Content uploaded by Joan Carles Medina
Author content
All content in this area was uploaded by Joan Carles Medina on Jun 25, 2018
Content may be subject to copyright.
Actas Esp Psiquiatr 2018;46(3):75-82 75
Original
Guillem Feixas1,2
Eric Badia1
Arturo Bados1
Joan C. Medina1,2
Antoni Grau3
Ernesto Magallón1
Luis Botella4
Chris Evans5
1Department of Clinical Psychology and Psychobiology, Universitat de Barcelona
2Institut de Neurociències, Universitat de Barcelona
3Institut de Trastorns Alimentaris, Barcelona
4Blanquerna Faculty of Psychology, Education and Sport Sciences, Universitat Ramon Llull, Barcelona
5Psychology Department, University of Roehampton, London
Adaptation and psychometric
properties of the spanish version of
the YP-CORE (Young Person’s Clinical
Outcomes in Routine Evaluation)
Introduction. Given the increasing prevalence of men-
tal health problems in the general population, it is indis-
pensable to use assessment tools aimed to assess the out-
come of therapeutic interventions in order to refine the
process of psychological rehabilitation.
Method. We describe the process of adaptation into
Spanish and a first psychometric study of the Young Per-
son’s-Clinical Outcomes in Routine Evaluation (YP-CORE), an
instrument designed to measure the outcome in terms of
general distress of therapeutic interventions in young peo-
ple (11-16 years). 104 adolescents participated in the clini-
cal and 131 in the non-clinical samples.
Results. Analyses showed good levels of acceptability,
adequate internal consistency and acceptable test-retest
stability, with moderately high correlations between admin-
istrations. In addition, the instrument yielded significant
correlations with all dimensions of the Youth Self Report,
the highest being between both total scores. Crucially, dis-
criminated between clinical and non-clinical samples and
showed a small effect of age but a larger effect of gender,
with higher scores for females. The Principal Component
Analysis replicates the original structure. Cut-off scores to
calculate the reliable and clinically significant change are
provided.
Conclusions. These results support initial use of the in-
strument though there are certain limitations that indicate
the need for more research with larger and more represen-
tative samples, in which the psychometric properties of the
instrument should be verified.
Keywords: YP-CORE, Test adaptation, Young people, Spanish, Psychometric properties
Correspondence:
Guillem Feixas
Departamento de Psicología Clínica y Psicobiología, Facultad de Psicología,
Universitat de Barcelona
Passeig Vall d’Hebron, 171, 08035 Barcelona, Spain
Tel.: (+34) 933125100
E-mail: gfeixas@ub.edu
Actas Esp
Psiquiatr 2018;46(3):75-82
Introducción. Ante la creciente prevalencia de proble-
mas de salud mental en la población general, resulta impres-
cindible el uso de instrumentos de evaluación destinados a
evaluar el resultado de las intervenciones terapéuticas, con
el fin de facilitar el proceso de rehabilitación psicológica.
Metodología. Se expone el proceso de adaptación al es-
pañol y un primer estudio psicométrico del Young Person’s
Clinical Outcomes in Routine Evaluation (YP-CORE), un ins-
trumento diseñado para medir el resultado de las interven-
ciones terapéuticas a través de la evaluación del malestar
general en población infanto-juvenil (11-16 años). Para ello,
se ha tenido en cuenta una muestra clínica de 104 partici-
pantes y otra no clínica de 131.
Resultados. Los análisis han demostrado una buena
aceptabilidad, una consistencia interna adecuada, así como
una estabilidad test-retest aceptable, con correlaciones mo-
deradamente elevadas. Además, el instrumento ha reflejado
correlaciones significativas con todas las dimensiones del
Youth Self Report, siendo las más elevadas entre ambas pun-
tuaciones totales. También resulta útil a la hora de discrimi-
nar entre la población clínica y no clínica, mostrando poca
influencia de la edad, pero sí del sexo, con puntuaciones más
elevadas en el género femenino. El Análisis de Componentes
Principales replica la estructura original. También se pro-
porcionan los puntos de corte que servirán para calcular el
cambio fiable y clínicamente significativo.
