BBHI^™ 2 (Brief Battery for Health Improvement 2)

How to Use This Test

The BBHI 2 test can be used in a wide variety of settings, including:

• As part of the initial evaluation



• Throughout the course of treatment to track patient progress



• Before and after:
  Surgery
  Diagnostic injections
  Multidisciplinary pain program
  Medication trials
  Rehabilitation programs
  Chiropractic adjustments
  Physical therapy



• To help medical evaluators provide reliable, objective information regarding:
  Cases involving occupational and auto injuries
  Social security and disability evaluations
  Workers' compensation cases

Key Features

The BBHI 2 assessment provides objective information and practical treatment strategies to physicians who treat patients in a variety of settings.

Taking only 7–10 minutes to administer, the BBHI 2 test:

• Provides a single instrument to help measure a variety of pain-related issues, including level of pain, functionality, and emotional distress.



• Uses a nationally standardized 0–10 pain scale, which assesses multiple dimensions of the pain experience, including level of pain in 10 body areas, pain tolerance, pain range, and peak pain.



• Efficiently assess patients to develop appropriate treatment plans and determine whether further psychological evaluation is needed.



• Includes validity checks. The Defensiveness Scale can help detect tendencies to minimize or magnify distress, while the inclusion of a validity item helps detect random responding.



• Helps practitioners meet assessment guidelines proposed by organizations such as the Counsel for the Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Quick Facts

About the Authors

Daniel Bruns, PsyD, and John Mark Disorbio, EdD, have collaborated on psychological test development since 1985. In addition to co-authoring the BBHI™ 2 test, they are also the authors of the BHI™ 2 (Battery for Health Improvement 2) test and the BHI™ (Battery for Health Improvement) test. Both live and practice in Colorado.

Daniel Bruns, PsyD

Daniel Bruns' practice, Health Psychology Associates, is affiliated with the Ramazzini Center, a multidisciplinary facility providing a range of rehabilitation services for injured patients. In his 20 years of clinical practice, Dr. Bruns has come to specialize in the psychological assessment and treatment of medical patients. As a result, he has taught graduate classes and workshops and has made numerous presentations to international, national, and regional professional societies on psychological testing, psychopathology, somatoform disorders, and the assessment and treatment of pain. As a member of three task forces for the Colorado Division of Workers' Compensation, (Psychiatric Disability, Chronic Pain, and Complex Regional Pain Syndrome), he helped to develop evidence-based guidelines to regulate the treatment of injured workers in Colorado. In the past, he has worked on the Chronic Illness Team at the Wellness Center of North Colorado Medical Center. He is also the webmaster of www.healthpsych.com. Dr. Bruns received his MA and PsyD degrees in counseling psychology from the University of Northern Colorado in Greeley.

John Mark Disorbio, EdD

Currently Dr. Disorbio works as a psychologist at Integrated Therapies, an interdisciplinary outpatient clinic for evaluating and treating patients with delayed recovery from chronic pain that he co-founded with Julia Copeland, PT, in 1985. In addition, he is a consultant to major companies throughout the U.S. and serves on the board of the National Pain Foundation. Having spent the majority of his educational and clinical career in the diagnosis and treatment of patients with psychological factors related to medical conditions, he is a frequent presenter at national and international conferences and has published research articles in numerous journals. An active member of the Biofeedback Society for 20 years, he also has extensive training in biofeedback and self-regulation techniques. Dr. Disorbio received his MA degree in counseling psychology from the University of Northern Colorado. He has been licensed as a psychologist in the state of Colorado since 1987.

Scales

BBHI 2 reports include scores and interpretation in the following areas.

Validity Scale

• Defensiveness

• Somatic Complaints
• Pain Complaints
• Functional Complaints

• Depression
• Anxiety

The BBHI 2 reports also include 17 critical items which address areas like satisfaction with care, compensation focus, suicidal ideation, chemical dependency and psychosis.

Norms

Normed on a community sample of 725 individuals and a sample of 527 physical rehabilitation and chronic pain patients. The report compares the patient to both norm groups and uses the average physical rehabilitation/pain patient as a benchmark for interpretations and recommendations.

To provide further context for assessing the patient's results, the BBHI 2 instrument also compares the patient, where appropriate, to 7 other reference groups in the reports:

• Head injury/Headache
• Neck injury
• Upper extremity injury
• Back injury
• Lower extremity injury
• Fake Good
• Fake Bad

Standard Report and Extended Reports

These reports present concise narrative statements about the patient's responses, including a profile graph and Clinical Summary. There reports also feature Treatment Recommendations and a Patient Summary.

The Critical Items section highlights red flag indicators of clinical concerns:

• Suicide Ideation
• Pain Fixation
• Chemical Dependency
• Sleep Disorder
• Perceived Disability
• Compensation Focus
• Home Life Problems
• Satisfaction with Care
• Doctor Dissatisfaction
• Psychosis
• Vegetative Depression
• Anxiety/Panic
• PTSD/Dissociation
• Death Anxiety
• Random Responding

The Pain Complaint Item Responses capture your patient's 0–10 pain ratings, similar to a VAS scale and also compares the patient's reports to one of several possible reference groups.

