ABSTRACT
The Brief Psychiatric Rating Scale for Children (BPRS-C) is increasingly used as an outcome measure in research, managed care, and public sector child/adolescent clinical settings. The BPRS-C was developed to provide a descriptive profile of symptoms applicable to a broad range of child and adolescent psychiatric disorders. Its use frequently includes trained and untrained clinician raters with differing degrees of experience and training in child and adolescent disorders. Unfortunately, this latter approach leads to a large amount of variability in scores and consequently reduces its overall reliability. This study reports on a revised BPRS-C with the addition of clinical descriptive anchors designed to improve reliability and validity for both trained and untrained raters. A sample of 4,733 children and adolescents seen in 10 public sector facilities was administered the BPRS-C along with other standard clinical measures (Child Behavior Checklist and Global Assessment of Functioning). Additional reliability data were gathered in a University Medical Center child and adolescent research site with both trained and untrained raters. The data indicated improvement in overall reliability and validity scores, good internal consistency, and improved factor scores. The addition of an overall total severity score may prove to be a useful outcome measure for assessment of treatment response.
Subject(s)
Mental Disorders/diagnosis , Psychiatric Status Rating Scales/standards , Adolescent , Child , Child, Preschool , Factor Analysis, Statistical , Female , Humans , Male , Observer Variation , Reproducibility of ResultsABSTRACT
The article presents a description of processes involved in developing and implementing a statewide continuous evaluation system for the Texas Children's Mental Health Plan (TCMHP) and quality management tools used to approach implementation challenges. Implementation issues are discussed relating to stakeholder involvement, evaluation design evolution, measurement method modification, evaluation integration, staff training, data quality control, communication of results, and use of results in decision making. A review of implementation processes suggests evaluation design and activities should be seen as constantly evolving in response to ongoing stakeholder input. Involving stakeholders in design and implementation can result in increased data quality, data-informed decision making to improve service delivery, and increased public accountability. The TCMHP evaluation system development demonstrates that quality management tools can provide a useful framework to work through design and implementation problems, and a continuous evaluation system can provide an infrastructure for meeting data needs in a managed care environment.
Subject(s)
Adolescent Health Services/standards , Child Health Services/standards , Community Mental Health Services/standards , Outcome Assessment, Health Care/organization & administration , Total Quality Management/organization & administration , Adolescent , Child , Humans , Outcome Assessment, Health Care/methods , Planning Techniques , Program Evaluation , Public Health Administration/standards , Research Design , Social Responsibility , Texas , Total Quality Management/methodsABSTRACT
With the focus of the National League for Nursing on therapeutic intervention, critical thinking, and communication skills, nursing programs are challenged to measure these outcomes for their BSN graduates. The authors report the use of the Critical Incident Technique to identify behavioral indicators of communication, critical thinking, and therapeutic intervention skills from first-line nursing supervisors' descriptions of exemplary nursing practice.