Conclusiones. Los resultados expuestos permiten hacer
un uso fiable del instrumento, aunque se mencionan ciertas
limitaciones que sugieren la necesidad de realizar investi-
gaciones con muestras mayores y más representativas, en
Adaptación y propiedades psicométricas de la
versión española del YP-CORE (Young Person’s
Clinical Outcomes in Routine Evaluation)
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
76 Actas Esp Psiquiatr 2018;46(3):75-82
INTRODUCTION
There is empirical evidence on the growing prevalence
of mental health problems among children and adolescents1,
estimated to be around 17-20%2. In order to address this
situation, strategies to improve mental health in these pop-
ulations are particularly relevant, especially treatment pro-
grams suitable for the wide range of problems that young
people may experience3. With growing need, it is vital to use
demonstrable effective and clinically useful resources4, to
prevent increasing biopsychosocial impairment and to im-
prove teenagers’ mental health and quality of life.
In this light it is important to monitor change through-
out the therapeutic process to give more extensive evidence
of progress and to allow comparisons between approaches,
centres, and practitioners5. Existing measures of change are,
for instance, direct observation, interviews, narrative self-re-
port and, above all, projective techniques6.
Nevertheless, these techniques may be insufficient and
are best complemented with assessment instruments allow-
ing quantitative record of changes occurred and potentially
supporting the detection of any necessary modification in
the therapeutic intervention. Many of the instruments de-
veloped so far are focused on measuring the symptomatolo-
gy of each pathology in particular, being poorly applicable
to patients with other problems and particularly unsatisfac-
tory with the unclear or uncertain diagnoses7, which are
fairly frequent in the adolescence. As a result, there are few
measures validated for children and adolescents, with most
tailored for high-severity cases8. Among the instruments
most used nowadays, there are the Children Depression In-
ventory9 (CDI), the State-Trait Anxiety Inventory for Chi-
dren10 (STAIC), the Strengths and Difficulties Questionaire11
(SDQ), and the Youth Self Report12 (YSR), derived from the
Child Behaviour Checklist13 (CBCL), among others. The Span-
ish version of the YSR, authored by Achenbach and Rescor-
la14, was used in this study.
The situation reported above describes the need for
brief, general instruments, which avoid the use of multiple
tools and resources15, foster the quantitative assessment of
the therapeutic process and are flexible in nature. Measures
with these features promote integration and analysis of in-
formation stemming from different professionals, areas, and
pathologies, and are especially relevant in young people, not
only because of their increasing difficulties and problems16,
but also due to heterogeneity of problems and prevalent co-
morbidity (around 50%).
One of the best proposals to solve these issues is the
CORE (Clinical Outcomes in Routine Evaluation) System, de-
veloped in 1988 by the CORE System Group in the United
Kingdom. This system tries to fulfil all the requirements de-
scribed in the previous paragraphs and supporting assess-
ment of the effectiveness of interventions within psycho-
therapeutic contexts17. The CORE-OM is the main instrument
of this system, which has experienced an extraordinary ex-
pansion since its creation. There are versions for more than
20 countries, including Spain18, where it has shown satisfac-
tory psychometric properties19.
The CORE system now includes the Young-Person’s
equivalent of the CORE, the YP-CORE, designed for children
and adolescents. The YP-CORE derives from the CORE-OM,
which itself was designed after reviewing 638 items from
the outcome measures most widely used instruments in the
United Kingdom5. The CORE-OM covers the following areas,
all related to psychological distress: depression, anxiety,
trauma, physical symptoms, subjective feeling of distress,
difficulties in relationships, and risk of aggression towards
oneself and others. The 34 items of the CORE-OM were re-
vised by a sample of 48 professionals and 45 youngsters,
leading to a preliminary version which was tested in a pilot
study with 343 participants, a process after which the final
version of the YP-CORE was finally obtained7. The main ob-
jective of this study is to establish the psychometric proper-
ties of its Spanish version, concluding the adaptation pro-
cess. The rationale for this procedure is to make the
instrument usable for all Spanish-speaking psychological or
psychiatric healthcare services for children and adolescents
willing to assess the result of their interventions, without
prejudice of further necessary cultural or linguistic adapta-
tions to specific contexts.
The Spanish version of the YP-CORE is already available
to download in open-access. It may be found both at http://
www.ub.edu/terdep/core/ and https://www.coresystemtrust.
org.uk/translations/spanish.
METHODS
Adaptation of the instrument
The study met all the requirements of the International
Test Comission20 and the criteria specified by the CORE Sys-
tem Trust (CST)21 for translation of their instruments. These
standards emphasise the importance of involving a hetero-
geneous group of people in the adaptation process, and also
the need to preserve the original meaning of items.
las cuales se verifiquen las propiedades psicométricas del
instrumento.
