Interpreting Assessment Results

Learn to interpret assessment scores, understand clinical significance, identify reliable change, and communicate findings effectively to clients and referrers.

Understanding Assessment Scores

Score Components

Most assessments in Praxi provide the following information:

Component	Description
Total score	Sum of all item responses
Severity band	Clinical category (e.g., minimal, mild, moderate, severe)
Subscales	Domain-specific scores (where applicable, e.g., DASS-21)
Item responses	Individual answers for detailed review
Percentile	Comparison to normative sample
Risk flags	Critical items highlighted for attention

Risk levels recorded in the client's safety assessment are the clinician's judgement. Praxi does not combine those domains into an overall risk rating. Exports retain the recorded domain levels and formulation.

For C-SSRS, review the recorded items. A category may be shown only for an identified instrument version with its published category and citation, using the Assessment summary pattern. The current structured risk record does not provide that mapping, so it shows no software-derived C-SSRS category.

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Scoring Tables for Core Assessments

PHQ-9 (Patient Health Questionnaire-9)

Items: 9 questions rated 0-3 over the past 2 weeks

Response options:

• 0 = Not at all
• 1 = Several days
• 2 = More than half the days
• 3 = Nearly every day

Severity cut-offs:

Score	Severity	Recommended clinical action
0-4	Minimal	No treatment indicated; monitor
5-9	Mild	Watchful waiting; repeat PHQ-9 at follow-up
10-14	Moderate	Treatment plan warranted; counselling and/or medication
15-19	Moderately severe	Active treatment; consider medication review
20-27	Severe	Immediate treatment; psychiatry referral strongly recommended

Diagnostic threshold: Score of 10+ suggests probable major depression (sensitivity 88%, specificity 88% for major depressive disorder).

Critical item: Item 9 ("Thoughts that you would be better off dead or of hurting yourself") requires immediate follow-up if score > 0.

Reliable Change Index: 6 points

Item 10 (functional impairment): Not included in total score but provides important context about impact on daily functioning.

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GAD-7 (Generalised Anxiety Disorder-7)

Items: 7 questions rated 0-3 over the past 2 weeks

Response options:

• 0 = Not at all
• 1 = Several days
• 2 = More than half the days
• 3 = Nearly every day

Severity cut-offs:

Score	Severity	Recommended clinical action
0-4	Minimal anxiety	Monitor; psychoeducation
5-9	Mild anxiety	Watchful waiting; relaxation techniques
10-14	Moderate anxiety	Treatment indicated; CBT recommended
15-21	Severe anxiety	Active treatment strongly recommended; consider medication

Diagnostic threshold: Score of 10+ indicates probable generalised anxiety disorder (sensitivity 89%, specificity 82%).

Reliable Change Index: 5 points

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DASS-21 (Depression Anxiety Stress Scales)

Items: 21 questions rated 0-3 over the past week

Response options:

• 0 = Did not apply to me at all
• 1 = Applied to me to some degree, or some of the time
• 2 = Applied to me to a considerable degree, or a good part of time
• 3 = Applied to me very much, or most of the time

Scoring Note

DASS-21 subscale scores must be multiplied by 2 to align with DASS-42 norms. Praxi does this automatically.

Subscale items:

• Depression: Items 3, 5, 10, 13, 16, 17, 21
• Anxiety: Items 2, 4, 7, 9, 15, 19, 20
• Stress: Items 1, 6, 8, 11, 12, 14, 18

Depression subscale severity (after x2):

Score	Severity	Description
0-9	Normal	Within normal range
10-13	Mild	Some depression symptoms
14-20	Moderate	Significant symptoms; treatment indicated
21-27	Severe	Severe symptoms; active treatment required
28+	Extremely severe	Critical level; urgent intervention

Anxiety subscale severity (after x2):

Score	Severity	Description
0-7	Normal	Within normal range
8-9	Mild	Some anxiety symptoms
10-14	Moderate	Significant symptoms; treatment indicated
15-19	Severe	Severe symptoms; active treatment required
20+	Extremely severe	Critical level; urgent intervention

Stress subscale severity (after x2):

Score	Severity	Description
0-14	Normal	Within normal range
15-18	Mild	Some stress symptoms
19-25	Moderate	Significant symptoms; intervention indicated
26-33	Severe	Severe symptoms; active intervention required
34+	Extremely severe	Critical level; urgent intervention

