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ACORN Criteria for Effectiveness (ACE)


The ACORN Criteria for Effectiveness (ACE) standards are established by the ACE workgroup, which is composed of a volunteer group of clinicians, researchers and health plan administrators interested in establishing the standards by which clinicians and treatment centers can provide evidence of the effectiveness of their services.

The idea behind the ACE Certificate comes from organic farming, where organic farmers realized that their product would have greater value in the market place if there was an external body that could "certify" their product as organic. See Certified Organic Farmers

Use of outcome questionnaires to inform care

  • Routine concurrent measurement of treatment outcomes through frequent administration of patient completed outcome questionnaires

Minimum sample size

  • Sample size based on clinical range cases only
  • Individual clinicians: 15 cases with pre-post change scores
    • Minimum sample size of 15 assumes that the outcome questionnaire has a reliability of .9 or higher
    • Clinicians using ultra brief measures (fewer than 10 items) with reliability less than .9 may require larger sample sizes due to the decreased measurement precision associated with low reliability measures.
  • Organizations: 100 cases with pre-post change scores

Consistency of data collection

  • At least 2 assessments obtained for 50% patients with intake scores in the clinical range.
    • Exceptions to the 50% threshold may be justified in certain circumstances, such as telephonic crisis services or EAP services where a high percentage of clients may have a single session.

Meets or exceeds benchmarks for effectiveness

  • Mean pre-post change exceeds .5 effect size (.8 effect size for highly effective) at 90% confidence.
    • The estimated effect size and confidence intervals for each clinician are calculated using Hierarchical Linear Modeling, which minimizes the effects of small sample sizes and provides the better estimate of the clinicians effect size than a simple averaging of cases.
  • These ranges are consistent with research literature regarding interpretations of effect size. For further discussion on effect size interpretation, see: EffectSize.
  • Based on the analyzes of current Toolkit users, over 90% of clinicians presently using ACORN questionnaires will meet the criteria for effectiveness if they collect multiple assessments on at least 50% of their cases, with the majority of these having an SAES of .8 or higher.

For more complete documentation see: ACETreatmentOutcomesEvaluationMethod.pdf

ACE Certificate

  • The ACE standards provide a benchmark for effectiveness.
  • The ACE certificate provides evidence (as verified by an independent analyst) that the clinician's (or organization's) outcomes meet or exceed the benchmarks for effectiveness
  • Download sample certificate: ACECertificate.pdf
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