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Published in: Child and Adolescent Psychiatry and Mental Health 1/2019

Open Access 01-12-2019 | Research article

Clinicians’ attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry

Authors: M. Danielson, A. Månsdotter, E. Fransson, S. Dalsgaard, J-O. Larsson

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2019

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Abstract

Background

There is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians’ attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning.

Methods

411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions.

Results

Overall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups.

Conclusion

The overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.
Literature
1.
go back to reference Garland AF, Kruse M, Aarons GA. Clinicians and outcome measurement: what’s the use? J Behav Health Serv Res. 2003;30(4):393–405.PubMedCrossRef Garland AF, Kruse M, Aarons GA. Clinicians and outcome measurement: what’s the use? J Behav Health Serv Res. 2003;30(4):393–405.PubMedCrossRef
2.
go back to reference Achenbach TM. Future directions for clinical research, services, and training: evidence-based assessment across informants, cultures, and dimensional hierarchies. J Clin Child Adolesc Psychol. 2017;46(1):159–69.PubMedCrossRef Achenbach TM. Future directions for clinical research, services, and training: evidence-based assessment across informants, cultures, and dimensional hierarchies. J Clin Child Adolesc Psychol. 2017;46(1):159–69.PubMedCrossRef
3.
go back to reference Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5:1.PubMedPubMedCentralCrossRef Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5:1.PubMedPubMedCentralCrossRef
4.
go back to reference Spring B. Evidence-based practice in clinical psychology: what it is, why it matters; What you need to know. J Clin Psychol. 2007;63(7):611–31.PubMedCrossRef Spring B. Evidence-based practice in clinical psychology: what it is, why it matters; What you need to know. J Clin Psychol. 2007;63(7):611–31.PubMedCrossRef
5.
go back to reference Youngstrom EA. Future directions in psychological assessment: combining evidence-based medicine innovations with psychology’s historical strengths to enhance utility. J Clin Child Adolesc Psychol. 2013;42(1):139–59.PubMedCrossRef Youngstrom EA. Future directions in psychological assessment: combining evidence-based medicine innovations with psychology’s historical strengths to enhance utility. J Clin Child Adolesc Psychol. 2013;42(1):139–59.PubMedCrossRef
6.
go back to reference American Psychological Association PTFoE-BP. Evidence-based practice in psychology. Am Psychol. 2006;61(4):271–85.CrossRef American Psychological Association PTFoE-BP. Evidence-based practice in psychology. Am Psychol. 2006;61(4):271–85.CrossRef
7.
go back to reference Aarons GA, Glisson C, Green PD, Hoagwood K, Kelleher KJ, Landsverk JA, Research Network on Youth Mental H, Weisz JR, Chorpita B, Gibbons R, et al. The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implement Sci. 2012;7:56.PubMedPubMedCentralCrossRef Aarons GA, Glisson C, Green PD, Hoagwood K, Kelleher KJ, Landsverk JA, Research Network on Youth Mental H, Weisz JR, Chorpita B, Gibbons R, et al. The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implement Sci. 2012;7:56.PubMedPubMedCentralCrossRef
8.
go back to reference Garland AF, Hurlburt MS, Hawley KM. Examining psychotherapy processes in a services research context. Clin Psychol Sci Pract. 2006;13(1):30–46.CrossRef Garland AF, Hurlburt MS, Hawley KM. Examining psychotherapy processes in a services research context. Clin Psychol Sci Pract. 2006;13(1):30–46.CrossRef
9.
