The Pre-Post Inventory is a test that is administered to a client more than once. It is typically given the first time (pretest) upon client admission into a treatment, counseling or intervention program, and before treatment has occurred. Then, after treatment is completed, the Pre-Post Inventory is administered to the same client again. This second testing is called the posttest (2nd test) which generates the "Comparison Report." The Pre-Post Inventory contains eight scales (measures): Truthfulness, Depression, Self-Esteem, Anxiety, Distress, Alcohol, Drugs and Stress Management. It consists of 161 items and takes 30 minutes to complete.

There are several levels of Pre-Post Inventory interpretation ranging from viewing the scales as self-reports to interpreting scale elevations and understanding scale interrelationships. Overlaying client change can be disconcerting unless attention is judiciously apportioned or divided between client "risk" and client "change."

When Pre-Post Inventory pretest and posttest comparisons are of interest, the following statements summarize pretest and posttest options. When a scales pretest score is higher than its posttest score, positive improvement (+) or change occurred. In contrast, when a scales pretest score is lower than its posttest score, negative (-) change or worsening has occurred. That said, the remainder of this discussion will emphasize Pre-Post Inventory scale understanding. The Pre-Post Inventory is used to assess the effects of counseling and treatment on clients and patients. The term "client" and "patient" are used interchangeably as synonyms. The following table is a starting point for interpreting Pre-Post Inventory scale scores.

With reference to the above table, a problem is not identified until a scale score is at the 70th percentile or higher. Elevated (70th percentile or higher) scale scores refer to problem and severe problem scores. Severe problem scores represent the highest eleven (11%) percent of clients evaluated with the Pre-Post Inventory. The same test (Pre-Post Inventory) is administered twice, at treatment intake (pretest) and again at treatment completion (posttest).

Truthfulness Scale: measures how truthful the patient (client) was while completing the Pre-Post Inventory. This scale identifies guarded and defensive people that attempt to deny or minimize their problems and fake good. Truthfulness Scale scores at or below the 89th percentile mean that all Pre-Post Inventory scale scores are accurate. In contrast, Truthfulness Scale scores at or above the 90th percentile mean that all scale scores are inaccurate and invalid due to client denial, problem minimization and attempts to fake good. If not consciously deceptive, clients with elevated (70th percentile and higher) Truthfulness Scale scores are resistant, uncooperative or fail to understand test items. The Pre-Post Inventory is written at a high 5th grade to low 6th grade reading level. If somebody can read the newspaper they can complete the Pre-Post Inventory. One of the first things to check when reviewing a Pre-Post Inventory report is the Truthfulness Scale score.

Truthfulness Scale scores in the 70 to 89th percentile range are accurate because they have been Truth-Corrected. This procedure is similar to that used in the Minnesota Multiphasic Personality Inventory (MMPI); the most widely used personality test in the United States and likely the world. As noted earlier, Truthfulness Scale scores at or above the 90th percentile are inaccurate due to client denial, attempts to minimize problems and attempts to fake good. If not consciously deceptive, clients with elevated Truthfulness Scale scores are often uncooperative and resistant. The Truthfulness Scale can be interpreted independently or in terms of its influence on other scale scores. And invalid Truthfulness Scale scores (90th percentile and higher) overrides all other Pre-Post Inventory scale scores.

Anxiety Scale: measures excessive worry about everyday real life problems. Worries are excessive, pervasive and pronounced. They can become focal sources of concern and interfere with relationships, social functioning, occupational performance and other activities. An elevated (70th percentile and higher) Anxiety Scale score reflects disruptive anxiety and worry. The higher the Anxiety Scale score the more severe the problem. Severe (90 to 100th percentile) Anxiety Scale scores are associated with intense, pervasive and pronounced apprehension and worries that can seriously disrupt ongoing life activities. Acute feelings of tension, agitation and apprehension along with anxious expectations permeate the client's life.

Other problems and disorders have been linked to anxiety. These include, but are not limited to the other Pre-Post Inventory scales (or more specifically the problems and disorders they represent). For example, recent or prolonged substance (alcohol and other drugs) abuse could result in a Substance-Induced Anxiety Disorder. There is also an Adjustment Disorder with Anxiety or With Anxiety and Depressed Mood. Anxiety appears to be inherent (or a component or factor) in many Diagnostic & Statistical Manual of Mental Disorders (DSM-IV) diagnosis. Some maintain that any kind of discomfort or illness can foster anxiety and fear. First year college students often refer to anxiety as "non-directed fear."

The Anxiety Scale can be interpreted individually. However, when other scales are also elevated, focus is then placed upon elevated scale interactions.

Depression Scale: depression is one of the most commonly occurring mental health disorders affecting the U.S. population. Signs of depression include chronic sadness, loss of interest and pleasure in daily activities (e.g., social, occupational, recreational, etc.), depressed concentration and feelings of worthlessness. The Pre-Post Inventory Depression Scale identifies depression and quantifies symptom severity.

