Use Of Evidence-based Assessments Research Articles

Mental Health Information Reporting Assistant (MHIRA)—an open-source software facilitating evidence-based assessment for clinical services

Evidence-based assessment (EBA) in mental health is a critical aspect of improving patient outcomes and addressing the gaps in mental health care. EBA involves the use of psychometric instruments to gather data that can inform clinical decision-making, inform policymakers, and serve as a basis for research and quality management. Despite its potential, EBA is often hindered by barriers such as workload and cost, leading to its underutilization. Regarding low- and middle-income countries (LMIC), the implementation of EBA is recognized as a key strategy to address and close the prevalent mental health treatment gap.To simplify the application of EBA including in LMIC, an international team of researchers and practitioners from Tanzania, Kosovo, Chile, and Switzerland developed the Mental Health Information Reporting Assistant (MHIRA). MHIRA is an open-source electronic health record that streamlines EBA by digitising psychometric instruments and organising patient data in a user-friendly manner. It provides immediate and convenient reports to inform clinical decision-making.The current article provides a comprehensive overview of the features and technical details of MHIRA, as well as insights from four implementation scenarios. The experience gained during the implementations as well as the user-feedback suggests that MHIRA has the potential to be successfully implemented in a variety of clinical contexts and simplify the use of EBA. However, further research is necessary to establish its potential to sustainably transform healthcare services and impact patient outcomes.In conclusion, MHIRA represents an important step in promoting the widespread adoption of EBA in mental health. It offers a promising solution to the barriers that have limited the use of EBA in the past and holds the potential to improve patient outcomes and support the ongoing efforts to address gaps in mental health care.

Qualifications, professional roles and service practices of nurses, occupational therapists and speech-language pathologists in the management of adults with oropharyngeal dysphagia: a Nordic survey

Purpose To identify the qualifications, professional roles and service practices of nurses, occupational therapists (OTs) and speech-language pathologists (SLPs) in the management of adults with oropharyngeal dysphagia (OD) in the Nordic countries. Methods A web-based survey was developed that consisted of 50 questions on respondent demographics, education, experience, roles and service practices provided for adults with OD. The survey was distributed to practicing nurses, OTs, and SLPs in five Nordic countries via professional associations, social media, online networks and snowballing. Results Data from 396 nurses, OTs and SLPs whom provided services for adults with OD revealed that the majority of respondents worked in acute care and inpatient rehabilitation facilities. Most respondents had minimal undergraduate education and practical clinical training in OD. Notable variances in roles and service practices in OD between professions and countries were found. OTs were the primary service provider for OD management in Denmark, while SLPs had this role in the other Nordic countries. Nurses were mainly involved in screening and some compensatory treatments in most Nordic countries. Limited use of evidence-based screening, non-instrumental or instrumental clinical assessments and rehabilitative therapeutic methods was evident. Conclusions Study results highlight challenges in education and training of professionals responsible for the management of adults with OD in the Nordic countries. Increased use of evidence-based assessment and exercise-based treatments to improve swallowing are warranted. Adherence to European and international clinical practice guidelines for the management of adults with OD is recommended.

Integrating Assessment for Social Disconnectedness Into Aging Services: Charting a Path Forward

Social disconnectedness poses a serious threat to the health and well-being of older adults. Although research demonstrates that social disconnectedness was prevalent among older adults long before the COVID-19 pandemic, the crisis has brought significant attention to this issue, as well as resources to address it. The crisis also shed light on the current gap in evidence and guidance on how best to assess for and address social disconnectedness, especially in practice settings. Researchers from the Georgia Health Policy Center conducted a review of existing assessment tools and processes for social disconnectedness and formulated recommendations for the Georgia Division of Aging Services (DAS) in November 2020. These recommendations involve the use of evidence-based assessments paired with person-centered counseling to address social disconnectedness among at-risk individuals. In this session, researchers from Georgia State University will define social disconnectedness, explain how it differs from related constructs, and discuss the necessity of a holistic approach to assessment; summarize the review and recommendations made to DAS; and present preliminary data from DAS’s initial implementation of the assessment process.

