Brief Battery for Health Improvement 2

BBHI 2

John Mark Disorbio, EdD, Daniel Bruns, PsyD

Brief Battery for Health Improvement 2 (BBHI™ 2) is a brief diagnostic tool well-suited for assessment of validity, physical symptoms, psychological, character, environment, and social factors that can impact response to normal course of treatment and recovery of patients. Guidance on using this test in your telepractice.

Publication date: 2002

Age range: Individuals 18–65 years old

Reading level: 6th Grade

Qualification level: B Additional information

Completion time: 7–10 minutes (63 multiple-choice items)

Administration: Paper-and-pencil, CD, computer or online administration

Norms: Census matched community sample, physical rehabilitation/pain patient sample

Other languages: Spanish

Telepractice: Guidance on using this test in your telepractice

The test helps practitioners quickly evaluate for a number of psychomedical factors commonly seen in patients with injuries, such as pain, somatic, and functional complaints, as well as traditional psychological concerns such as depression, anxiety and patient defensiveness.

Benefits

Useful to a variety of professionals in the medical setting: psychologists, physical therapists, surgeons, rehabilitation specialists, and nurses.
Provides a single instrument to help measure a variety of pain-related issues, including level of pain, functionality, and emotional distress.
Uses 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.
Enables efficient assessment of 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 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).

Features

BBHI 2 test takes only 7-10 minutes to administer and is 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.

Validity Scale: Defensiveness
Physical Symptom Scales: Somatic Complaints; Pain Complaints; Functional Complaints
Affective Scales: Depression; Anxiety
Character Scales: Borderline; Symptom Dependency; Chronic Maladjustment; Substance Abuse; Perseverance
Psychosocial Scales: Family Dysfunction; Survivor of Violence; Doctor Dissatisfaction; Job Dissatisfaction

Scales

View list of scales

Sample Reports

Standard report provides a concise narrative statement about the patient in the following sections: profile graph, critical items, clinical summary, and pain complaints item responses.

View a sample Standard Report.

Extended report provides more in-depth information about the patient in the following sections: profile graph, critical items, clinical summary, and pain complaints item responses. This report includes a diagnostic probabilities section as well.

View a sample Extended Report.

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

View a sample Progress Report.

The following resources are available for BBHI-2.

Health Psychology

Screen, Assess, and Monitor for Better Chronic Pain Management Flyer

Brochure

BHI2 BBHI2 Brochure

Presentation & Articles

Case Study Articles

Bibliography

BBHI 2 Bibliography

Frequently asked questions follow. Click on a question to see the response.

Test Content

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.

Administration

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

Scoring

What are the BBHI 2 defaults?

If I score a Standard Report, can I print an Extended Report at no extra charge?

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.

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