Critical items:

• Item 21 ("I felt that life was meaningless") - follow up at any endorsement
• Item 10 ("I felt that I had nothing to look forward to") - follow up if score 3

Reliable Change Index: 7 points per subscale

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K10 (Kessler Psychological Distress Scale)

Items: 10 questions rated 1-5 over the past 4 weeks

Response options:

• 1 = None of the time
• 2 = A little of the time
• 3 = Some of the time
• 4 = Most of the time
• 5 = All of the time

Australian Standard

The K10 is the recommended outcome measure for Australian Medicare-funded mental health services. It is used in the Australian National Survey of Mental Health and Wellbeing.

Severity cut-offs:

Score	Level	Clinical interpretation
10-19	Low	Likely to be well
20-24	Moderate	Likely to have a mild mental disorder
25-29	High	Likely to have a moderate mental disorder
30-50	Very high	Likely to have a severe mental disorder

Note: Some sources use slightly different cut-offs (10-19, 20-24, 25-29, 30-50). Praxi uses the original Andrews & Slade (2001) thresholds.

Critical items:

• Item 4 ("About how often did you feel hopeless?") - score 4-5 requires follow-up
• Item 10 ("About how often did you feel worthless?") - score 4-5 requires follow-up

Reliable Change Index: 5.5 points

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Critical Items and Risk Flags

What Are Critical Items?

Critical items are questions that warrant immediate clinical attention, regardless of total score. They typically relate to:

• Suicidal ideation
• Self-harm thoughts
• Hopelessness
• Worthlessness
• Life meaninglessness

Critical Items by Assessment

Assessment	Item	Content	Trigger
PHQ-9	Item 9	"Thoughts that you would be better off dead or of hurting yourself"	Any score > 0
DASS-21	Item 21	"I felt that life was meaningless"	Any score > 0
DASS-21	Item 10	"I felt that I had nothing to look forward to"	Score = 3
K10	Item 4	"About how often did you feel hopeless?"	Score 4-5
K10	Item 10	"About how often did you feel worthless?"	Score 4-5
C-SSRS	Multiple	Suicidal ideation and behaviour items	Any ideation endorsed

Responding to Critical Item Endorsement

The results banner says "Positive screen. For your clinical judgement." Use Open safety plan and risk to review the client's record. A positive screen is not a Praxi risk rating or a recommendation to administer another instrument.

When a client endorses a critical item:

1. Review immediately - Don't wait until the end of the session
2. Follow up directly - Ask open-ended questions about the endorsed item
3. Assess thoroughly - Conduct a structured risk assessment if indicated
4. Document your response - Record your clinical assessment and actions taken
5. Take appropriate action - Safety planning, increased monitoring, or referral
6. Notify if required - Supervisor, GP, or emergency contacts as appropriate

Clinical Obligation

A score of 1 or higher on PHQ-9 item 9 requires direct conversation about suicidal ideation, regardless of total score. Document your assessment and clinical response.

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Understanding Change Over Time

Types of Change

When comparing assessment results over time, consider three types of change:

Change Type	Definition
Raw change	Simple difference between scores (may be measurement error)
Reliable change	Change that exceeds measurement error
Clinically significant change	Reliable change that crosses a clinical threshold

Reliable Change Index (RCI)

Not all score changes are meaningful. The Reliable Change Index determines whether change exceeds what could occur by measurement error alone.

RCI thresholds for core assessments:

Assessment	RCI Threshold	Interpretation
PHQ-9	6 points	Change of 6+ points is reliable at 95% confidence
GAD-7	5 points	Change of 5+ points is reliable at 95% confidence
DASS-21	7 points (per subscale)	Change of 7+ points is reliable at 95% confidence
K10	5.5 points	Change of 5.5+ points is reliable at 95% confidence

Example: A client's PHQ-9 drops from 18 to 14. The raw change is 4 points, but this does NOT exceed the RCI threshold of 6. We cannot conclude this represents true improvement rather than measurement variability.

Duration-Adjusted Reliable Change (DARCI)

Standard RCI uses the same threshold regardless of how much time has passed between administrations. Praxi also calculates the Duration-Adjusted Reliable Change Index (DARCI), which adjusts the threshold based on the interval between assessments.

