ارزیابی مبتنی بر شواهد در بهداشت روانی مدرسه

Although best practice for children's mental health services emphasizes ongoing assessment and monitoring of clinical progress, community based clinicians inconsistently implement assessment as part of clinical care due to a variety of practical barriers. The current study explores which factors may be related to the use and function of evidence-based assessment (EBA) in real-world, clinical settings, particularly school mental health (SMH). Mixed methodologies surveying a national sample of SMH clinicians and interviewing clinicians and program managers were used to explore current assessment practices, including use of specific tools and barriers, facilitators and attitudes toward EBA. Results indicate that clinician level of experience is negatively related to overall attitudes toward EBA, particularly openness. The most commonly-reported barriers to using assessments were difficulty reaching parents, respondents not understanding items, and clinicians not having access to measures they like or need. Also, supervision, when received, does not often include EBA. Academic indicators were more regularly collected than any of the 18 clinical assessment tools queried. Qualitative themes including barriers and facilitators to conducting EBA, specific measures' weaknesses and strengths, strategies to increase response rates and regular administration, and program management considerations regarding EBA implementation provide supporting details to these results. Implications for ongoing quality improvement efforts by program managers and clinicians related to the feasible implementation of EBA in school mental health settings are discussed.

Evidence-based practice in psychology (EBPP) encompasses the application of both empirically supported assessment and intervention principles (American Psychological Association [APA] Presidential Task Force on Evidence-Based Practice, 2006). An evidence-based orientation to clinical practice with children and adolescents has been noted to incorporate three evidence-based elements: (a) assessment that informs diagnosis, treatment planning, and outcome; (b) intervention; and (c) ongoing progress monitoring (APA Task Force on Evidence-Based Practice with Children and Adolescents, 2008). Evidence-based assessment (EBA), in particular, is described as including the use of assessments that have demonstrated psychometric soundness and social validity, and that are used at regular intervals throughout a youth’s treatment (Hunsley & Mash, 2007). EBA strategies assist in the accurate diagnosis of a youth’s concerns, thus facilitating selection of the appropriate evidence-based treatments. EBA also includes the ongoing monitoring of a youth’s progress, which can assist in determining whether modifications to treatment are needed and when treatment can end. At the conclusion of treatment, the use of EBA strategies can be used to inform the evaluation of the outcome (APA Task Force on Evidence-Based Practice with Children and Adolescents, 2008). The importance of EBAs is further underscored when considering that both obtaining an accurate diagnosis (Jensen-Doss & Weisz, 2008) and monitoring treatment progress (Lambert et al., 2003) are associated with success of treatment. Despite the importance and benefit of EBA strategies, the focus of EBPP efforts have largely centered on the application of evidence-based treatment strategies (Hoagwood et al., 2001, Hunsley and Mash, 2007 and Mash and Hunsley, 2005). Although best practice for children’s mental health care emphasizes ongoing assessment and monitoring of clinical progress (Mash and Barkley, 2007 and Mash and Hunsley, 2005), community-based clinicians inconsistently implement EBA as part of clinical care (Jensen-Doss & Hawley, 2011). Practicing psychologists, for instance, endorse the unstructured clinician interview as the most commonly and often only used method of assessment, despite a key aspect of EBA being the use of psychometrically strong, standardized assessment tools (Cashel, 2002). While limited, studies conducted on the topic indicate that master’s-level clinicians who represent the majority of mental health providers for youth are less likely to engage in EBA and use fewer assessment tools than doctoral-level clinicians (Frauenhoffer et al., 1998 and Palmiter, 2004). Taken together, limited findings about use of EBA indicate that neither master’s- nor doctoral-level practitioners consistently use EBA in clinical practice. Barriers to use of EBA include concerns with practicality (e.g., time burden, insufficient financial resources), social validity (e.g., relevance to diverse clinical populations), and utility (e.g., relative benefit of information gained from assessment measures as compared to clinical judgment) (Garland et al., 2003, Hatfield and Ogles, 2007 and Jensen-Doss and Hawley, 2011). Indeed, findings suggest that practical barriers, such as those related to a lack of financial resources to purchase certain assessments and the time to use lengthy assessment measures, are the primary challenges for clinicians implementing EBA (Hatfield & Ogles; Jensen-Doss & Hawley). Despite such barriers, the use of EBA strategies and measures remains critical to the provision of quality clinical care (Groth-Marnat, 2009), and thus should be attended to. School-based clinicians are a particularly important group of practitioners to study in regards to their use of EBA, as schools are a critical setting for reaching youth with mental health needs. Moreover, barriers to EBA may be especially salient to school-based clinicians. However, to our knowledge, studies examining the barriers and facilitators for implementation of evidence-based practices have not examined implementation of EBA strategies, particularly in school settings (cf. Harrison et al., 2010, Lyon et al., 2011, Pagoto et al., 2007 and Ploeg et al., 2007). Given the importance of implementation of EBA in clinical practice, coupled with both evidence that EBA is underutilized and a scant literature base to indicate levers for bolstering use of EBA, it is critical to better understand the actual use of EBA among community-based mental health clinicians, particularly those in schools. Understanding the barriers and facilitators to EBA use within this population would assist in generating practical strategies for sustainable improvement of usual care in schools.