go back to reference Jorm AF. Mental health literacy. Empowering the community to take action for better mental health. Am Psychol. 2012;67(3):231–43.PubMedCrossRef Jorm AF. Mental health literacy. Empowering the community to take action for better mental health. Am Psychol. 2012;67(3):231–43.PubMedCrossRef
10.
go back to reference Ramirez Basco M, Bostic JQ, Davies D, Rush AJ, Witte B, Hendrickse W, Barnett V. Methods to improve diagnostic accuracy in a community mental health setting. Am J Psychiatry. 2000;157(10):1599–605.PubMedCrossRef Ramirez Basco M, Bostic JQ, Davies D, Rush AJ, Witte B, Hendrickse W, Barnett V. Methods to improve diagnostic accuracy in a community mental health setting. Am J Psychiatry. 2000;157(10):1599–605.PubMedCrossRef
11.
go back to reference Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. 2000;157(4):581–7.PubMedCrossRef Shear MK, Greeno C, Kang J, Ludewig D, Frank E, Swartz HA, Hanekamp M. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry. 2000;157(4):581–7.PubMedCrossRef
12.
go back to reference Angold A, Costello EJ. Nosology and measurement in child and adolescent psychiatry. J Child Psychol Psychiatry. 2009;50(1–2):9–15.PubMedCrossRef Angold A, Costello EJ. Nosology and measurement in child and adolescent psychiatry. J Child Psychol Psychiatry. 2009;50(1–2):9–15.PubMedCrossRef
13.
go back to reference Galanter CA, Patel VL. Medical decision making: a selective review for child psychiatrists and psychologists. J Child Psychol Psychiatry. 2005;46(7):675–89.PubMedCrossRef Galanter CA, Patel VL. Medical decision making: a selective review for child psychiatrists and psychologists. J Child Psychol Psychiatry. 2005;46(7):675–89.PubMedCrossRef
14.
go back to reference Nakash O, Nagar M, Kanat-Maymon Y. Clinical use of the DSM categorical diagnostic system during the mental health intake session. J Clin Psychiatry. 2015;76(7):e862–9.PubMedCrossRef Nakash O, Nagar M, Kanat-Maymon Y. Clinical use of the DSM categorical diagnostic system during the mental health intake session. J Clin Psychiatry. 2015;76(7):e862–9.PubMedCrossRef
15.
go back to reference McClellan JM, Werry JS. Introduction–research psychiatric diagnostic interviews for children and adolescents. J Am Acad Child Adolesc Psychiatry. 2000;39(1):19–27.PubMedCrossRef McClellan JM, Werry JS. Introduction–research psychiatric diagnostic interviews for children and adolescents. J Am Acad Child Adolesc Psychiatry. 2000;39(1):19–27.PubMedCrossRef
16.
go back to reference Rettew DC, Lynch AD, Achenbach TM, Dumenci L, Ivanova MY. Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews. Int J Methods Psychiatr Res. 2009;18(3):169–84.PubMedCrossRef Rettew DC, Lynch AD, Achenbach TM, Dumenci L, Ivanova MY. Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews. Int J Methods Psychiatr Res. 2009;18(3):169–84.PubMedCrossRef
17.
go back to reference First MB, Pincus HA, Levine JB, Williams JBW, Ustun B, Peele R. Clinical utility as a criterion for revising psychiatric diagnoses. Am J Psychiatry. 2004;161:946–54.PubMedCrossRef First MB, Pincus HA, Levine JB, Williams JBW, Ustun B, Peele R. Clinical utility as a criterion for revising psychiatric diagnoses. Am J Psychiatry. 2004;161:946–54.PubMedCrossRef
18.
go back to reference Joiner TE Jr, Walker RL, Pettit JW, Perez M, Cukrowicz KC. Evidence-based assessment of depression in adults. Psychol Assess. 2005;17(3):267–77.PubMedCrossRef Joiner TE Jr, Walker RL, Pettit JW, Perez M, Cukrowicz KC. Evidence-based assessment of depression in adults. Psychol Assess. 2005;17(3):267–77.PubMedCrossRef
19.
go back to reference Zimmerman M, Mattia JI. Psychiatric diagnosis in clinical practice: is comorbidity being missed? Compr Psychiatry. 1999;40(3):182–91.PubMedCrossRef Zimmerman M, Mattia JI. Psychiatric diagnosis in clinical practice: is comorbidity being missed? Compr Psychiatry. 1999;40(3):182–91.PubMedCrossRef
