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

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, Children's 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.

Assessing outcomes in child psychiatry.

OBJECTIVE: To report on the first year of a program using standardized rating scales within a large, multisite mental health system of care for children and to assess the validity, reliability, and feasibility of these scales. STUDY DESIGN: Naturalistic follow-up of clinicians' ratings. METHODS: Clinicians filled out the Brief Psychiatric Rating Scale for Children (BPRS-C) and the Children's Global Assessment Scale (CGAS) at intake and discharge/90-day follow-up for all new patients. RESULTS: Data were collected on 2396 patients from all 20 sites serving children in the Partners HealthCare network. Mean scores for both BPRS-C and CGAS showed worst functioning at inpatient sites, followed by Acute Residential Treatment, then partial hospital, then outpatient sites. All patients re-rated at discharge or 90-day follow-up showed a significant improvement in scores. Inter-item reliability on the BPRS-C was acceptable, with Cronbach alphas of .78 and .81. Feasibility at intake was demonstrated in that 66% of all patients had a completed form at intake. Reassessment at discharge also appeared to be feasible in more restrictive levels of care, but less feasible in outpatient sites, where fewer than 25% of all patients had a follow-up form. CONCLUSIONS: This evaluation suggested that the 2 standardized measures appeared to be valid and reliable as part of routine intake and discharge/follow-up in a large child psychiatry system of care. Whether these measures are truly clinically useful remains to be demonstrated because there is at present no gold standard for assessing the quality of treatment or change caused by it.