Palabras clave: YP-CORE, Adaptación de test, Español, Adolescentes, Propiedades
psicométricas
77
Actas Esp Psiquiatr 2018;46(3):75-82
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
Following these guidelines, the CORE System Group rep-
resentative (C.E.) was contacted to establish the initial
agreement and plan the procedure. Afterwards, the transla-
tion process of the instrument into Spanish began, asking
one professional translator, one mental health expert, and
four lay people to make their own translations. All these col-
laborators were proficient English-speakers. Following this
step, a meeting was arranged with C.E., three mental health
professionals, and a lay person aged 14, whose opinions
about the understanding of the questionnaire were espe-
cially taken into account. All the translations were consid-
ered, discussing about which one attained best the original
meaning of every item, and was more applicable to the
Spanish-speaking population.
The meeting led to a preliminary version of the test,
which was further reviewed by 7 Spanish-speaking youths
from a medium socioeconomic background. Feedback was
collected from them and discussed with C.E., producing
slight changes in some items. Finally, two different bilingual
persons back-translated the questionnaire into English, a fi-
nal step that did not reveal any major differences from the
original version.
Participants
The non-clinical sample comprised 136 participants in
the first administration of the test and 128 in the second. All
were students from the sixth year of primary school or the
four years of secondary school. The questionnaire was ap-
plied twice, with an interval of 14 days.
The clinical sample was composed of 122 participants
with a wide range of diagnoses. These were grouped accord-
ing to the diagnostic criteria provided by their healthcare
centre and dimensions proposed by the DSM-IV-TR22. In to-
tal, 11 different diagnostic categories were used, which were
registered, either combined or standalone, in 196 occasions.
It is important to underline the high comorbidity, since the
number of simultaneous disorders ranged from 2 (n=35,
28.69%) to 4 (n=1, 0.82%).
Inclusion criteria were: being between 11 and 16 years
old, good level of Spanish understanding, not being diag-
nosed with any psychotic or autism spectrum disorder (ASD)
and, for the clinical sample, having been given at least one
other diagnosis in the DSM-IV-TR except the aforemen-
tioned.
From the 258 initial participants, 10 were excluded, all
of them from the clinical sample; 6 for not meeting the age
criterion (one of them was additionally diagnosed with a
psychotic disorder), and 4 having been diagnosed with an
ASD.
Instruments
- YP-CORE7: This is a brief self-report instrument used as
a generic measure to detect distress generated by a
wide range of problems and to provide information
about the person’s general functioning. The question-
naire is designed to be filled by people between 11 and
16 years old. It is composed of 10 items (1 Risk item, 1
Wellbeing item, 4 Problems/Symptoms items, and 4
General Functioning items), which are answered with a
5-point Likert scale (from 0 to 4). Thus, the possible
scores range from 0 to 40, obtaining an overall score.
This score is divided by the number of completed items
in order to control missing values and facilitate inter-
pretation of the results. In 2015, the British YP-CORE
psychometric properties were updated with new pub-
lished data, which have been used for the comparisons
in this article8.
- YSR12: Self-report scale to assess psychosocial compe-
tencies (17 items), and emotional and behavioural prob-
lems (112 items) among children and adolescents aged
between 11 and 18 years. This second part includes 14
items describing adaptive or prosocial behaviours, and
98 referring to problematic behaviours. According to
Achenbach23, the scale classifies disorders into two
“broadband” syndromes (internalising and externalising
problems), and eight “narrowband” syndromes (with-
drawn, somatic complaints, anxiety/depression, social
problems, thought problems, attention problems,
rule-breaking behaviours, and aggressive behaviours).
Respondents are asked to focus on the last six months,
scoring from 0 to 2. Finally, the overall degree of psy-
chological imbalance is summarised in a total score of
problematic behaviours, while the degree of adaptation
is summarised in a total score of desirable behaviours. In
this study, the YSR was only administered to the clinical
sample.
Procedure
Once the study was approved by the CST and the ethics
committees of the organisations involved, the next step was
to start the administration of questionnaires at the collabo-
rating centres. For the non-clinical sample, the school Insti-
tució Pedagògica Sant Isidor (IPSI), from Barcelona, agreed
to participate. Data collection was conducted by a masters’
student with the teacher present at the classroom.
For the clinical sample, two healthcare centres, partners
of the Universitat de Barcelona (UB), were contacted: Hos-
pital de Mataró and Institut de Trastorns Alimentaris (ITA).