20.
go back to reference Bruchmuller K, Margraf J, Suppiger A, Schneider S. Popular or unpopular? Therapists’ use of structured interviews and their estimation of patient acceptance. Behav Ther. 2011;42(4):634–43.PubMedCrossRef Bruchmuller K, Margraf J, Suppiger A, Schneider S. Popular or unpopular? Therapists’ use of structured interviews and their estimation of patient acceptance. Behav Ther. 2011;42(4):634–43.PubMedCrossRef
22.
go back to reference Mash EJ, Hunsley J. Evidence-based assessment of child and adolescent disorders: issues and challenges. J Clin Child Adolesc Psychol. 2005;34(3):362–79.PubMedCrossRef Mash EJ, Hunsley J. Evidence-based assessment of child and adolescent disorders: issues and challenges. J Clin Child Adolesc Psychol. 2005;34(3):362–79.PubMedCrossRef
23.
go back to reference Christon LM, McLeod BD, Jensen-Doss A. Evidence-based assessment meets evidence-based treatment: an approach to science-informed case conceptualization. Cogn Behav Pract. 2015;22(1):36–48.CrossRef Christon LM, McLeod BD, Jensen-Doss A. Evidence-based assessment meets evidence-based treatment: an approach to science-informed case conceptualization. Cogn Behav Pract. 2015;22(1):36–48.CrossRef
24.
go back to reference Jensen-Doss A, Hawley KM. Understanding clinicians’ diagnostic practices: attitudes toward the utility of diagnosis and standardized diagnostic tools. Adm Policy Ment Health. 2011;38(6):476–85.PubMedPubMedCentralCrossRef Jensen-Doss A, Hawley KM. Understanding clinicians’ diagnostic practices: attitudes toward the utility of diagnosis and standardized diagnostic tools. Adm Policy Ment Health. 2011;38(6):476–85.PubMedPubMedCentralCrossRef
25.
go back to reference Jensen-Doss A, Hawley KM. Understanding barriers to evidence-based assessment: clinician attitudes toward standardized assessment tools. J Clin Child Adolesc Psychol. 2010;39(6):885–96.PubMedPubMedCentralCrossRef Jensen-Doss A, Hawley KM. Understanding barriers to evidence-based assessment: clinician attitudes toward standardized assessment tools. J Clin Child Adolesc Psychol. 2010;39(6):885–96.PubMedPubMedCentralCrossRef
26.
go back to reference Ramklint M, Hellgren L. Diagnostics in child psychiatry must be quality assured. Lakartidningen. 2009;106(36):2184–5.PubMed Ramklint M, Hellgren L. Diagnostics in child psychiatry must be quality assured. Lakartidningen. 2009;106(36):2184–5.PubMed
27.
28.
go back to reference Frazer P, Westhuits D, Daley JG, Philips I. How clinical social workers are using the DSM-IV: an national study. Soc Work Ment Health. 2009;7(4):325–39.CrossRef Frazer P, Westhuits D, Daley JG, Philips I. How clinical social workers are using the DSM-IV: an national study. Soc Work Ment Health. 2009;7(4):325–39.CrossRef
29.
go back to reference Jampala VC, Zimmerman M, Sierles FS, Taylor MA. Consumers’ attitudes toward DSM-III and DSM-III-R: a 1989 survey of psychiatric educators, researchers, practitioners, and senior residents. Compr Psychiatry. 1992;33(3):180–5.PubMedCrossRef Jampala VC, Zimmerman M, Sierles FS, Taylor MA. Consumers’ attitudes toward DSM-III and DSM-III-R: a 1989 survey of psychiatric educators, researchers, practitioners, and senior residents. Compr Psychiatry. 1992;33(3):180–5.PubMedCrossRef
30.
go back to reference Lilienfeld SO, Ritschel LA, Lynn SJ, Cautin RL, Latzman RD. Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies. Clin Psychol Rev. 2013;33(7):883–900.PubMedCrossRef Lilienfeld SO, Ritschel LA, Lynn SJ, Cautin RL, Latzman RD. Why many clinical psychologists are resistant to evidence-based practice: root causes and constructive remedies. Clin Psychol Rev. 2013;33(7):883–900.PubMedCrossRef
31.
