When is Sessional Monitoring More Likely in Child and Adolescent Mental Health Services?

Evidence-Based Assessment in Routine Mental Health Services for Youths

OBJECTIVE

Evidence-based assessment (EBA) plays a critical role in the delivery of effective treatments. However, little is known about the assessment practices of mental health clinicians who treat youths and the factors that support EBA. The authors examined when, how, and under what conditions clinicians conduct EBA.

METHODS

In two multidisciplinary surveys (combined N=2,575), clinicians reported how frequently they conducted pretreatment, ongoing, and posttreatment assessments and how frequently they used standardized measures in usual care of youths.

RESULTS

Although clinicians reported frequent pretreatment, ongoing, and posttreatment assessments, use of standardized measures was rare. Clinician and practice setting characteristics predicted standardized measure use, and a lack of practical assessment tools appears to be a barrier to use of standardized measures in EBA of youths.

CONCLUSIONS

Many clinicians conduct assessments during treatment, but more practical measures and clinician training may improve the integration of standardized measures into routine practice.

Sociodemographic factors associated with routine outcome monitoring: a historical cohort study of 28,382 young people accessing child and adolescent mental health services

BACKGROUND

Patient-reported outcome measures (PROMs) are important tools to inform patients, clinicians and policy-makers about clinical need and the effectiveness of any given treatment. Consistent PROM use can promote early symptom detection, help identify unexpected treatment responses and improve therapeutic engagement. Very few studies have examined associations between patient characteristics and PROM data collection.

METHODS

We used the electronic mental health records for 28,382 children and young people (aged 4-17 years) accessing Child and Adolescent Mental Health Services (CAMHS) across four South London boroughs between the 1st of January 2008 to the 1st of October 2017. We examined the completion rates of the caregiver Strengths and Difficulties Questionnaire (SDQ), a ubiquitous PROM for CAMHS at baseline and 6-month follow-up.

RESULTS AND CONCLUSIONS

SDQs were present for approximately 40% (n = 11,212) of the sample at baseline, and from these, only 8% (n = 928) had a follow-up SDQ. Patterns of unequal PROM collection by sociodemographic factors were identified: males were more likely (aOR 1.07, 95% CI 1.01-1.13), whilst older age (aOR 0.87, 95% CI 0.87-0.88), Black (aOR 0.79 95% CI 0.74-0.84) and Asian ethnicity (aOR 0.75 95% CI 0.66-0.86) relative to White ethnicity, and residence within the most deprived neighbourhood (aOR 0.87 95% CI 0.80-0.94) were less likely to have a record of baseline SDQ. Similar results were found in the sub-group (n = 11,212) with follow-up SDQ collection. Our findings indicate systematic differences in the currently available PROMS data and highlights which groups require increased focus if we are to gain equitable PROM collection. We need to ensure representative PROM collection for all individuals accessing treatment, regardless of ethnic or socioeconomic background; biased data have adverse ramifications for policy and service level decision-making.

Using patient-reported outcome measures to improve service effectiveness for supervisors: a mixed-methods evaluation of supervisors' attitudes and self-efficacy after training to use outcome measures in child mental health

BACKGROUND

Patient-reported outcome measures (PROMs) are recommended by healthcare systems internationally, but there are a number of barriers to implementation. The aim of this research was to examine the impact of training supervisors in using PROMs on clinical practice, given the importance of leadership when changing behaviour.

METHOD

Data included pre-post questionnaires from 42 supervisors, interviews after training with six supervisees and nonparticipant observations of nine video-recorded supervision sessions.

RESULTS

After training, supervisors had more positive attitudes to administering PROMs and using feedback from PROMs and had higher levels of self-efficacy about using PROMs in supervision.

CONCLUSIONS

Findings are in line with the growing body of evidence that training child mental health staff to use PROMs may be associated with changes in attitudes, self-efficacy and use of PROMs.

Patient reported outcome measures in child and adolescent mental health services: associations between clinician demographic characteristics, attitudes and efficacy

BACKGROUND

Policy recommends using patient reported outcome measures (PROMs), yet their use is persistently low. Our aim was to examine the association between PROM use and clinician demographic characteristics, attitudes and efficacy.

METHOD

A sample of N = 109 clinicians completed an online survey.

RESULTS

Clinicians who reported higher levels of use of cognitive behaviour or humanistic approaches had higher levels of PROM use than clinicians who reported lower levels of use of these approaches. Clinicians who reported having received training had higher levels of self-efficacy regarding PROMs than clinicians who reported not having received training, but the effects of training on PROM attitudes and use were not significant. Still, clinicians with more positive attitudes or self-efficacy regarding PROMs had higher levels of PROM use than clinicians with less positive attitudes or self-efficacy regarding PROMs.

CONCLUSION

Clinicians should be supported to have the knowledge, skills and confidence to effectively use PROMs in their clinical practice.