The Use of Rating Scales to Measure Outcomes in Child Psychiatry and Mental Health

Abstract

Objective. To help clinicians and administrators select among rating scales in common use in child and adolescent psychiatry. Background. In Massachusetts, many insurers now require the use of standardized scales to rate child and adult mental health patients. With literally hundreds scales available, clinicians and administrators who have to choose a rating scale may find the vast assortment of instruments bewildering. This chapter brings a theoretical framework to bear on a review of some of the most commonly used scales and provides a case study example of a recent set of decisions in Massachusetts. Results. We conducted a PubMed search using the term ‘Rating scales’ combined with ‘Child psychiatry’ and came up with over 700 papers. Restricting our search to the years from 2002-present reduced the list to 149 articles and 103 named scales in current use. Further restricting our search to those measures mentioned in three or more publications resulted in a list of 11 commonly and recently used measures, only three of which were broadband scales. Since a number of scales commonly used in clinical practice were not on the above list, we added the ten recommended child and adolescent instruments named on the website of a large mental health carve-out insurance company as well as two of the most widely used scales that were not on either of these two lists. We then reviewed the resultant list of 15 scales in terms of a sixteen dimensions that are important to consider in making selection decisions. Conclusions. Results from the current review identified hundreds of instruments that potentially meet the requirements of insurers but just over a dozen broadband scales which appear to be in common recent use in child psychiatry. All of these rating scales have been used to establish profiles at intake and although all have been used as pre-post measures, none have been expressly validated as measures of clinically significant change. Thus, although there appears to be growing pressure to use standardized rating scales at intake in psychiatry, there is no evidence to support the validity of any available scale as a ‘gold standard’ yardstick to demonstrate diagnostic or treatment efficacy, let alone for using any scale to restrict access to care or length of treatment. Too little is known about the real world reliability and true clinical predictive validity of such measures to allow them to replace the judgment of experienced clinicians in these matters at this time.

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