Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy: a review of child self-report measures.

Jessica Deighton,Praveetha Patalay,Jeb Brown,Peter Fonagy,Miranda Wolpert,Tim Croudace

doi:10.1186/1753-2000-8-14

Abstract

There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures’ psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy.

Highlights

There is a growing number of children’s mental health and wellbeing measures that have the potential to be used in child and adolescent mental health services (CAMHS) to inform individual clinical practice e.g. [1], to provide information to feed into service development e.g. [2] and for local or national benchmarking e.g. [3]
The review identified some limitations in each measure in terms of either the time and cost associated with administration, or the strength of the psychometric evidence
The different strengths and weaknesses to some extent reflect the heterogeneity in purposes for which mental health measures have been developed

Summary

Introduction

There is a growing number of children’s mental health and wellbeing measures that have the potential to be used in child and adolescent mental health services (CAMHS) to inform individual clinical practice e.g. [1], to provide information to feed into service development e.g. [2] and for local or national benchmarking e.g. [3]. National and international policy has focused on the importance of the voice of the child, of shared decision making for children accessing health services, and of self-defined recovery [10,11,12,13]. This policy context gives a clear rationale for the use of self-report measures for child mental health outcomes. Research has indicated that, due to their difficulties with reading and language and their tendencies to respond based on their state of mind at the moment (rather than on more general levels of adjustment), children may be less reliable in their assessments of their own mental health, and there is evidence of under-reporting behavioral difficulties [15,16]. A number of interactive, online self-report measures have been developed e.g., Dominic interactive; and see [17,21], which appear to elicit valid and reliable responses from children as young as eight years old

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Discussion

Conclusion