Two modes:

Mode	When to use	How it adjusts
Treatment monitoring	During active treatment	Stricter thresholds for short intervals (less change is expected early on)
Relapse prevention	During maintenance or after discharge	More sensitive for long intervals (any change during stable periods is noteworthy)

DARCI is shown alongside standard RCI in assessment results when two or more administrations are available. You do not need to configure it -- Praxi calculates both automatically.

Clinically Significant Change

Two criteria must be met for change to be clinically significant:

1. Reliable change - The change exceeds the RCI threshold
2. Threshold crossed - The client has moved from clinical to non-clinical range (or vice versa)

Clinical thresholds:

Assessment	Clinical threshold	Meaning
PHQ-9	10	Score < 10 = non-clinical; Score 10+ = clinical
GAD-7	10	Score < 10 = non-clinical; Score 10+ = clinical
DASS-21 Depression	14	Score < 14 = normal/mild; Score 14+ = moderate+
DASS-21 Anxiety	10	Score < 10 = normal/mild; Score 10+ = moderate+
DASS-21 Stress	19	Score < 19 = normal/mild; Score 19+ = moderate+
K10	20	Score < 20 = low; Score 20+ = elevated

Outcome Categories

Based on reliable change and threshold crossing:

Outcome	Description	Example (PHQ-9)
Recovered	Reliable improvement AND now below clinical threshold	18 → 8 (change = 10, now below 10)
Improved	Reliable improvement but still above clinical threshold	22 → 14 (change = 8, still above 10)
Unchanged	Change within measurement error	16 → 14 (change = 2, below RCI of 6)
Deteriorated	Reliable increase in symptoms	12 → 19 (change = 7, above RCI of 6)

Viewing Trends in Praxi

1. Open the client's Assessments tab
2. Select the assessment type (e.g., PHQ-9)
3. View the score graph showing all administrations
4. Hover over data points for detailed results
5. Look for trend arrows and RCI indicators

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Subscale Analysis

When to Use Subscales

Subscales provide more specific information about symptom patterns. Use subscale analysis to:

• Differentiate between symptom domains
• Target treatment to specific problem areas
• Identify mixed presentations
• Track domain-specific change

DASS-21 Subscale Interpretation

The DASS-21 measures three distinct but related constructs:

Subscale	What it measures	High scores indicate
Depression	Dysphoria, hopelessness, anhedonia, lack of interest, self-deprecation, inertia	Low mood, loss of pleasure, negative self-view
Anxiety	Autonomic arousal, situational anxiety, subjective anxious affect	Physical anxiety symptoms, worry, panic
Stress	Difficulty relaxing, nervous arousal, irritability, over-reactivity	Tension, agitation, impatience

Interpreting profiles:

Profile	Description	Clinical approach
Single elevated subscale	One domain significantly elevated	Target treatment to that domain
Multiple elevated	Two or more domains elevated	Broader treatment approach; consider comorbidity
Mixed profile	Depression and anxiety both elevated	Common; may indicate mixed anxiety-depressive features
Discrepant subscales	Large differences between subscales	Unusual presentation; explore further

PCL-5 Subscale Analysis

The PCL-5 (PTSD Checklist for DSM-5) has four symptom clusters:

Cluster	Items	Focus
Intrusion	1-5	Re-experiencing symptoms
Avoidance	6-7	Avoiding trauma-related stimuli
Cognition/Mood	8-14	Negative thoughts and feelings
Arousal	15-20	Hypervigilance and reactivity

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Normative Comparisons

Understanding Percentiles

Percentiles compare your client's score to a reference population:

Percentile	Interpretation
< 25th	Below average symptom levels
25th-75th	Average range
75th-90th	Above average symptom levels
> 90th	Significantly elevated compared to population

Australian Normative Data

Praxi includes Australian normative data where available:

Assessment	Australian norms source	Sample
DASS-21	Lovibond & Lovibond (1995); Crawford & Henry (2003)	Australian community
K10	Slade et al. (2011); Australian National Survey of Mental Health	8,841 Australian adults
PHQ-9	Stocker et al. (2021)	13,829 Australian adults
GAD-7	Stocker et al. (2021)	13,829 Australian adults

