Understanding Clinicians’ Diagnostic Practices: Attitudes Toward the Utility of Diagnosis and Standardized Diagnostic Tools

Jensen‐Doss, Amanda; Hawley, Kristin M.

doi:10.1007/s10488-011-0334-3

Cited by 58 publications

(47 citation statements)

References 37 publications

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“…These findings therefore raise questions about whether those practices are being applied to appropriate clients and suggest a need for efforts to improve clinician diagnostic practices. Despite data indicating that patients actually prefer structured approaches (Suppiger et al, 2009), practitioners rarely use SDIs (Jensen-Doss & Hawley, 2011), likely due to time and funding challenges associated with training in and administerting these time intensive measures. A hybrid approach, combining checklists and other brief assessments to indicate targets for intensive interviewing, might offer the benefits of structured approaches at less cost in terms of time, while preserving some flexibility for the clinician (Ebesutani, Bernstein, Chorpita, & Weisz, 2012; Youngstrom, 2013).…”

Section: Discussionmentioning

confidence: 99%

Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Jensen‐Doss¹,

Youngstrom²,

Youngstrom³

et al. 2014

Journal of Consulting and Clinical Psychology

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Objective Diagnoses play an important role in treatment planning and monitoring, but extensive research has shown low agreement between clinician-generated diagnoses and those from structured diagnostic interviews. However, most prior studies of agreement have not used research diagnoses based on gold standard methods, and research needs to identify characteristics of diagnostically challenging clients. This study examined agreement between youth diagnoses generated through the research-based LEAD (Longitudinal, Expert, and All Data) Standard to clinician diagnoses. Method Participants were 391 families seeking outpatient community mental health services for youths ages 6-18 (39.1% female, 88.2% African American). Youths and parents completed research interviews and clinic diagnoses were extracted from clinic records. LEAD diagnoses synthesized results of the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime (KSADS-PL) and the youth's developmental, family, and psychiatric history. Results Agreement between the LEAD and chart diagnoses was low, not exceeding “poor” agreement for most diagnostic categories (κ = .10-.46, median = .37). Disagreement was largely driven by missed diagnoses, although clinicians also did assign extra diagnoses for some clients. Fewer diagnostic errors occurred when the youth's clinical picture was more clear (e.g., high or low symptom severity, lower comorbidity), when the youth was older, when the family was higher functioning, and when the parent had more depression. However, youth and family characteristics explained very little of the variability in diagnostic errors. Conclusions Results support the need to investigate strategies to improve clinician diagnostic accuracy.

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Section: Discussionmentioning

confidence: 99%

Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Jensen‐Doss¹,

Youngstrom²,

Youngstrom³

et al. 2014

Journal of Consulting and Clinical Psychology

Self Cite

View full text Add to dashboard Cite

show abstract

“…The most commonly endorsed theoretical orientations were cognitivebehavioral and family systems. Provider gender in the current sample was consistent with previous observational and survey studies with child clinicians (Garland, BrookmanFrazee, et al, 2010;Jensen-Doss & Hawley, 2011). Participant professional disciplines and theoretical orientations were consistent with Garland and colleagues' (2010) study examining child therapist practices.…”

Section: Provider Characteristicssupporting

confidence: 86%

“…Organizations were mostly private practices, which is consistent with previous research examining usual child mental health care (Jensen-Doss & Hawley, 2011;Schoenwald et al, 2008), followed by community mental health centers and outpatient clinics. Most of the public organizations were state-funded.…”

Section: Practice Characteristicssupporting

confidence: 82%

“…Participant professional disciplines and theoretical orientations were consistent with Garland and colleagues' (2010) study examining child therapist practices. Providers in the current sample were, on average, older than providers in an observational study of therapy practices (Garland, BrookmanFrazee, et al, 2010) and younger than providers in a national survey of child clinicians (Jensen-Doss & Hawley, 2011). Participant education also differed from previous studies.…”

Section: Provider Characteristicsmentioning

confidence: 56%

“…It is possible that the smaller proportion of bachelors-level providers in the current sample compared to masters-or doctoral-level providers influenced these findings. Previous research examining provider attitudes towards standardized diagnostic tools has excluded bachelors-level providers from analyses in order to minimize variability (Jensen-Doss & Hawley, 2011). In the current study, however, all providers were included, as the primary aim was to characterize the full range of infant mental health services.…”

Section: Participant Attitudes Toward Evidence-based Practicesmentioning

confidence: 99%

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Psychological conditions with severe symptoms can result in considerable impairment in functioning, and psychological disability claims, also called behavioral health disability, have increased during the past two decades. A review of states’ workers’ compensation (WC) systems shows no overlap between systems; that is, all states and federal WC systems have unique terminology, rules, and laws. In order to thoroughly evaluate the individual, evaluators must use a biopsychosocial approach that combines aspects of biological, psychological, and psychosocial issues. Studies consistently demonstrate a high degree of comorbidity between physical and psychological conditions, but frequently only the former are identified and treated. Current disability systems use byzantine definitions of disability and require professional opinions and documentation that do not comport with current psychological standards of care, introducing imprecision. Many issues relating to WC terminology and laws can be addressed if the Daubert standard is incorporated into any amendment of WC state and federal laws. The Daubert standard requires that currently accepted scientific methods be used when a professional offers testimony as an expert or is submitting professional treatment records (eg, in a WC determination). Compliance with the Daubert standard requires more consistent, objective professional documentation and testimony to ensure even-handed decisions that align with standards of psychological care. One observer has suggested that the Daubert standard is a mechanism by which junk science is kept out of legal proceedings.

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Understanding Clinicians’ Diagnostic Practices: Attitudes Toward the Utility of Diagnosis and Standardized Diagnostic Tools

Cited by 58 publications

References 37 publications

Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Predictors and moderators of agreement between clinical and research diagnoses for children and adolescents.

Characterizing Community-Based Usual Mental Health Care for Infants

Imprecision in the Evaluation of Workers’ Compensation Psychological Injury Claims

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