The Use of Evidence-Based Assessment for Anxiety Disorders in an Australian Sample

Anxiety disorders are common and cause considerable functional impairment. Fortunately, evidence-based treatments are available, however, treatment effectiveness is often reliant on the provision of an accurate diagnosis. Accurate diagnosis requires a multi-method evidence-based assessment (EBA). Assessment techniques available to clinicians include a clinical interview, semi-structured diagnostic interview, self-report/clinician-administered rating scales and direct observation. Research demonstrates that only a small number of therapists utilize EBA, and to date this has not been investigated in an Australian sample. One hundred and two registered Australian psychologists (Mage = 40.98; SD = 12.67; 83.6% female) participated in an online study investigating assessment practices. Participants were asked to indicate EBA frequency of use and the obstacles they face to using EBA. The majority of participants (69% working with adult patients and 51% working with pediatric patients) reported partial use of EBA. Few psychologists (21% working with adult patients and 11% working with child patients) indicated complete use of EBA. Thirty-six percent of participants indicated negative beliefs about the usefulness or helpfulness of EBA. Multiple obstacles to the use of EBA were reported including concerns with the time required to complete assessment (27%), and a lack of access to assessment tools (10%). Implications for training and clinical practice are discussed.

The quality of assessments for childhood psychopathology within a regional medical center.

Accurate assessment is essential to implementing effective mental health treatment; however, little research has explored child clinicians' assessment practices in applied settings. The current study thus examines practitioners' use of evidence-based assessment (EBA) instruments (i.e., self-report measures and structured interviews), specificity of identified diagnoses (i.e., use of specific diagnostic labels vs. nonstandardized labels, not otherwise specified [NOS] diagnoses, and adjustment disorder diagnoses), and documentation of Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., DSM-IV-TR, American Psychiatric Association, 2000) criteria. Use of these practices was evaluated via analysis of documentation contained within a regional medical center's medical records. This analysis was limited to 2,499 session notes from patient appointments associated with psychiatric disorders newly diagnosed during 2013. In total, session notes were linked to 694 children aged 7 to 17. Results indicated that EBA use was low overall, although self-report measures were utilized relatively frequently versus structured interviews. Diagnostic specificity was also low overall and clinicians rarely documented full diagnostic criteria; however, EBA use was associated with increased diagnostic specificity. Further, clinicians practicing in psychological, psychiatric, and primary care settings were more likely to use self-report measures as compared to those practicing in an integrated behavioral health social work setting. In addition, structured interviews were most likely to be utilized by clinicians practicing in a psychological services setting. Finally, clinicians were more likely to use self-report measures when the identified primary concern was a mood disorder or attention-deficit/hyperactivity disorder (ADHD). Based on these results, we provide suggestions and references to resources for clinicians seeking to improve the quality of their assessments via implementation of EBA. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects.

BackgroundEfficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings.ObjectiveThe goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span.MethodsProject 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches.ResultsEnrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted.ConclusionsThis research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders.Trial RegistrationClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD)International Registered Report Identifier (IRRID)DERR1-10.2196/12121

Understanding allied health practitioners’ use of evidence-based assessments for children with cerebral palsy: a mixed methods study

Purpose: Evidence-based assessments for children with cerebral palsy are not widely used by healthcare professionals in day-to-day practice. This study aimed to examine allied health practitioner experiences, perceptions, and use of assessments for children with cerebral palsy.Method: A mixed methods study was conducted in two rehabilitation organisations. Three focus group interviews explored therapists’ assessment experiences with data analysed using interpretive description. Assessment practices of therapists (n = 55) were assessed through self-report questionnaire and case-file audit of children with cerebral palsy (n = 44).Results: Emergent themes described therapists’ motivation to use evidence-based assessments on a behavioural continuum – I don’t; I can’t; I try; I do; We do; influenced by assessment satisfaction, child and family collaboration, organisational expectation, research fit, and time dedication. Only two of fifteen audited assessments were documented in more than 50% of files. Use was higher where assessments positively connected therapists, children and parents, and use was organisationally endorsed. The Cultural Cone for evidence-based assessment behaviour was conceptualised.Conclusions: “Engagement in” assessment appears to require a conceptual shift by therapists and organisations to understanding assessment as part of, not an adjunct to, therapy. The Cultural Cone framework may assist therapists and services in designing strategies to promote evidence-based assessment behaviours.Implications for rehabilitationTherapists’ can reflect on where they are positioned on the “use continuum” in the Cultural Cone framework, and consider the contextual influences contained in this framework to understand their motivation to use evidence-based assessments.Routine use of evidenced-based assessments for children with cerebral palsy by allied health practitioners remains generally low and therapists and service organisations need to consider ways to increase use.Where possible, therapists’ should choose assessment tools that fully engage children and families and themselves in the assessment process.The Cultural Cone framework may be used to assist therapists and organisations identify and design site specific strategies to increase evidence-based assessment use in day-to-day practice.