At these centres, the administration was conducted by four
child clinical psychologists and one psychiatrist at the be-
ginning or the end of therapeutic group sessions, always
informing and obtaining the consent of all participants’ par-
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
78 Actas Esp Psiquiatr 2018;46(3):75-82
ents or tutors first. Before any answer was collected, the
study aims, information about their freedom to choose
whether to participate or not, and the questionnaire charac-
teristics were highlighted.
Non-parametric statistics were considered to be the
best option due to the non-normality of the questionnaire’s
scores24,25. But parametric statistics are also reported given
their greater statistical power and to support comparability
between these and other results.
For the analysis of the data collected, the Statistical
Package for the Social Sciences (SPSS) 21.026 was used. Addi-
tionally, to compute the YSR scores from the test applied to
estimate the convergent validity, the, the Achenbach System
of Empirically Based Assessment(ASEBA) was used. Finally,
for Principal Component Analysis (PCA) of the question-
naire, the software Monte Carlo PCA for Parallel Analysis
was also used to compute a parallel analysis.
RESULTS
Acceptability
A total of 235 participants (94.8%) completed the entire
questionnaire. In the non-clinical group, the number was 131
(96.3%), whereas in the clinical one the number was 104
(92.9%). The difference between samples in non-completion
was not significant (χ²(1, 248)=1.486; p=0.223). In the non-clin-
ical sample there were 3 (2.2%) questionnaires with one miss-
ing item, and 2 (1.5%) with two missing items. The mean per-
centage of missing items was 0.05%. With regard to the
clinical sample, 6 questionnaires (5.3%) were returned with
one missing item, 1 questionnaire (0.9%) with two missing
items and one participant (0.9%) omitted five items, giving an
overall percentage of missing items of 0.12%. The most com-
mon missing item in both samples was the 5th, with two and
three omissions respectively. For the rest of the analyses, data
from only the completers of the entire questionnaire have
been used (see Table 1).
Normality
Considering the skewness and kurtosis results and the
Kolmogorov-Smirnov test (K-S) for which the scores were
0.113 for the non-clinical sample and 0.094 for the clinical
(p<0.05) it can be concluded that the scores of the YP-CORE
do not follow a Gaussian distribution. As an example, the
distribution of the Total score in the non-clinical sample
may be seen in Figure 1. As noted above, for this reason,
non-parametric statistics were the first choice for the anal-
yses.
Figure 1 Histogram of the Total score in the
non-clinical sample
Table 1 Age and sex of the participants who
completed the whole YP-CORE
Sample
n
Sex (%) Age
Boys Girls Range Quartile
Clínica 104 30 (29%) 74 (71%) 11-16 14,15,16
No clínica 131 64 (49%) 67 (51%) 11-16 12,13,14
Total 235 94 (40%) 141 (60%) 11-16 13,14,15
Reliability
The YP-CORE showed good internal consistency, with
Cronbach’s Alpha values higher than 0.7, both for the Total
and for the Total except Risk scores in the whole sample.
Specifically, for the boys in the non-clinical sample, the re-
liability of the Total score was 0.72 (IC 95%: 0.71–0.91),
while for the girls it was 0.85 (IC 95%: 0.79–0.89). These
results are consistent with the British8. For the clinical sam-
ple is concerned, the values were 0.82 (IC 95%: 0.71–0.90)
and 0.86 (IC 95%: 0.81–0.90) for boys and girls respectively.
Test-retest stability
Among the 131 participants in the non-clinical sample
who completed the entire questionnaire at the first admin-
istration, 125 (95.42%) filled it in the second time. Data
30
20
10
00 10 20 30
79
Actas Esp Psiquiatr 2018;46(3):75-82
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
from the 120 (91.60%) participants who completed the
whole questionnaire are reported here.
Following Hinkle, Wiersma, and Jurs27 categories, a mod-
erately positive correlation was found between the first and
second administrations of the questionnaire, both for the
Total score (Spearman’s rho=0.638; Pearson’s r=0.645) and
for the Total except Risk score (rho=0.637; r=0.644).
The Wilcoxon test statistic showed statistically signifi-
cant differences between the two administrations, both for
the Total score (Z=3.053, p<0.05) and for the Total except
Risk score (Z=3.083, p<0.05), an effect that has previously
been found in other studies with repeated administrations
of the same assessment measure28. Furthermore, if we con-
sider the mean scores, these differences show an improve-
ment of the symptomatology within the non-clinical sam-
ple, although both Pearson correlation (r=0.20 for both
scores) and Cohen’s d (d=0.26 and 0.27 respectively) suggest
a small effect size for both scores.