The higher the Depression Scale score the more severe the depression. Elevated (70th percentile and higher) Depression Scale scores identify patients in the early to middle stages of depression. A severe Depression Scale score (90 to 100th percentile) represents severe depression.

The Depression Scale score can be interpreted as a self-report or in terms of its interactions with other Pre-Post Inventory scale scores. People with depression are at greater risk for suicide. Alcohol and drug abuse can also reflect attempts of self-medication. Other elevated (70th percentile and above) Pre-Post Inventory scale scores usually mean there is an interaction effect that can exacerbate reactions among the elevated scale scores. More specifically, the problems and disorders represented by the elevated scores can interact. Such interaction can contribute to exacerbated or magnified problems.

Depression symptoms are especially dangerous when combined with co-morbid problems and disorders like substance (alcohol and drug) abuse, intense anxiety, acute distress, suicide ideation and impaired self-esteem. Each of the co-morbid disorders is represented in the Pre-Post Inventory as a scale or measure: Anxiety Scale, Distress Scale, Alcohol Scale, Drug Scale, Self-Esteem Scale and the Stress Management Scale.

Depression is treatable. Contingent upon symptom severity, treatment approaches often combine psychotherapy with prescribed medication. An integrated treatment approach should incorporate co-morbid disorders when present. Several effective psychotherapies are available. Cognitive Behavioral Therapy (CBT) is popular and effective when treating depression.

Distress Scale: measures pain (physical and mental), misery and suffering. Distress is a common reason why people seek counseling and psychotherapy. Distress incorporates "great pain," anxiety and acute physical and/or mental suffering. At lower intensity it has been described as discomfort; whereas at high levels of intensity it is often described as extreme, acute or intense pain and suffering.

An elevated (70th percentile and higher) Distress Scale score identifies people with problematic distress (pain, suffering). This level of distress is problematic in that it interferes with a person's overall adjustment and lifestyle. Severe problem (90 to 100th percentile) scorers report severe pain, suffering and distress. Severe distress can be incapacitating and result in extreme emotionality, conflict and confusion.

Reactions to extreme distress are diverse. Distress can vary from mild downheartedness to despair. Other reactions include emotional withdrawal, over reactivity or sensitivity. At the extreme, there may be a pervasive and distressing feeling of estrangement. These extreme distress reactions can occur in almost anybody, particularly after shock.

When the Distress Scale score and the Stress Management Scale score are elevated (70th percentile and higher), the probability of an identifiable (diagnosable) mental health problem increases. The higher their elevations, the greater the probability of a diagnosable disorder.

Other elevated (70th percentile and higher) Pre-Post Inventory scale scores in conjunction with a severe problem (90 to 100th percentile) Distress Scale score can identify important areas of inquiry. For example, a severe problem Self-Esteem Scale score in conjunction with an elevated (70th percentile and higher) the Distress Scale identifies a lonely distressed person that disapproves of and rejects themselves. In this example, suicidal ideation is possible. And, if there is also an elevated Alcohol or Drug Scale score, the probability of suicide is further increased.

The Distress Scale can be interpreted individually. However, when other scales are also elevated, focus is then placed upon elevated scale interactions.

Self-Esteem Scale: measures patient's feelings of self-acceptance and self-worth. Self-esteem refers to a person's appraisal of self. The concept of self-esteem is often addressed in clinical settings because an individual's actions or behaviors can be viewed as a reflection of their self-esteem.

Negative or low self-esteem underlies many mental health problems, including those represented by Pre-Post Inventory scales (Depression, Anxiety, Distress, substance (alcohol and other drugs) abuse and Stress Management). Negative or low self-esteem has been associated with impaired abilities to adapt appropriately to ones environment. Poor self-esteem has been characterized by feelings of guilt, shame, humiliation and remorse. An elevated (70th percentile or higher) Self-Esteem Scale score co-occurring with other elevated Pre-Post Inventory scale scores underlies the seriousness of these interactions. A Self-Esteem Scale score in the 70th percentile or higher (elevated score) reflects problematic or poor self-esteem. A severe (90th percentile or higher) Self-Esteem Scale score is descriptive of severely impaired self-esteem. Untreated negative self-esteem can grow and expand until it negatively impacts upon a person's life. Self-Esteem is treatable.

Self-Esteem Scale scores can be interpreted individually or in conjunction with other Pre-Post Inventory scale scores. Many view self-esteem as a gauge or measure of mental health or well being.

Alcohol Scale: measures alcohol use and the severity of abuse. Alcohol refers to beer, wine and other liquors. It is a licit substance. An elevated (70th percentile and higher) Alcohol Scale score is indicative of a drinking problem. The higher the score the more serious the problem. Alcohol Scale scores in the severe problem (90 to 100th percentile) range identify established and very serious drinking problems (e.g., alcoholism).

Since a history of alcoholism could result in an abstainer (current non-drinker) attaining a low to medium Alcohol Scale score, precautions have been built into the Pre-Post Inventory to identify "recovering" alcoholics. The client's answer to the "recovering" question (item #154) is printed in the Alcohol Significant Items section of the pretest and comparison reports. Other Alcohol Scale admissions are also printed as "significant items," e.g., #36, 64, 69, 91, etc. in the pretest and comparison reports.