Measurement equivalence: A non-technical primer on categorical multi-group confirmatory factor analysis in school psychology

Evidence-based interventions (EBIs) have become a central component of school psychology research and practice, but EBIs are dependent upon the availability and use of evidence-based assessments (EBAs) with diverse student populations. Multi-group confirmatory factor analysis (MG-CFA) is an analytical tool that can be used to examine the validity and measurement equivalence/invariance of scores across diverse groups. The objective of this article is to provide a conceptual and procedural overview of categorical MG-CFA, as well as an illustrated example based on data from the Social and Academic Behavior Risk Screener (SABRS) – a tool designed for use in school-based interventions. This article serves as a non-technical primer on the topic of MG-CFA with ordinal (rating scale) data and does so through the framework of examining equivalence of measures used for EBIs within multi-tiered models – an understudied topic. To go along with the illustrated example, we have provided supplementary files that include sample data, Mplus input code, and an annotated guide for understanding the input code (http://dx.doi.org/10.1016/j.jsp.2016.11.002). Data needed to reproduce analyses in this article are available as supplemental materials (online only) in the Appendix of this article.

National Study of School Psychologists’ Use of Evidence-Based Assessment in Autism Spectrum Disorder

ABSTRACTThis study aimed to better understand predictors of evidence-based assessment practices for autism spectrum disorder (ASD). Nationwide, 402 school psychologists were surveyed for their knowledge of and training and experience with ASD on assessment practices, including reported areas of training needs. The majority of school psychologists reported that they did not engage in comprehensive assessment of ASD, which was defined as assessments that consider all areas of development in addition to the use of ASD-specific instruments. Results from logistic regression revealed that experience and training, working with young children with ASD, and geographic location predicted use of evidence-based assessment practices. Experience and training with ASD was the strongest predictor of evidence-based assessment. No differences in training needs were indicated by school psychologists whose practices were consistent with evidence-based assessment and those whose practices were not. Overall, the results identified gaps between best and current practices by school psychologists and highlight areas of need for additional training and professional development.

Use of evidence-based assessments for childhood anxiety disorders within a regional medical system.

Anxiety disorders represent a common and serious threat to mental health in children and adolescents. To effectively treat anxiety in children, clinicians must conduct accurate assessment of patients' symptoms. However, despite the importance of assessment in the treatment of childhood anxiety disorders, the literature lacks a thorough analysis of the practices used by clinicians' when evaluating such disorders in community settings. Thus, the current study examines the quality of assessment for childhood anxiety disorders in a large regional health system. The results suggest that clinicians often provide non-specific diagnoses, infrequently document symptoms according to diagnostic criteria, and rarely administer rating scales and structured diagnostic interviews. Relatedly, diagnostic agreement across practice settings was low. Finally, the quality of assessment differed according to the setting in which the assessment was conducted and the complexity of the patient's symptomatology. These results highlight the need to develop and disseminate clinically feasible evidence-based assessment practices that can be implemented within resource-constrained service settings. (PsycINFO Database Record

Future Directions for Clinical Research, Services, and Training: Evidence-Based Assessment Across Informants, Cultures, and Dimensional Hierarchies