Selecting Appropriate Norms

Consider the following when interpreting normative comparisons:

• Age: Norms may vary by age group
• Gender: Some assessments have gender-specific norms
• Population: Community norms differ from clinical norms
• Cultural background: Standard norms may have limitations for diverse populations

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Cultural Considerations

Validity Across Cultures

Be aware of potential limitations when using standardised assessments with culturally diverse clients:

Factor	Consideration
Language	Is the translation validated? Does the client fully understand questions?
Concept understanding	Do symptoms translate culturally? (e.g., somatic vs. psychological expression)
Response style	Some cultures may minimise or maximise symptom reporting
Stigma	Mental health stigma may affect disclosure
Normative data	Australian norms may not apply to all cultural groups

Clinical Judgment

Scores should be interpreted with awareness of:

• Cultural background and worldview
• Immigration and refugee experiences
• Language proficiency
• Community context and support
• Cultural expressions of distress

Clinical Guidance

Assessment scores are one data point. Always integrate scores with your clinical interview, behavioural observations, and cultural understanding. When in doubt, discuss score interpretation collaboratively with the client.

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Communicating Results

To Clients

Effective feedback involves:

1. Explain the measure - What it assesses and why it's useful
2. Share the score - Give the concrete number
3. Contextualise - Explain what the score means
4. Compare - Reference previous scores if available
5. Discuss implications - What this means for treatment
6. Invite questions - Ensure collaborative understanding

Example script:

"This questionnaire measures depression symptoms over the past two weeks. Your score was 14, which falls in the moderate range. This suggests you're experiencing significant symptoms that are likely affecting your daily life. Last time we did this, your score was 18, so we've seen a meaningful improvement of 4 points. This tells me the approach we're taking is helping, though there's still room to continue working on things. What's your sense of how things have been?"

To Referrers (GP Letters)

When reporting to GPs, include:

Element	Example
Assessment name and date	PHQ-9 administered 15 January 2026
Score and severity	Score: 14 (Moderate)
Change from previous	Reduced from 18 (6 weeks prior)
Clinical interpretation	Reliable improvement but remains in clinical range
Treatment implications	Continuing current treatment approach

Example GP letter excerpt:

"Outcome measurement using the PHQ-9 shows a reduction from 18 (moderately severe) to 14 (moderate) over the past 6 weeks. This 4-point reduction approaches the threshold for reliable change, suggesting treatment is having a positive effect. [Client name] remains in the clinical range and we will continue with the current treatment plan."

In Clinical Notes

Document:

1. Which assessment was administered
2. Total score and severity classification
3. Relevant subscales (if applicable)
4. Any critical items endorsed and your response
5. Comparison to previous scores
6. Clinical interpretation
7. Treatment implications

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Red Flags and Patterns

Scores Requiring Attention

Pattern	Concern	Action
Critical item endorsed	Immediate safety concern	Assess risk; document response
Sudden large increase	Deterioration or crisis	Review treatment; increase contact
Maximum or near-maximum scores	Severe distress	Intensive support; consider psychiatry referral
Inconsistent responding	Validity concern	Discuss with client; consider re-administration
Very rapid completion	May not have read items carefully	Discuss; re-administer if needed
All items same response	Response pattern suggests invalidity	Explore engagement; discuss barriers

Automatic Validity Detection

Praxi automatically flags two common validity concerns:

Flag	What it detects	Default threshold
Rapid responding	Median response time below a minimum threshold	Less than 2 seconds per item
Straight-lining	Most Likert-scale responses are the same value	More than 80% identical responses

When either flag is raised:

• The assessment results are marked with a validity warning
• You can review the flags in the session results
• If clinically appropriate, you can dismiss the flags by adding a clinical note explaining your reasoning

Dismissing Validity Flags

Some clients may legitimately complete assessments quickly (for example, because they are familiar with the items from previous administrations). Dismissing a flag records your clinical judgment and removes the warning from the results display.

Other Validity Concerns

Additional signs an assessment may not be valid:

• Contradictory responses (e.g., "not at all" for both sleep problems and sleeping too much)
• Score dramatically inconsistent with presentation
• Language or comprehension barriers evident

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Assessment Summary

On a completed assessment's results, Assessment summary asks Praxi for a summary of the result. It shows the total score, the instrument's published score band and the instrument's citation. It is worked out from the published scoring rules, not by an AI model, and it does not interpret the result for the client. If an instrument has no verified published band, the summary shows the score and says so. Interpretation stays with you.