go back to reference Harvey AG, Gumport NB. Evidence-based psychological treatments for mental disorders: modifiable barriers to access and possible solutions. Behav Res Ther. 2015;68:1–12.PubMedPubMedCentralCrossRef Harvey AG, Gumport NB. Evidence-based psychological treatments for mental disorders: modifiable barriers to access and possible solutions. Behav Res Ther. 2015;68:1–12.PubMedPubMedCentralCrossRef
32.
go back to reference Hunsley J. Translating evidence-based assessment principles and components into clinical practice settings. Cogn Behav Pract. 2015;22(1):101–9.CrossRef Hunsley J. Translating evidence-based assessment principles and components into clinical practice settings. Cogn Behav Pract. 2015;22(1):101–9.CrossRef
33.
go back to reference Almquist YB, Ashir S, Brännström L. A guide to quantitative methods. Stockholm: Chess Stockholm University; 2015. p. 342. Almquist YB, Ashir S, Brännström L. A guide to quantitative methods. Stockholm: Chess Stockholm University; 2015. p. 342.
34.
go back to reference StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP. StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: StataCorp LP.
35.
go back to reference Altman DG. Practical statistics for medical research. London: Chapman & Hall/CRC; 1991. Altman DG. Practical statistics for medical research. London: Chapman & Hall/CRC; 1991.
36.
go back to reference Cohen J. Statistical power analysis for the behavioral science. 2nd ed. New Jersey: Lawrence Erlbaum; 1988. Cohen J. Statistical power analysis for the behavioral science. 2nd ed. New Jersey: Lawrence Erlbaum; 1988.
37.
go back to reference Kotrlik JWW, Heather A, Jabor M. Khata: reporting and interpreting effect size in quantitative agricultural education research. J Agric Educ. 2011;52(1):132–42.CrossRef Kotrlik JWW, Heather A, Jabor M. Khata: reporting and interpreting effect size in quantitative agricultural education research. J Agric Educ. 2011;52(1):132–42.CrossRef
38.
go back to reference Traynor M. Indeterminacy and technicality revisited: how medicine and nursing have responded to the evidence based movement. Sociol Health Illn. 2009;31(4):494–507.PubMedCrossRef Traynor M. Indeterminacy and technicality revisited: how medicine and nursing have responded to the evidence based movement. Sociol Health Illn. 2009;31(4):494–507.PubMedCrossRef
39.
go back to reference Addis ME, Wade WA, Hatgis C. Barriers to dissemination of evidence based practice: addressing practioners’s concerns about manual based psychotherapies. Clin Psychol Sci Pract. 1999;6(4):430–41.CrossRef Addis ME, Wade WA, Hatgis C. Barriers to dissemination of evidence based practice: addressing practioners’s concerns about manual based psychotherapies. Clin Psychol Sci Pract. 1999;6(4):430–41.CrossRef
40.
go back to reference Osterberg LD, Jensen-Doss A, Cusack KJ, de Arellano MA. Diagnostic practices for traumatized youths: do clinicians incorporate symptom scale results? Community Ment Health J. 2009;45(6):497–507.PubMedCrossRef Osterberg LD, Jensen-Doss A, Cusack KJ, de Arellano MA. Diagnostic practices for traumatized youths: do clinicians incorporate symptom scale results? Community Ment Health J. 2009;45(6):497–507.PubMedCrossRef
41.
go back to reference Nakamura BJ, Higa-McMillan CK, Okamura KH, Shimabukuro S. Knowledge of and attitudes towards evidence-based practices in community child mental health practitioners. Adm Policy Ment Health. 2011;38(4):287–300.PubMedCrossRef Nakamura BJ, Higa-McMillan CK, Okamura KH, Shimabukuro S. Knowledge of and attitudes towards evidence-based practices in community child mental health practitioners. Adm Policy Ment Health. 2011;38(4):287–300.PubMedCrossRef
42.
go back to reference Wood JM, Garb HN, Lilienfeld SO, Nezworski MT. Clinical assessment. Annu Rev Psychol. 2002;53:519–43.PubMedCrossRef Wood JM, Garb HN, Lilienfeld SO, Nezworski MT. Clinical assessment. Annu Rev Psychol. 2002;53:519–43.PubMedCrossRef
43.