As the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) acknowledges, DSM diagnostic categories do not fit the real-world heterogeneity, comorbidity, and complexity of most mental health problems. Many efforts to develop and test evidence-based treatments also fail to take account of the heterogeneity, comorbidity, and complexity of problems seen in the community settings where most mental health services are rendered. Most community services cannot attain the treatment specificity and fidelity characterizing randomized controlled trials, which often yield larger therapeutic effects than when the tested treatments are tried in community services. Widely applicable evidence-based assessments (EBAs) can bridge gaps between evidence-based treatments and the diverse providers, cases, and conditions characterizing community services. To advance community services, intake EBAs can help providers take account of cross-informant discrepancies, parents’ problems, multicultural variations, and hierarchical dimensional aspects of psychopathology. To capitalize on intake EBAs, progress and outcome EBAs should be used to identify changes and failures-to-change on which to base recalibrations of treatments. To strengthen therapeutic alliances, the results of intake, progress, and outcome EBAs can be shared with parents. To bridge gaps between research and services, it is recommended that training in clinical research and services should (a) focus on widely applicable EBAs as essential foundations for evidence-based practice; (b) systematically promote intake, progress, and outcome EBAs; and (c) equip psychologists to advance evidence-based practice in community services. To implement these recommendations, research is needed on how to increase use of EBAs, organize services around routine use of EBAs, and help providers base service decisions on EBAs.

Use of evidence-based assessment for childhood anxiety disorders in community practice

High-quality assessment is essential to the delivery of effective treatment for childhood anxiety disorders. However, relatively little is known about how frequently child clinicians utilize evidence-based assessment (EBA) techniques in practice, and even less is known about the factors that influence EBA use in such settings. Thus, the current study presents data from a survey of 339 clinicians from a variety of professional backgrounds concerning their use of EBA for childhood anxiety disorders and explores issues preventing EBA implementation. Results indicated infrequent EBA use with clinicians citing practical barriers (i.e., time, access, knowledge, cost) and negative beliefs about EBA techniques (i.e., unhelpful) as issues preventing implementation. Implications for future EBA dissemination and implementation efforts are discussed.

Clinician use of standardized assessments following a common elements psychotherapy training and consultation program.

Despite increasing emphasis on the implementation of evidence-based treatments in community service settings, little attention has been paid to supporting the use of evidence-based assessment (EBA) methods and processes, a parallel component of evidence-based practice. Standardized assessment (SA) tools represent a key aspect of EBA and are central to data-driven clinical decision making. The current study evaluated the impact of a statewide training and consultation program in a common elements approach to psychotherapy. Practitioner attitudes toward, skill applying, and use of SA tools across four time points (pre-training, post-training, post-consultation, and follow-up) were assessed. Results indicated early increases in positive SA attitudes, with more gradual increases in self-reported SA skill and use. Implications for supporting the sustained use of SA tools are discussed, including the use of measurement feedback systems, reminders, and SA-supportive supervision practices.

Evidence-Based Assessment in Children and Adolescents with Obsessive–Compulsive Disorder

The assessment of varied psychiatric disorders, including obsessive–compulsive disorder (OCD), is shifting towards the use of evidence-based assessments (EBAs). This shift has fostered the development, validation and adaptation of several measures to rate obsessive–compulsive symptoms and other related problematic areas such as functional impairment or family attitudes among others. The aim of this paper is to present a systematic review of psychometric studies on pediatric OCD-specific measures to classify these according to assessment evidence-based criteria. Selection criteria that determined which studies were included in the review were: (1) analyzing an OCD measure and (2) including participants’ age being 18 years or younger. The literature search procedure was conducted in Medline, PsycINFO, PsycARTICLES, ERIC, Cochrane Library, and Scholar Google databases and enabled us to locate 42 studies which analyzed psychometric properties of 14 OCD measures studied in children and adolescents. Instruments were grouped into the following assessment areas: symptom presence and severity, functional impairment, family functioning and cognitive dimensions of OCD. Psychometric data regarding internal structure, internal consistency, reliability, validity and diagnostic precision were also reported. Further, measures were classified as well-established, approaching well-established and promising assessments in terms of reliability and validity. We concluded that the assessment of OCD in pediatric populations is a growing field that in a short-medium term could provide a wide variety of EBAs for the evaluation obsessive–compulsive symptoms and other OCD-related dimensions. The paper concludes by highlighting directions for future research.