Regarding the use of parametric statistics, the Student’s
t test also showed statistically significant differences in the
Total score between the first and the second administration
of the test (t(119)=2.847, p<0.05). In the case of the Total ex-
cept Risk score the results were similar, founding statistical-
ly significant differences between the first and second ad-
ministrations (t(119)=2.938, p<0.05).
Convergent validity
In order to conduct this analysis, only the 112 items
belonging to the second part of the YSR, assessing emotion-
al and behavioral problems, were taken into account. We
discarded those questionnaires with more than 11 missing
items, since any interpretation of subsequent analyses would
be unreliable12. Following this criterion, 95 participants of
the clinical sample were included.
Initially, the internal consistency of all dimensions of
the test was analysed, which proved to be good for most
scales (0.8 < α < 0.9). Subsequently, the correlation analysis
between the two tests was performed interrelating all the
possible YSR scores with the YP-CORE Total and Total except
Risk scores. According to the Spearman statistic (rho), we
found correlations between 0.39 and 0.75, while with Pear-
son statistic (r), the values were from 0.36 to 0.75, all highly
statistically significant (p<0.001). The highest correlations
were found between the Total scores of both tests (0.75 in
both statistics), and between the YP-CORE Total score and
the Internalizing broadband problems of the YSR, as well as
the Affective and Isolation/Depression narrowbands, with
scores of 0.69, 0.70, and 0.70 respectively according to the
Spearman statistic, and 0.72, 0.72, and 0.71 according to
Pearson.
Inuence of gender
Statistically significant differences between males and
females were observed in both the non-clinical (Z=-2.08,
p=0.037, for the Total score; Z=-1.99, p=0.047, for the Total
except Risk score) and the clinical samples (Z=-2.33, p=0.020,
for the Total score; Z=-2.21, p=0.027, for the Total except
Risk score), with higher scores in girls. The effect sizes for
this difference were larger in the clinical sample (d=0.52 and
r=0.23 for the Total score; d=0.48 and r=0.22 for the Total
except Risk score) than in the non-clinical sample (d=0.35
and r=0.18 for the Total score; d=0.34 and r=0.17 for the
Total except Risk score). This was the only test for which
parametric and non-parametric statistics gave different re-
sults: for the Total except Risk score in the non-clinical sam-
ple the t-test was not statistically significant (t(129)=-1.94,
p=0.55) where the Mann-Whitney U test had been.
Inuence of age
The results showed the absence of significant correla-
tions in both the clinical (rho=0.16 and r=0.19) and the
non-clinical samples (rho=0.09; r=0.10 and 0.11), in Total
scores and Total except Risk scores respectively. Although in
our participants a slight age-related increase in scores was
found in the clinical sample, this was not statistically signif-
icant, unlike British results8. Analysing age separately within
gender, the correlations were also not significant in any of
the two samples.
Differences between clinical and non-clinical
samples
The results of the Mann-Whitney U test showed statis-
tically significant differences between the two samples in
both Total and Total except Risk scales, with higher scores in
the clinical sample. Nevertheless, there are discrepancies be-
tween the effect sizes (see Table 2).
The Student’s t corroborated those differences. Taking
into account the Total score of the test, clinical participants
obtained significantly higher scores compared to the
non-clinical sample (t(233)=-5.95, IC 95%=-7.53 to -3.78,
p<0.001). In addition, without the Risk, item there were also
statistically significant differences (t(233)=-5.55, IC 95%=
-7.21 to -3.43, p<0.05).
In the light of the effect of gender noted above, it was
considered relevant to explore the clinical vs. non-clinical
difference within gender. The Mann-Whitney U test showed
statistically significant differences within the boys (Z=-2.26,
p=0.024 for the Total score; Z=-2.06, p=0.039 for Total ex-
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
80 Actas Esp Psiquiatr 2018;46(3):75-82
cept Risk scores) and within the girls (Z=-4.33 and Z=-4.08
for the Total score and for Total except Risk score, p<0.0005).