go back to reference Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003. Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003.
44.
go back to reference Okamura KH, Hee PJ, Jackson D, Nakamura BJ. Furthering our understanding of therapist knowledge and attitudinal measurement in youth community mental health. Adm Policy Ment Health. 2018;45(5):699–708.PubMedCrossRef Okamura KH, Hee PJ, Jackson D, Nakamura BJ. Furthering our understanding of therapist knowledge and attitudinal measurement in youth community mental health. Adm Policy Ment Health. 2018;45(5):699–708.PubMedCrossRef
45.
go back to reference Lyon AR, Dorsey S, Pullmann M, Silbaugh-Cowdin J, Berliner L. Clinician use of standardized assessments following a common elements psychotherapy training and consultation program. Adm Policy Ment Health. 2015;42(1):47–60.PubMedPubMedCentralCrossRef Lyon AR, Dorsey S, Pullmann M, Silbaugh-Cowdin J, Berliner L. Clinician use of standardized assessments following a common elements psychotherapy training and consultation program. Adm Policy Ment Health. 2015;42(1):47–60.PubMedPubMedCentralCrossRef
46.
go back to reference Edbrooke-Childs J, Wolpert M, Deighton J. Using patient reported outcome measures to improve service effectiveness (UPROMISE): training clinicians to use outcome measures in child mental health. Adm Policy Ment Health. 2016;43(3):302–308.PubMedCrossRef Edbrooke-Childs J, Wolpert M, Deighton J. Using patient reported outcome measures to improve service effectiveness (UPROMISE): training clinicians to use outcome measures in child mental health. Adm Policy Ment Health. 2016;43(3):302–308.PubMedCrossRef
47.
go back to reference Youngstrom EA, Meter AV, Hunsley J, Prinstein MJ, Ong M-L, Youngstrom JK. Evidence-based assessment as an integrative model for applying psychological science to guide the voyage of treatment. Clin Psychol Sci Pract. 2017;24(4):331–66.CrossRef Youngstrom EA, Meter AV, Hunsley J, Prinstein MJ, Ong M-L, Youngstrom JK. Evidence-based assessment as an integrative model for applying psychological science to guide the voyage of treatment. Clin Psychol Sci Pract. 2017;24(4):331–66.CrossRef
48.
go back to reference Sharples E, Qin C, Goveas V, Gondek D, Deighton J, Wolpert M, Edbrooke-Childs J. A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services. Clin Child Psychol Psychiatry. 2017;22(2):219–28.PubMedCrossRef Sharples E, Qin C, Goveas V, Gondek D, Deighton J, Wolpert M, Edbrooke-Childs J. A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services. Clin Child Psychol Psychiatry. 2017;22(2):219–28.PubMedCrossRef
49.
go back to reference Jones DJ. Future directions in the design, development, and investigation of technology as a service delivery vehicle. J Clin Child Adolesc Psychol. 2014;43(1):128–42.PubMedPubMedCentralCrossRef Jones DJ. Future directions in the design, development, and investigation of technology as a service delivery vehicle. J Clin Child Adolesc Psychol. 2014;43(1):128–42.PubMedPubMedCentralCrossRef
50.
go back to reference Mitchell PF. Evidence-based practice in real-world services for young people with complex needs: new opportunities suggested by recent implementation science. Child Youth Serv Rev. 2011;33(2):207–16.CrossRef Mitchell PF. Evidence-based practice in real-world services for young people with complex needs: new opportunities suggested by recent implementation science. Child Youth Serv Rev. 2011;33(2):207–16.CrossRef
Metadata
Title
Clinicians’ attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry
Authors
M. Danielson
A. Månsdotter
E. Fransson
S. Dalsgaard
J-O. Larsson
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Child and Adolescent Psychiatry and Mental Health / Issue 1/2019
Electronic ISSN: 1753-2000
DOI
https://doi.org/10.1186/s13034-019-0269-0

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