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Assessing outcomes in child psychiatry
Joseph Gold1, Ralph J Buonopane, Robert A Caggiano
1McLean Hospital, Belmont, MA, USA.
The American Journal of Managed Care
|April 10, 2009
Summary
Standardized rating scales, Brief Psychiatric Rating Scale for Children (BPRS-C) and Children's Global Assessment Scale (CGAS), proved valid and reliable in a large child mental health system. Data showed significant patient improvement over time.
Area of Science:
- Child and Adolescent Psychiatry
- Mental Health Services Research
- Psychometric Evaluation
Background:
- Implementing standardized rating scales in large child mental health systems is crucial for consistent care evaluation.
- Assessing the validity, reliability, and feasibility of these scales is essential for their effective use.
Purpose of the Study:
- To evaluate the first year of a program utilizing standardized rating scales in a multisite child mental health system.
- To determine the validity, reliability, and feasibility of the Brief Psychiatric Rating Scale for Children (BPRS-C) and the Children's Global Assessment Scale (CGAS).
Main Methods:
- Naturalistic follow-up of clinician ratings for 2396 new child patients across 20 sites.
- Clinicians completed the BPRS-C and CGAS at intake and discharge/90-day follow-up.
Main Results:
- Both BPRS-C and CGAS scores indicated poorer functioning in more intensive treatment settings.
- All patients showed significant improvement from intake to discharge/follow-up.
- BPRS-C demonstrated acceptable inter-item reliability (Cronbach's alpha .78–.81).
- Intake feasibility was high (66% completion); however, discharge/follow-up feasibility was lower in outpatient settings (<25%).
Conclusions:
- The BPRS-C and CGAS appear valid and reliable for routine use in child mental health systems.
- The clinical utility of these measures requires further demonstration, as a gold standard for treatment quality assessment is lacking.
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