE-10 and -OM. Psychotherapy Research, 1–10. https://doi.org/10.1080/10503307.2022.2074807 * Twigg, E., Barkham, M., Bewick, B. M., Mulhern, B., Connell, J., & Cooper, M. (2009). The Young Person’s CORE: Development of a brief outcome measure for young people. Counselling and Psychotherapy Research, 9(3), 160–168. https://doi.org/10.1080/14733140902979722