Practitioners’ attitudes towards the use of standardized diagnostic assessment in routine practice: A qualitative study in two Child and Adolescent Mental Health Services

Abstract

There is tension within Child and Adolescent Mental Health Services (CAMHS) assessments between the richness of differing practitioner's perspectives and maintaining a basic level of assessment that is acceptable to all disciplines. Standardized assessments are mandatory in research, yet are rarely applied systematically across CAMHS.The use of standardized assessments in routine practice might aid the allocation of families to the practitioners best able to meet their needs and free up time for intervention. However, practitioners' attitudes towards standardized assessment will dictate the success of such an approach. Fifty practitioners working in two CAMHS completed semi-structured interviews that explored their attitudes towards the use of standardized assessments in clinical practice, which were analysed using thematic analysis. Practitioners could identify both advantages and disadvantages of the routine use of standardized assessment. While they valued standardization, opportunities for service organization and increased information, some expressed concerns related to the choice, accuracy and influence of measures, as well as labelling. Almost one-third complained about their lack of pre-registration training in working with children, let alone their assessment. Practitioners, clinicians and policy makers need to consider these issues if they wish to introduce standardized assessments into routine practice. Senior staff need to be aware how unskilled some junior practitioners feel when they start working in CAMHS and offer appropriate support and supervision.

Implementing for Sustainability: Promoting Use of a Measurement Feedback System for Innovation and Quality Improvement

“…For example, we found that clinicians who were top implementers (based on rates of measure completion and feedback viewing) believed that the MFS empowered clients and enhanced the client-clinician relationship through the process of engaging clients in reporting on outcomes and facilitating clinical conversation based on feedback. These anecdotal findings are consistent with the personcentered themes from qualitative studies of routine outcome monitoring (Hall et al 2014;Martin et al 2011;Unsworth et al 2012;Wolpert et al 2014).…”

“…There are practical (e.g., time burden, organizational and managerial resources) and philosophical barriers (e.g., clinician perceptions and attitudes) (Boswell et al 2013;Duncan and Murray 2012). The regular use of data from feedback in clinical decision-making may seem antithetical to the person-centered values of a typical clinician (Fitzpatrick 2012;Martin et al 2011;Wolpert et al 2014). Sustainable implementation requires intensive support for individual attitude and knowledge shifts Hall et al 2014;Unsworth et al 2012) and organizational culture change using complex and subtle implementation methodologies and post-implementation strategies (Mellor-Clark et al 2014).…”

A qualitative process evaluation of electronic session-by-session outcome measurement in child and adolescent mental health services

“…In general, HCPs were supportive of using outcome measures as an adjunct to support clinical opinion, but some raised concerns about favouring outcome measures over clinical judgment [4,15]. …”

“…It is encouraging for such systems as CYP-IAPT to observe that families do not perceive it as a burden which may help HCPs overcome some concerns with asking patients to complete multiple forms [15]. …”

“…Research has indicated a lack of time, resources, training and feedback from the measures to be fundamental barriers to their use [3,4], [12,13]. Additional concerns focus on data misuse, questionnaires being unable to capture complexity of issues and regular monitoring not fitting with all therapeutic approaches [11,12,14,15]. …”