The t test showed similar statistically significant differ-
ences: (t(92)=-3.68, 95% CI from -6.78 to -0.58, p<0.05, for
the Total score; t(92)=-3.58, 95% CI from -6.82 to -0.35,
p<0.05, for the Total except Risk score) both within the boys
and (t(139)=-5.91, IC 95% CI from -8.26 to -3.55, p<0.05, for
the Total score; t(139)=-5.46, 95% CI from -7.82 to -3.10,
p<0.05, for the Total except Risk score) within the girls. Like
in the comparison of the whole samples, and as can be seen
in Table 2, discrepancies between the effect sizes appeared,
but were even higher for the female sample.
Principal component analysis (PCA)
Parallel analysis, which is a more robust test of number
of factors in a dataset than other methods29, suggested two
factors be retained in both samples (clinical and non-clini-
cal). The items mapped to the same factor in both samples,
varying only in the precise loadings.
As in the original study7, the item mappings resulting
from the oblique rotation (see Table 3) suggest one compo-
nent of positively worded (3, 5 and 10) and one of negative-
ly worded items (1, 2, 4, 6, 7, 8 and 9). Moreover, it should be
noted that the correlation between factors for the clinical
sample was almost identical to that of the original study
(0.36).
Cut-off points and Reliable and Clinically
signicant change
Having found statistically significant differences be-
tween sexes, the cut-off points were calculated for both
groups separately. In addition, they were also provided for
the Total except Risk scale (see Table 4). In relation to the
British study of 2015, the results replicated the differences
between sexes, with higher cut-off points for girls (almost 3
points above). The cut-off points of the Total except Risk
score were slightly higher, a difference that may be attribut-
ed to the respondents’ tendency to score low in the Risk
item.
The estimation of the reliable change was also per-
formed by both sexes separately, using the total sample. In
the case of boys, the value of the reliable change was 8.17
for the Total score, and 8.83 for the Total except Risk score,
while for girls it was 8.86 for the Total score, and 9.46 for
Total except Risk score. Therefore, any change greater than
those indicated in each case can be considered a reliable
change. In the British article values are given only for the
Total score, being 8.2 in boys and 7.7 in girls: very similar to
our Spanish values for boys, though in girls the Spanish cut-
ting point is higher by more than one point.
Table 2 Difference in scores between clinical and non-clinical samples
Measure Non-clinical Clinical Mean Difference Z (U Mann-Whitney) p
r
d Cohen
MSD MSD
Total 12.18 5.55 17.84 5.96 -5.65 (- 7.53 - -3.78)* -5.31 0.000 0.35 0.98
Total no R 13.37 8.34 18.69 8.21 -5.32 (-7.21 - -3.43)* -5.02 0.000 0.33 0.64
* Condence Intervals of 95%.
Table 3 PCA for both samples
Non-clinical sample Clinical sample
Items Factors Items Factors
1 2 1 2
70.752 10.885
60.701 60.847
90.685 90.787
20.647 70.718
10.616 20.643
80.500 80.570
40.493 40.505
30.721 10 0.838
50.666 30.708
10 0.624 50.673
81
Actas Esp Psiquiatr 2018;46(3):75-82
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
CONCLUSION
This paper is the first psychometric exploration in Span-
ish of the YP-CORE, an instrument widely used in the psy-
chological counseling services of the United Kingdom30 and
a measure one meta-analysis suggests is the most reliable
test to calculate the change produced by therapy31.
The results show good psychometric properties for the
Spanish version. Firstly, acceptability was good with a high
percentage of usable responses, something that can be at-
tributed, amongst other things, to brevity of the YP-CORE.
In addition, as in the British study of 2015, it has shown
good internal consistency in both samples, as well as for
both sexes separately. It also showed acceptable temporal
stability, though with a statistically significant reduction in
scores over time with low effect sizes, something that was
observed in the validation of the original CORE-OM32 and is
not uncommon with psychopathology measures. The con-
vergent validity analysis showed high correlations between
almost all the scales considered, but mainly between the
overall scores of both questionnaires, and between the YP-
CORE Total score and the YSR Internalizing problems broad-
band. This result suggest greater suitability of the YP-CORE
to measure internalised than externalised distress. We also
found higher scores for females; the difference in the influ-
ence of age between this study and the British one8 under-
lines the importance of considering demographic character-
istics and doing so for any translation, in addition to the
sample size. It is likely that these results reflect socioeco-
nomic, cultural and developmental issues33. The initial facto-
rial structure has been replicated by the PCA, reproducing
almost exactly the mapping of items by factor the original
UK analysis. Similarly, the cutoffs have reflected similarities
with recent British results, though they are a little higher for
these Spanish participants. Taking this into account, effects
of sociodemographic characteristics of samples should be
considered, as well as the effect of the medication and diag-
noses, comorbidities and severity of symptoms when inter-
preting scores. As for the estimation of the reliable change,
the values identified in the Spanish sample coincide with the
British in the case of the boys, but not in the case of the
girls. Finally, although the Risk item is the one with the low-
est factor loading in both samples, it seems that its exclusion
from the Total score does not lead to different results in any
of the analysis, so the use of the Total except Risk score does
not seem to be statistically necessary.
