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Evidence Based Practices for Children and Adolescents with Serious Emotional Disturbances. Session 2: The Role of Assessment In Evidence-Based Mental Health Practices for Children and Adolescents Beth Troutman, PhD, ABPP Iowa Consortium for Mental Health September 1, 2005.
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Evidence Based Practices for Children and Adolescents with Serious Emotional Disturbances Session 2: The Role of Assessment In Evidence-Based Mental Health Practices for Children and Adolescents Beth Troutman, PhD, ABPP Iowa Consortium for Mental Health September 1, 2005
Assessment Data Can Be Used To Enhance Clinical Decision Making At The Level Of • System of care • Program • Individual patient/family
Assessments Evaluated According To • Psychometric Properties • Reliability • Validity
Assessment Data Can Be Used For • Treatment planning • Monitoring treatment • Assessing outcomes
Using Initial Assessment Data For Treatment Planning • What type of intervention does my patient need to address target symptoms? • What are the appropriate interventions for our target population?
Treatment planning • Assessments can be used to inform • Type of intervention • Level of care/service intensity • Other factors that need to be addressed
Describing Patient/Target Population • Diagnosis • Target Symptoms • Other Factors • Functional Status
Using Initial Assessment Data for Treatment Planning Diagnosis
Initial Assessment & Treatment Planning • Diagnosis • Primary • Comorbid
Disadvantages of Diagnosis • Labels or stigmatizes child • Labeling or stigmatizing a child with a diagnosis is of particular concern if the diagnosis does not lead to effective, evidence-based treatment.
Disadvantages of Diagnosis • Poor interrater reliability of clinical diagnosis • Short-hand method of communicating that fails to capture special strengths and weaknesses of particular child and family
Advantage of Diagnosis • Clinical eligibility for services • Funding for services • Method for organizing vast amount of treatment data so provider/program can select an effective, evidence-based intervention
Using Initial Assessment Data For Treatment Planning Describing Target Symptoms
Describing Target Symptoms • Symptom measures • Broadband • Symptom specific
Factors To Consider When Selecting Assessment Instrument • Source of information • Child • Parent • Teacher
Factors To Consider When Selecting Assessment Instrument • Clinician rated vs. respondent rated • Norm-referenced vs. criterion-referenced
Examples of Broadband Symptom Measures • Parent Report Measures • Behavior Assessment System for Children, Second Edition (BASC-2) (AGS) • Personality Inventory for Children, Second Edition (PIC-2) (Western Psychological Services) • Achenbach Child Behavior Checklist (ASEBA) • Note: Parent report tends to underestimate anxiety and depression compared to self report.
Examples of Broadband Symptom Measures • Self-Report Measures • Behavior Assessment System for Children, Second Edition (BASC-2) (AGS) • Personality Inventory for Youth (Western Psychological Services) • Achenbach Youth Self Report (ASEBA) • Note: Self-report tends to underestimate disruptive behavior problems compared to parent report.
Examples of Broadband Symptom Measures • Teacher Report Measures • Behavior Assessment System for Children, Second Edition (BASC-2) (AGS) • Achenbach Teacher Report Form (ASEBA) • Note: Teacher report tends to underestimate anxiety and depression compared to self-report.
Example of Using Broadband Symptom Measure To Describe Target Population • Target population: Children aged 5 through 18 in long-term family foster care in Iowa (> 6 months in same foster home) • Broadband symptom measure: Achenbach Child Behavior Checklist completed by foster parents • Source: Momany et al., University of Iowa Public Policy Center
Rates and Types of Mental Health Problems in Iowa’s Family Foster Care Population Momany et al., University of Iowa Public Policy Center
Example of Symptom Specific Measure – Attention Problems • Parent/teacher report • Conners rating scales (Psychological Corporation)
Examples of Symptom Specific Measures - Depression • clinician ratings • Children’s Depression Rating Scale - Revised (CDRS-R) (American Psychiatric Publishing) • self-report • Child Depression Inventory (CDI) (Psychological Corporation) • Beck Depression Inventory – Second Edition (BDI-2) (Psychological Corporation) • Reynolds Adolescent Depression Scale – Second Edition (RADS-2) (PAR)
Using Initial Assessment Data For Treatment Planning Assessing Other Factors That May Affect Treatment Planning
Child Factors That May Affect Treatment Planning • Cognitive functioning • IQ tests • Academic functioning • Standardized academic tests • Speech and language functioning • Standardized speech and language tests
Family Factors That May Affect Treatment Planning • Parenting stress • Parenting Stress Index – Third Edition (PSI-3) (PAR) • Maternal or paternal depression • Beck Depression Inventory – Second Edition (BDI-2) (Psychological Corporation)
Using Initial Assessment Data For Treatment Planning Assessing Functioning Level and Level of Services Needed
Determining Level of Functioning/Level of Services Needed • What level of care/service intensity does my patient need? • What level of care/service intensity do the patients in our program/system of care need?