Evidence-Based Well-Being/Positive Psychology Assessment and Intervention with Quality of Life Therapy and Coaching and the Quality of Life Inventory (QOLI)

Quality of Life Therapy and Coaching (also known as Quality of Life Therapy) is a comprehensive, manualized, theory-based, and, according to Diener (2013) and Seligman (Flourish, Free Press, NY, 2011, p. 292), evidence-based approach to well being, happiness, and positive psychology intervention suitable for both coaching and clinical applications. Clients are taught strategies and skills aimed at helping them to identify, pursue, and fulfill their most cherished needs, goals, and wishes in sixteen valued areas of life said to comprise human well-being and happiness. Quality of Life Therapy and Coaching is “manualized” in the form of the book entitled Quality of Life Therapy (Frisch 2006), providing step-by-step instruction in assessing well-being, tailoring interventions, and monitoring progress, outcome, and follow-up with the evidence-based well-being assessment, the Quality of Life Inventory or QOLI®. This article describes Quality of Life Therapy and Coaching and reviews developments and research since the publication of the manual in 2006. Randomized controlled trials bearing on the empirical support of Quality of Life Therapy and Coaching and the related assessment, the Quality of Life Inventory, are reviewed. The steps in Quality of Life Therapy and Coaching are delineated in the context of an illustrative case and an underlying theory which attempts to integrate findings from the fields of well-being, positive psychology, happiness, quality of life, social indicators research, psychotherapy, and coaching. Future applications and research are suggested which may identify the effective components of Quality of Life Therapy and Coaching and assess their direct impact on health and illness, encourage the use of evidence-based assessments and interventions on the part of well being coaches and therapists, and create health care delivery systems in which well being assessments and interventions are conducted concurrently with symptom-oriented tests and treatments.

Enhancing Professional Reasoning through the Use of Evidence-Based Assessments, Robust Case Formulations and Measurable Goals

The value of therapists documenting their clinical reasoning and negotiating specific and measurable goals is widely acknowledged. However, the literature suggests that practitioners often encounter barriers when implementing best practice. This article details how occupational therapists in Derbyshire Healthcare NHS Foundation Trust entered an academic partnership, which transformed their communication of clinical and professional reasoning. Having adopted a conceptual model of practice, they established clearly defined processes for assessment, case formulation and goal setting. Service users, carers and team members confirmed that these initiatives enhanced person-centred practice, highlighted occupational issues and made treatment planning more effective for the whole team.

Sustained Improvement in Pediatricians' ADHD Practice Behaviors in the Context of a Community-Based Quality Improvement Initiative

The long-term sustainability of a quality improvement project was examined. The ADHD Collaborative was designed to assist community-based pediatricians in adhering to the American Academy of Pediatrics evidence-based assessment and treatment guidelines for attention deficit hyperactivity disorder (ADHD). Patient chart reviews were completed out to 2 years post training for 14 practices (N = 38 pediatricians), who received the ADHD Collaborative intervention to assess whether improvements made immediately post training were sustained. Pediatricians maintained significant improvements in their use of evidence-based assessment and treatment practices for a period of 2 years. The majority of the improvements occurred quickly, within 6 months of training. Pediatricians focused most of their continuous quality improvement (CQI) efforts on improving follow-up care for their patients with ADHD. Systematic monitoring and follow up of ADHD patients who were prescribed medication improved considerably from pre-training (10%) to 6 months (49%), and pediatricians continued to make gradual improvements in follow-up care (62% at the 2-year follow up). Systematic intervention efforts with a focus on CQI are effective at improving and sustaining quality of ADHD care. More work is needed to determine how to disseminate, support, and deliver this and similar intervention models to the many physicians who may benefit.

Proton Beam Therapy and the Convoluted Pathway to Incorporating Emerging Technology into Routine Medical Care in the United States

The pathway that emerging medical technologies take to incorporation into routine medical care in the United States is a product of the social, economic, and political milieu. Our review explores how this milieu brought the incorporation of proton beam therapy into the healthcare delivery system to its current point. We look at how new technologies are presently accepted into this system and discuss the emerging trends--such as the use of evidence-based assessment of technology, coverage with evidence policies, and comparative effectiveness analysis--that are affecting proton beam therapy's effort to finds its place in the pantheon of available medical treatments for patients with cancer.