Though these results strongly support the Spanish YP-
CORE, limitations of the present study should be noted.
These include a moderately low sample size (both clinical
and non-clinical), which makes its generalization difficult
and prevented analysis of scores in relation to clinical as-
pects such as diagnosis or medication. The crucial compari-
son between the clinical and non-clinical samples showed
some overlap: non-clinical participants with slightly elevat-
ed scores could fall within the clinical spectrum, suggesting
an only moderate discriminative power of the test so it
should not be used diagnostically. In addition, the lack of
post-therapy data means cannot yet comment on the sensi-
tivity to change of the instrument in clinical contexts,
though the reported initial estimates of the reliable change
index gives a statistical basis on which to categorise change.
In conclusion, the YP-CORE seems a promising instru-
ment to be used in a wide range of psychological services for
young people. The results have reaffirmed its potential to
detect psychological distress in adolescent Spanish-speaking
populations, as well as to give levels of severity. Its brevity
and comprehensibility make it ideal for its routine use in
order to monitor the progress and changes produced by the
therapeutic intervention. However, studies with larger sam-
ples and assessing the effects of therapeutic interventions
are still needed.
ACKNOWLEDGEMENTS
In particular, the voluntary and generous participation
of Alejandro Botella in the process of translating the test
into Spanish is appreciated. The collaboration of the Insti-
tució Pedagògica Sant Isidor (IPSI), the Hospital de Mataró,
and the Institut de Trastorns Alimentaris (ITA) is also appre-
ciated. This study has been partially funded by the Genera-
litat de Catalunya (ref. SGR717).
CONFLICT OF INTERESTS
The authors do not report any conflict of interest.
REFERENCES
1. Collishaw S, Maughan B, Goodman R, Pickles A. Time trends
in adolescent mental health. J Child Psychol Psychiatr. 2004;
45(8):1350-62.
2. Lemos S. La psicopatología de la infancia y la adolescencia:
consideraciones básicas para su estudio. Pap Psicol. 2003;
24(85):19-28. Disponible en: http://www.redalyc.org/pdf/778/
77808503.pdf?origin=publication_detail
3. Caballo VE, Simón MÁ.Manual de psicología clínica infantil y del
Table 4 Cut-off points for the Total score
and for the Total except Risk score
Group CP Total CP Total no R
Chicos 12.72 13.88
Chicas 15.49 16.64
Muestra Total 14.91 16.05
Adaptation and psychometric properties of the spanish version of the YP-CORE (Young
Person’s Clinical Outcomes in Routine Evaluation)
Guillem Feixas, et al.
82 Actas Esp Psiquiatr 2018;46(3):75-82
adolescente: trastornos especícos. Madrid: Ediciones Pirámide;
2002.
4. Bados A, García E, Fusté A. Ecacia y utilidad clínica de la terapia
psicológica.Int J Clin Health Psychol. 2002;2(3):477-502.
5. Evans C, Mellor-Clark J, Margison F, Barkham M, Audin K,
Connell J, et al. CORE: Clinical outcomes in routine evaluation. J
Mental Health. 2000;9:247-55.
6. del Barrio V. Evaluación psicológica en la infancia y la
adolescencia. Madrid: Universidad Nacional de Educación a
Distancia; 2003.
7. Twigg E, Barkham M, Bewick BM, Mulhern B, Connell J,
Cooper M. The Young Person’s CORE: Development of a brief
outcome measure for young people. Couns Psychother Res.
2009;9(3):160-8.
8. Twigg E, Cooper M, Evans C, Freire E, MellorClark J, McInnes
B, et al. Acceptability, reliability, referential distributions and
sensitivity to change in the Young Person’s Clinical Outcomes
in Routine Evaluation (YPCORE) outcome measure: replication
and renement.Child Adolesc Ment Health. 2015;21(2):115-
23.