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Using Results Clinically

Treatment Planning

Assessment data informs treatment decisions:

Decision	How assessments help
Diagnosis support	Screening tool results support (but don't replace) clinical diagnosis
Treatment intensity	Severity scores guide whether intensive or less intensive treatment
Focus areas	Subscales and elevated items identify treatment targets
Progress monitoring	Regular assessment tracks treatment response
Treatment ending	Document improvement to support discharge decisions

Session Integration

Use assessment results in sessions:

1. Before session: Review recent scores; identify discussion points
2. Start of session: Share results briefly; get client's reaction
3. During session: Explore elevated items; discuss changes
4. End of session: Note implications for treatment plan
5. Treatment review: Summarise trajectory; adjust approach if needed

Treatment Adjustment Based on Trajectory

Pattern	Consider
Steady improvement	Continue current approach; may reduce frequency
Plateau (no change)	Adjust treatment strategy; add new interventions
Deterioration	Review formulation; intensify treatment; consider referral
Fluctuation	Identify triggers; focus on stabilisation

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Generating Reports

PDF Progress Report

Generate a professional PDF report showing a client's assessment progress over time:

1. Go to the client's Assessments tab
2. Click Download PDF
3. Praxi generates a PDF including:
   • Client name, date of birth, and treatment period
   • Score trends for each assessment type administered
   • Baseline versus current scores with severity interpretation
   • Reliable Change Index (RCI) analysis for each comparison
   • Population percentile comparisons (where Australian norms are available)
   • Practitioner name, AHPRA number, and practice name

The report downloads as an A4 PDF suitable for sharing with GPs, insurance providers, NDIS plan managers, or the client themselves.

Practice Letterhead

If your practice has uploaded a logo in Settings > Branding, the PDF report will include your practice letterhead automatically.

Reports for Referrers

When writing to GPs or other referrers, you can attach the PDF progress report to your correspondence. The report provides a clear, professional summary of treatment outcomes without requiring the referrer to access Praxi.

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Best Practices

Interpretation Guidelines

1. Context is key - Scores are one data point among clinical interview, observation, and history
2. Use clinical judgment - Integrate assessment data with your overall formulation
3. Pattern over point - Trajectory matters more than any single score
4. Cultural awareness - Consider validity for client's background
5. Client collaboration - Discuss scores and interpretation together

Documentation Standards

1. Record all administrations - Complete data enables tracking
2. Note interpretation - Document clinical meaning, not just numbers
3. Document critical item response - Record your assessment and actions
4. Link to treatment - Connect findings to treatment plan
5. Track consistently - Use the same measures over time

AHPRA and Medicare Compliance

• Use validated outcome measures appropriate to the client and presentation
• Document assessment results and clinical interpretation in notes
• Include outcome data in reports to GPs
• Maintain assessment records for 7 years under the Privacy Act 1988

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Permissions

Action	Required Role
View own client results	Any clinical role
View all client results	Supervisor, practice owner
Dismiss validity flags	Practitioner, supervisor, practice owner
Generate PDF reports	Any clinical role
View outcome tracking data	Any clinical role
Receive critical item alerts	Any clinical role (automatic)

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Related

• Assessments Overview - Available assessments and scoring details
• Scheduling Assessments - Automating assessment delivery
• Clinical Notes Overview - Documenting findings
• Care Plans - Integrating assessments into care

References

• Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health, 25(6), 494-497.
• Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. British Journal of Clinical Psychology, 42(2), 111-131.
• Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.). Psychology Foundation of Australia.
• Slade, T., Grove, R., & Burgess, P. (2011). Kessler Psychological Distress Scale: Normative data from the 2007 Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry, 45(4), 308-316.
• Stocker, R., Tran, T., Hammarberg, K., Broadbent, J., Nguyen, T., Greenwood, C., ... & Fisher, J. (2021). Patient Health Questionnaire 9 (PHQ-9) and General Anxiety Disorder 7 (GAD-7) data contributed by 13,829 respondents to a national survey about COVID-19 restrictions in Australia. Psychiatry Research, 298, 113792.

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