The need for evidence-based intake, progress, and outcomes assessment

Abstract

standardized data on problems and strengths manifested by the child and parents. Parallel self-report and collateralreport instruments for developmentally appropriate assessment of child and parent functioning can give clinicians a comprehensive picture of areas in which children and parents may need help [3]. To qualify as evidence-based, assessment instruments should be supported by published standardization, reliability, validity, and normative data [4]. Multi-informant dimensional assessment of children and their parentsAssessment instruments that are scored on developmentally normed dimensional scales document the problems and strengths that can then be compared with subsequent reassessments to measure the progress and outcomes of treatment. If clinicians deem it appropriate, they can show parents bar graphs of dimensional scales that are scored from ratings of their child's functioning, their partner's functioning, and their own functioning. Bar graphs of data from multiple informants can help parents understand how views of their child's functioning and of their own functioning may differ. For example, a child's teachers may report more attention problems than reported by the child or parents. On the other hand, a child may report more depression than reported by the child's parents or teachers. One parent may report that the other parent displays much more aggressive behavior than that parent reports. Graphs of normed dimensional scores derived from each informant's reports provide clinicians and parents with concrete pictures of problems for which help may be needed. Graphs also reveal differences between informants' reports that can help parents understand variations in how their child functions in different contexts and in how their child is seen by different informants.Mental health clinicians are under increasing pressure to provide evidence for the effectiveness of their services. Many kinds of treatment are being promoted as "evidence based," with randomized controlled trials (RCTs) serving as gold standards for evidence-based treatments. Despite the importance of RCTs for evaluating treatments, it has been found that therapeutic benefits achieved in RCTs often shrink markedly when the treatments are applied to children in community mental health services [1,2].One possible reason for the shrinkage of benefits is that children seen in community services are not recruited for having the specific problems targeted by particular evidence-based treatments. A second possible reason for shrinkage is that community clinicians are not trained to provide all the relevant evidence-based treatments. And a third possible reason is that parents in community services may not collaborate as effectively as parents participating in RCTs. Whether to treat, what to treat, whom to treat?To benefit from RCT findings, clinicians need to have a clear basis for determining whether particular children need treatment. If treatment is indicated, clinicians also need a clear basis for determining what should be treated and w...

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