Using brief clinician and parent measures to track outcomes in outpatient child psychiatry: longer term follow‐up and comparative effectiveness

Abstract

Background: This study explored the feasibility and validity of using brief clinician-and parent-rated measures routinely over 6 months in outpatient child psychiatry. Method: All patients under 18 years of age seen for intake in the Child Psychiatry Clinic from 1 August 2007 through 31 July 2010 were eligible for inclusion in the study. Data were collected at intake for 1033 patients and at 3-and 6-month follow-up. Results: ANOVA for repeated measures showed statistically significant improvements in total and subscale scores on all three measures (Brief Psychiatric Rating Scale for Children, ChildrenÕs Global Assessment Scale, and Pediatric Symptom Checklist) at both second and third assessments. Conclusion: The fact that both broadband and narrowband scales showed significant improvements over the first 6 months of care establishes the possibility that these measures could be used in experimental designs studying comparative effectiveness. Key Practitioner Message:• It is possible to measure changes in outcomes over the first 6 months of outpatient treatment in child psychiatry using several brief broadband measures available in the public domain • Two of these measures, the Pediatric Symptom Checklist and the Brief Psychiatric Rating Scale for Children, have validated subscales that can also be used to measure changes in specific domains like attention, anxiety/depression, and conduct • These measures can be administered, scored, and stored electronically

Measuring outcomes in outpatient child psychiatry: Reliable improvement, deterioration, and clinically significant improvement

“…Although the PSC can be used with children as young as three, the cutoff score is lower for pre-schoolers Murphy et al, 2012), so a decision was made for the current study to focus exclusively on patients in the primary and secondary school age range (6-17 years at intake)-therefore, 218 patients (11%) were excluded because they were less than six years of age, leaving 1692 patients. Of these, 1602 (95%) had a complete clinician form and 1294 (76% of total forms and 81% of clinician forms) had a complete parent form as well.…”

“…The few pediatric outcome research projects that have been conducted have focused mostly on specific diseases or chronic conditions (Forrest, Shipman, Dougherty & Miller, 2003), a focus which has been called ‘narrow-band’ (as opposed to ‘broad-band’ or global with regard to the types of problems assessed) (O’Connell, Boat & Warner, 2009). Relatively little research has been conducted on child and adolescent mental health outcomes or the change processes seen in routine care (Hamilton & Bickman, 2008; Warren, Nelson, Mondragon, Baldwin & Burlingame, 2010; Weisz et al, 2011) and even less on broad-band measures of functioning (Murphy et al, 2012). As health reform increasingly focuses on outcomes, there is a need for studies looking into the effectiveness of child mental health treatment and for data analytic strategies that allow for rigorous and relevant evaluations of pediatric mental health outcome measures, as well as of outcomes themselves (World Health Organization, 1992).…”

“…Therefore, much of the work of outcome research is best performed in actual clinical practice, where researchers can observe diverse and heterogeneous patients being treated under usual conditions (Krumhoz, 2008). This entails real-time research and responsive data collection systems as well as valid and reliable outcome measures, and it is made easier by the availability of electronic data collection and storage technologies (Murphy et al, 2012).…”

“…We characterized changes in these outcome scores by determining the rates of reliable improvement or deterioration and then the percentage of subjects who achieved CSI from intake to first follow-up. A detailed description of this hospital-wide outcome measurement program is reported in two previous papers (Murphy et al, 2011, 2012).…”

Implementing an aim-based outcome measure in a psychoanalytic child psychotherapy service: Insights, experiences and evidence

“…This is not an outcome study or formal audit, although we will briefly describe the conclusions that can be drawn from the data collected thus far. Rather, we are attempting to show that measuring outcomes in psychoanalytic child psychotherapy need not be an intrusive activity that gets in the way of clinical work, as indeed others have found, both within child psychotherapy (Baruch & Vrouva, 2010;Troupp, 2013;Urwin, 2007) and child psychiatry (Murphy et al, 2012). We argue that it provides a simple and useful way of clarifying the focus of the clinical work and reflecting its progress, while also having the potential to illuminate the clinical picture by contributing an additional source of clinical information directly from the patient.…”