The question posed in the title is one that Benchmarks’ project managers and coordinators hear often during our implementation work within our state’s social services and mental health agencies. As busy as our mental health clinicians are, why would we want them to spend more time completing a battery of measures for children and families that need to get into services as quickly as possible? Isn’t it better to get their basic comprehensive clinical assessment completed quickly and start working on their treatment plans?
Children and families deserve to begin their journey on the path of well-being as quickly as possible, especially for those involved with the foster care system. However, we run the risk of missing important information about those we serve when we don’t take more time to meet with them and assess their strengths, challenges, and needs holistically and thoroughly. Requiring an appropriate, standardized assessment battery based upon age/developmental level builds the foundation for the delivery of more robust services to children and their families. An effective assessment ensures good recommendations that encompass not only a diagnosis (if there is one) but cross all of the domains of a child’s life.
Using a standard set or group of well-validated measures gives clinicians a consistent way to assess, diagnose, and monitor symptom reduction and progress in children regardless of which agency provides the assessment service. For families that are more transient, utilization of a standard assessment approach is helpful as they may access services from providers across a wide area. Requiring the use of a standardized set of measures raises and equalizes the quality of assessment children receive across a system. as well.
A standardized battery of measures assists clinicians by allowing them to accurately define the treatment need, aids in determining a quality differential diagnosis, and deepens the clinician’s overall assessment, guiding more effective treatment. Trauma often presents itself as a set of outward symptoms that seem to be consistent with a behavioral disorder, leading clinicians to select assessment measures (if any) that are based upon the presenting problem. This leads to an overrepresentation of behavioral disorders. Using a battery allows caregivers to identify the child’s presenting issue in a more accurate and comprehensive way. It allows them to see what is driving the behaviors, often traumatic experiences, rather than seeing it as solely a behavioral issue.
Clinical competence and judgment vary among clinicians, including those that work in the same state. Even well-trained and experienced clinicians can be overconfident in their own clinical judgment and may fail to see errors that can be made in the assessment process (these may include race/ethnic/social/gender or confirmatory biases, diagnostic overshadowing). A standardized battery of measures counterbalances the limitations of clinical lenses and offsets subjective assessment. Additionally, use of a measures battery allows the clinician to receive input from multiple contacts in the child’s life, giving the clinician information about various aspects of the presenting issue and the child’s functioning.
Completing multiple measures during the assessment process requires an additional investment of time and money for clinicians and their agencies. Spending those resources at the assessment phase may improve clinical judgment and treatment recommendations. Improved, holistic treatment recommendations, when implemented effectively, can lead to reduction in trauma symptoms, less time spent addressing crises and accessing restrictive mental health crisis services, and fewer placement moves due to behavioral disruptions. Together, these create better outcomes for youth and their families.
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