Examples of Functional Assessment/Service Intensity Instruments • Clinician ratings • Children’s Global Assessment Scale (CGAS) • Child and Adolescent Functional Assessment Scale (CAFAS) • Child and Adolescent Level of Care Utilization System (CALOCUS) • Child and Adolescent Needs and Strengths – Mental Health (CANS-MH)
Using Assessment For Program Improvement • Assessments can be used to • Monitor treatment • Assess outcomes
Specify Core Components of Practice The Evidence Based Practice Cycle Optimize Priority Outcomes
Target Population Diagnosis Target symptoms Functional status Other factors Outcomes Identify Prioritize Quantify Role of Assessment in EBP Cycle
Treatment Monitoring • Is my patient benefiting from the intervention? • Are there any negative consequences (side effects/iatrogenic effects) associated with the intervention?
Example of Symptom Scale Used For Treatment Monitoring – Disruptive Behavior • Eyberg Child Behavior Inventory administered at each session in Parent Child Interaction Therapy • Parent rates a series of specific items addressing noncompliance and disruptive behavior according to: • How often the behavior occurred. • Whether it was a problem for the parent.
Example of Assessment Used For Treatment Monitoring – Separation Anxiety • Exposure treatments for anxiety have child or adolescent rate items on their systematic desensitization hierarchy at each session • E.g. walking from front door of school to classroom alone, walking from car to school alone
Using Assessment Data For Program Improvement Assessing Outcomes
Assessing Outcomes • Did my patient benefit from the intervention? • Are patients in our program/system of care benefiting from interventions?
Assessments Used to Evaluate Outcomes • Diagnosis • Target Symptoms • Other Factors • Functional Status
Use Of Diagnosis To Evaluate Outcome • Recovery/remission of diagnosis is relevant for some diagnoses: • E.g. depressive episode, adjustment disorder
Use Of Diagnosis To Evaluate Outcome • Diagnosis may not be useful for evaluating outcomes for other disorders • E.g. Attention Deficit Hyperactivity Disorder
Use Of Symptom Specific Measures To Assess Outcomes • The more reliable the symptom measure is, the better it will be at detecting improvement • Important that symptom measure is valid for intervention – i.e. does it assess what your intervention is targeting?
Examples Of Symptom Assessments Used To Evaluate Outcomes • Depression – self-report • Children’s Depression Inventory • Beck Depression Inventory – Second Edition (BDI-II)
Examples Of Symptom Assessments Used To Evaluate Outcomes • Attention and distractibility • Parent report/teacher report • Conners’ Rating Scales
Examples Of Symptom Assessments Used To Evaluate Outcomes • Anxiety • Self-report • Revised Children’s Manifest Anxiety Scale • Parent report • Achenbach Child Behavior Checklist – internalizing scale
Use of Other Assessments to Assess Outcomes • Some intervention studies have assessed changes in parenting stress or mood • Parenting Stress Index – Third Edition (PSI-3) • Beck Depression Inventory – Second Edition (BDI-2)
Use of Functional Assessments To Assess Outcome • CGAS is most widely used assessment of functioning in treatment outcome studies • Often a delay between symptom improvement and improvement in functioning
Using Outcome Data For Program Improvement • Is there a particular group of patients we should target for improved outcomes? • age • diagnosis • type of problem
Improving Outcomes For Target Population • Is there an Evidence Based Treatment available for this group of patients?
Program Improvement Process • Review of outcomes • Systematic modification of intervention