9. Kovacs M. Children’s depression inventory (CDI2). North
Tonawanda, NY: Multi-Health Systems, Inc.; 2011.
10. Spielberger CD, Edwards CD, Montuori J, Lushene R. State-
Trait Anxiety Inventory for Children. Palo Alto, CA: Consulting
Psychologist Press; 1973.
11. Goodman R. The Strengths and Difculties Questionnaire: a
research note.J Child Psychol Psychiatr. 1997;38(5):581-6.
12. Achenbach T.Manual for the youth self-report and 1991 prole.
Burlington, VT: University of Vermont Department of Psychiatry;
1997.
13. Achenbach T, Edelbrock C. Child Behavior Checklist: CBCL.
Burlington, VT: University of Vermont Department of Psychiatry;
1980.
14. Achenbach T, Rescorla L. ASEBA school-age forms & proles.
Burlington, VT: ASEBA; 2001.
15. Barkham M, Evans C, Margison F, McGrath G, Mellor-Clark J,
Milne D, et al. The rationale for developing and implementing
core outcome batteries for routine use in service settings and
psychotherapy outcome research.J Ment Health. 1998;7(1):35-47.
16. Forns M. Evaluación psicológica infantil. Barcelona: Barcanova;
1993.
17. Barkham M, Mellor-Clark J, Connell J, Cahill J. A core approach
to practice-based evidence: A brief history of the origins
and applications of the CORE-OM and CORE System. Couns
Psychother Res. 2006;6(1):3-15.
18. Feixas G, Evans C, Trujillo A, Saúl LA, Botella L, Corbella S, et al.
La versión española del CORE-OM: Clinical Outcomes in Routine
Evaluation-Outcome Measure.Rev Psicoter. 2012;89:1-22.
19. Trujillo A, Feixas G, Bados A, García-Grau E, Salla M, Medina
JC, et al. Psychometric properties of the spanish version
of the clinical Outcomes in routine evaluation–Outcome
Measure.Neuropsychiatr Dis Treat. 2016;12:1457-66.
20. Hambleton RK, Merenda PF, Spielberger CD. Adapting educational
and psychological tests for cross-cultural assessment. Tilburg:
Psychology Press; 2005.
21. Evans C. Translating and “normalising” CORE system: CORE
System Trust (CST) position statement; 2008. Disponible en:
http://www.psyctc.org/CORE-OM/Translating_CORE-OM_CST_
position_statement.pdf
22. Michael B, Harold PA, Allen F. DSM-IV TR. Manual diagnóstico y
estadístico de los trastornos mentales. Barcelona: Masson; 2002.
23. Achenbach T. Manual for the youth self-report and 1991 prole.
Burlington, VT: University of Vermont Department of Psychiatry;
1991.
24. Gómez-Gómez M, Danglot-Banck C, Vega-Franco L. Sinopsis de
pruebas estadísticas no paramétricas. Cuándo usarlas.Rev Mex
Pediatr. 2003;70(2):91-9.
25. Guàrdia J, Peró M, Freixa M, Turbany J. Análisis de datos en
psicología (2ª ed.). Barcelona: Delta Publicaciones; 2008.
26. IBM Corporation. IBM SPSS statistics for Windows, Version 21.0.
Armonk, NY: IBM Corp; 2012.
27. Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the
behavioral sciences. Michigan: Houghton Mifin; 2003.
28. Durham C, McGrath L, Burlingame G, Schaalje G, Lambert M,
Davies D. The effects of repeated administrations on self-report
and parent-report scales.J Psychoeduc Assess. 2002; 20(3):240-
57.
29. Horn J. A rationale and test for the number of factors in factor
analysis. Psychometrika. 1965;30(2):179-85.
30. Cooper M, Pybis J, Hill A, Jones S, Cromarty K. Therapeutic
outcomes in the Welsh Government’s school-based counselling
strategy: An evaluation.Couns Psychother Res. 2013;13(2):86-
97.
31. Cooper M. Counselling in UK secondary schools: A comprehensive
review of audit and evaluation data. Couns Psychother Res.
2009;9(3):137-50.
32. Evans C, Connell J, Barkham M, Margison F, McGrath G, Mellor-
Clark J, et al. Toward a standardised brief outcome measure:
Psychometric properties and utility of CORE-OM. Br J Psychiatry.
2002;180(1):51-60.
33. Greig A, Taylor J, MacKay T. Doing research with children: A
practical guide. Glasgow: Sage; 2012.
