Adaptação cultural da escala Youth Outcome Questionnaire Self-Report 2.0 (Y-OQ-SR 2.0) para a realidade brasileira

Abstract

Introduction: The Outcome Questionnaire System (OQ System) is a system developed by the American psychologists Michael Lambert and Gary Burlingame in the early 90s; nowadays it is recognized by the Substance Abuse and Mental Health Administration's National Registry of Evidence-based Programs and Practices (SAMHSA's NREPP). The system is composed by questionnaires for the purpose of obtaining quantitative data on psychotherapeutic treatment in order to evaluate and monitor its outcome (Erekson, Lambert & Eggett, 2015). The results obtained through the application of the questionnaires in the context of psychotherapy helped to verify if the intervention is effective so that, through this feedback, the psychotherapist can prevent withdrawal, modify the therapeutic plan and provide feedback to the patient and the team in order to discuss the clinical case based on quantitative evidence (Nordal, 2012). Among the several questionnaires in the OQ System, the Youth Outcome Questionnaire Self-Report 2.0 (Y-OQ-SR 2.0) was developed to evaluate the psychotherapy of teenagers between 12 and 18 years old (Wells & Burlingame, 2003). The Y-OQ SR 2.0 has 64 items consisting of affirmative first-person phrases and shall be answered on a Likert scale from 0 to 4: 0 (never), 1 (rarely), 2 (sometimes), 3 (often ) and 4 (always). The items are distributed into six factors that evaluate: Intrapersonal Stress; Somatic; Interpersonal Relationships; Critical Items; Social problems; Behavioral Disorders. The questionnaire is non-theoretical and self-applied. Goal: culturally adapt the Y-OQ-SR 2.0 to the Brazilian reality. Method: the study followed the following steps: 1) From the original instrument, two translations into Portuguese were performed by two bilingual translators; 2) Synthesis of the two translations by a third translator overseen by an expert committee; 3) Evaluation of the target audience in order to investigate the understanding of the items; 4) Adjusting the instrument after a consensus among the ideas resulting from the evaluation of the target audience; 5) Back-translation of the Portuguese version into English, by a fourth bilingual translator; 6) Submission of the back-translation to the original authors to ensure that the content has equivalent meaning to the original content; 7) The original authors considered the back-translation appropriate, the Portuguese translation will be used to carry out a pilot study (Borsa et al., 2012; Cassepp-Borges, Balbinotti & Teodoro, 2010; Gjersing, Caplehorn & Clausen, 2010; Takara, 2015). Outcomes: Some terms and words that needed clarification were evaluated by a committee of experts before the synthesis itself. The translation was made by two bilingual translators using the Parallel Blind Technique. The synthesis of the translations was evaluated by the target audience in order to ensure the understanding of the translated items. Five out of these items required review by the committee for a second audience assessment, followed by semantic adjustments. This second evaluation took place satisfactorily, as the target audience understood the phrases and modified words. The final version was submitted to the reverse translation process (Portuguese to English) by a C2 level translator in the Common European Framework of Reference (CEFR). Finally, the final version was sent to the original authors in order to ensure the equivalence of content with the original version. The final approval of the Brazilian-Portuguese version of the instrument was satisfactory; in other words, no adjustments were required. A committee of experts comprehending adolescent clinical psychologists with fluency in English employed the procedures for operational equivalence and it was concluded that the Y-OQ-SR 2.0 is suitable for the pilot study. Discussion: The evaluation of the target audience was made through stratified focus groups. The group provided discussions about the items to be evaluated, providing both objective data, that were filled by adolescents, and subjective data related to participants' understanding and discussion on terms and words. Once the steps proposed by Borsa et al., 2012, Cassepp-Borges, Balbinotti & Teodoro, 2010, Gjersing, Caplehorn & Clausen, 2010 and Takara, 2015 were successfully achieved, the proposed goal was therefore achieved. The gathering and analysis of data were performed through a rigorous and systematic process to ensure adequate adaptation to the Brazilian reality. The Y-OQ-SR 2.0 is an important tool for adolescent and patient psychotherapists, as it was developed exclusively to assess youth psychotherapy. Its purpose is, therefore, to monitor the psychotherapeutic process (Lambert, 2010) and provide feedback to find out if the psychotherapy is being effective (Lambert, Hansen & Harmon, 2010). The adaptation of the Y-OQ-SR 2.0 to the Brazilian reality will allow the instrument to be released for subsequent studies of evidence of validity.