Concurrently elevated Alcohol and Drug Scale scores indicate polysubstance abuse and the highest score reflects the client's substance of choice. Alcohol and Drug Scale scores in the severe problem (90 to 100th percentile) range are a malignant sign. Elevated (70th percentile and higher) Alcohol Scale scores can exacerbate or magnify other elevated scale scores. This interaction can contribute to a mutual exacerbation syndrome. For example, a client with an elevated Alcohol Scale score that also has an elevated Distress Scale score can be even more self-destructive when drinking.

The Alcohol Scale can help staff work through client denial. Most clients defer to the objective and standardized Alcohol Scale score rather than what they often perceive as a staff members subjective opinion. This is particularly true when it is explained that elevated scores do not occur by chance. The patient must answer a definite pattern of alcohol-related admissions for an elevated score to occur. And scale scores are based upon thousands of patients (clients) Alcohol Scale scores. In summary, the Alcohol Scale can be interpreted independently or in conjunction with other elevated Pre-Post Inventory scale scores.

Drug Scale: measures drug use and the severity of abuse. Drugs refer to marijuana, crack, ice, cocaine, ecstasy, amphetamines, barbiturates, heroin, etc. These are illicit substances. An elevated (70 to 89th percentile) Drug Scale score is indicative of drug abuse or a drug-related problem. A Drug Scale score in the severe problem (90 to 100th percentile) range identifies established and severe drug abusers. Similar to the Alcohol Scale, a history of drug abuse could result in a current drug abstainer (drug history but not presently using drugs) attaining a low to medium score. Precautions have been built into the Pre-Post Inventory to correctly identify "recovering" drug abusers. The patients answer to the "recovering" questions (item #154) is printed in the Drug Significant Items section of the pretest and comparison reports. Other drug admissions (e.g., #39, 43, 53, 62, 86, etc.) are also printed as "significant items" in the pretest and comparison reports.

Concurrently elevated scale scores can reflect co-occurring disorders. Concurrently elevated Drug Scale and Alcohol Scale scores reveal polysubstance abuse with the highest score identifying the patient's substance of choice. Co-occurring disorders are a malignant sign. Drug abuse can exacerbate symptoms of other elevated Pre-Post Inventory scales. For example, clients with an elevated Drugs Scale score and an elevated Depression Scale score can become even more depressed, emotionally overwhelmed and even suicidal when abusing drugs.

The Drugs Scale can also help patients work through their drug-related denial. Patients often accept evidence based findings as opposed to people's subjective opinions. This is particularly true when it is explained that no Pre-Post Inventory scale score is based on any one or two admissions. Indeed, they are positively receptive when they know any elevated score involves a pattern of admissions. In summary, the Drug Scale can be interpreted independently. However, when other elevated scale scores are present the elevated Drug scale is invariably analyzed in terms of multiple scale interpretations.

Stress Management Scale: measures the client's ability to positively manage stress, tension and pressure. It is now understood that unmanaged or severe stress exacerbates or magnifies other disorders and their symptoms. Thus, an elevated Stress Management Scale score in conjunction with other elevated Pre-Post Inventory scale scores can help in understanding patient's problems and situations. Such problem augmentation applies to substance (alcohol and other drugs) abuse, attitudinal problems, other disorders and even acting out behaviors.

When the Stress Management Scale score is in the problem (70 to 89th percentile) range, that client would benefit from completing a stress management program. Stress management is learned. Therefore, in "stress management programs" or classes participants learn to recognize their stress and positively intervene. Stress management techniques, procedures and strategies are taught.

When the Stress Management Scale score is in the severe problem (90 to 100th percentile) range co-existing problems and disorders are likely. Co-occurring disorders complicate treatment because they also need to be included in the client's treatment plan. And in many severe problem cases, treatment needs may exceed stress management classes. In these instances outpatient psychotherapy may be needed. Among several affective psychotherapies, Cognitive Behavioral Therapy (CBT) is effective and popular.

The Stress Management Scale is a non-introversive way to screen client problems. Elevated (70th percentile and higher) Stress Management Scale scores can provide considerable insight into how the client is managing the stress they are experiencing in their lives. Stress usually accompanies increased distress, substance abuse, anxiety, depression and impaired self-esteem. The Stress Management Scale can be interpreted independently. However, when other Pre-Post Inventory scale scores are also elevated (70th percentile or higher) scale elevations and interrelationships become important.

In conclusion, the Pre-Post Inventory is a counseling or treatment effectiveness test. The same test is administered twice, at the beginning of treatment (pretest) and annually or at the completion of treatment (posttest). Pretest scale scores serve as a baseline for comparison to posttest scale scores.

Parties interested in more Pre-Post Inventory information can visit www.online-testing.com. Our telephone number is (602) 234-3506 and our email address is hl@online-testing.com.