The Extended Report includes amore in-depth Clinical Summary section, as well as Diagnostic Probabilities.

The Progress Report enables the clinician to monitor the patient's progress over time through repeat administrations.

View a sample Standard Report.

View a sample annotated Standard Report.

View a sample Progress Report.

Scoring Options

Q™ Local Software - Enables you to score assessments, report results, and store and export data on your computer.

Mail-in Scoring Service - Specially designed answer sheets are mailed to us for processing within 24–48 hours of receipt and returned via regular mail.

Fax-in Service - Specially designed answer sheets are faxed to us for processing within 1-2 hours of receipt and returned via fax.

PAD (Patient Assessment Device) Hand-held Electronic Device - Administer the test on a portable, hand-held device. The PAD is placed on a docking station connected to a printer and a results report is printed immediately.

Optical Scan Scoring - Allows you to score the assessments at your site.

Common Questions and Answers

What is the BBHI 2 assessment designed to do?
The BBHI 2 assessment is designed to identify factors that may interfere with a patient's normal course of recovery from an injury or chronic pain. The purpose of the BBHI 2 assessment is to provide relevant information and treatment recommendations to professionals who treat injured patients in a variety of settings, including physical rehabilitation, chronic pain, and general medicine.

When is it appropriate to use the BBHI 2 assessment?
The BBHI 2 assessment is intended to be used by a variety of clinicians and medical specialists, including anesthesiologists, neurologists, occupational therapists, physical therapists, surgeons, rehabilitation specialists, nurses, psychologists, psychiatrists, family physicians, multidisciplinary teams, and other healthcare providers involved in the treatment and care of injured patients. It is appropriate to use the BBHI 2 assessment with patients from 18 to 65 (inclusive) who are currently being treated for an injury or chronic pain. The test should not be used with patients who have serious cognitive impairment. The BBHI 2 assessment is also appropriate as a research instrument.

What are the benefits of having a test normed on rehabilitation/pain patients?
The benefit of having a test normed on rehabilitation/pain patients (rather than on community subjects) is that it reduces the chances of overpathologizing patients. The symptoms of the average patient, which are often labeled "extreme" or "highly problematic" on other tests, are appropriately labeled "average" on the BBHI 2 inventory. By comparing rehabilitation/pain patients to other rehabilitation/pain patients, the clinician or healthcare provider is able to assess which scale scores are elevated above what is normal or expected for the average rehabilitation/pain patient.

Can I administer just one of the BBHI 2 scales?
Yes. In fact, the BBHI 2 instrument is a modular assessment. It consists of four parts that can be administered individually if desired. Thus, if some of the BBHI 2 scales are not of interest to a caregiver, if time constraints prevent the administration of the entire BBHI 2, or if caregivers prefer to rely upon other instruments to assess certain factors, parts of the BBHI 2 assessment can be left blank. Unlike most psychological tests, the BBHI 2 assessment invalidates one scale at a time, rather than the whole test. As a result, even when entire scales are left blank, the BBHI 2 assessment still provides interpretable information.

Part I scores the Pain Complaints scale
Part II scores the Somatic Complaints scale
Part III scores the Defensiveness and Functional Complaints scales
Part IV scores the Depression and Anxiety scales

What are the BBHI 2 defaults?
If a Pain Diagnostic Category is not selected, it will default to a pain comparison for community norms. If none of the print option boxes are selected, a Standard Report will print. By default, you will NOT receive Item Responses or the Patient Summary.

If I score a Standard Report, can I print an Extended Report at no extra charge?
Yes. This is also the case if you print an Extended Report and would like to print a Standard Report.

How are the ratings and percentiles of each scale determined on the profile report?
The ratings are based on approximate percentile ranks. An extremely high or extremely low score suggests that the patient is in the highest or lowest 1% of the patient group.

A very high or very low score suggests that the patient is in the highest or lowest 5% of the patient group.

A high or low score suggests that the patient is in the highest or lowest 16% of the patient group, which means that he or she is more than one standard deviation away from the mean of the patient group.

A moderately high or moderately low score suggests that the patient is reporting a level of difficulties that is within normal limits for a patient but is more than one standard deviation away from the mean of "normal" nonpatients in the community.

What is the benefit of using the BBHI 2 Pain Scale?
The BBHI 2 Pain Complaints Scale is a double-normed scale, standardized on two national samples. One was a patient sample, and the other a community sample, and both of these samples were stratified to meet U.S. census data for gender, ethnicity, age, and level of education. The patient data was further subdivided into a chronic pain group, which comprised almost half of the sample, with the remainder being acute pain patients. The patients were also subdivided into diagnostic groups by their treating professionals. The pain diagnostic groups are divided into five groups: head injury/headache patients, neck injury patients, back injury patients, upper extremity injury patients, and lower extremity injury patients. These groups allow clinicians to make specific comparisons of their patients with a reference group of similarly diagnosed patients.