Can standardized diagnostic assessment be a useful adjunct to clinical assessment in child mental health services? A randomized controlled trial of disclosure of the Development and Well-Being Assessment to practitioners

  • Tamsin Ford
  • Anna Last
  • William Henley
  • Shelley Norman
  • Sacha Guglani
  • Katerina Kelesidi
  • Anne-Marie Martin
  • Pippa Moran
  • Harriett Latham-Cork
  • Robert Goodman
Original Paper



While research demands standardized diagnostic assessments as an indication of sufficient methodological rigour, there is debate about their application to clinical practice. The Development and Well-Being Assessment (DAWBA) provides a structured assessment of psychiatric disorder. Since it can be completed on-line, it could be used by Child and Adolescent Mental Health Services with few additional demands on staff. Access to the standardized diagnostic information as an adjunct to clinical assessment could reduce the number of appointments spent on assessment, free up practitioner time to work on engagement and improve clinical outcomes by increasing the accuracy of assessment and thus access to the appropriate evidence-based treatment.


Randomized controlled trial of the disclosure of the DAWBA to the assessing practitioner (n = 117) versus assessment at normal (n = 118) and analysed by “intention to disclose”.


Exposure to the DAWBA may increase agreement between the DAWBA and practitioners about some anxiety disorders, but detected no other statistically significant increased agreement for other disorders, nor a reduced need for further assessment, the number of difficulties recognised or influence on outcomes.


The results may be explained by the inadequacy of the DAWBA, lack of statistical power to detect any effects that were present or a reluctance of some practitioners to use the DAWBA in their assessment. Future research might benefit from exploring the use of the DAWBA or similar assessments as a referral rather than an assessment tool, and exploring how practitioners and parents experience and use the DAWBA and what training might optimise the utility of the DAWBA to clinical practice.


DAWBA Standardized Assessments Diagnosis RCT 



We are extremely grateful to the two child and adolescent mental health services that hosted` the study, and to the parents and practitioners who gave up their time to participate, and to the Medical Research Council in England who funded the original project as part of a Clinician Scientist Fellowship for Tamsin Ford.

Conflicts of interest

RG is the owner of Youthinmind, which provides no-cost and low-cost software and web sites related to the SDQ and DAWBA. TF was supported by a Clinician Scientist award from the Medical Research Council in England to complete this work. Anna Last, Shelley Norman and William Henley completed this work while supported by the Collaboration for Applied Health Services Research and Care (CLAHRC) for the South West of England. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. None of these funders had any influence over the design, analysis or writing up of this work.


  1. 1.
    Foreman D, Foreman D, Prendergast M, Minty B (2001) Is clinic prevalence of ICD-10 hyperkinesis underestimated? Impact of increasing awareness by a questionnaire. Eur J Child Adolesc Psychiatry 10:130–134CrossRefGoogle Scholar
  2. 2.
    Ford T, Hamilton H, Goodman R, Meltzer H (2005) Service contacts among the children participating in the British child and adolescent mental health. Child Adolesc Mental Health 10:2–9CrossRefGoogle Scholar
  3. 3.
    Martin A, Fishman R, Baxter L, Ford T (2011) Practitioners’ attitudes to standardized diagnostic assessment in routine practice: a qualitative study in two Child and Adolescent Mental Health Services. Clin Child Psychol Psychiatry 16(3):407–420PubMedCrossRefGoogle Scholar
  4. 4.
    Jones J (2004) The post-registration education and training for nurses working with children and young people with mental health problem. RCN Institute, LondonGoogle Scholar
  5. 5.
    Lindsay C, Griffiths P (2004) Developing a comprehensive CAMHS. YoungMinds Magazine 73:31–33Google Scholar
  6. 6.
    Shah P, Mountain D (2007) The medical model is dead: long live the medical model. Br J Psychiatry 19:375–377CrossRefGoogle Scholar
  7. 7.
    Weinstein SR, Stone K, Noam GG, Grimes K, Schwab-Stone M (1989) Comparison of DISC with practitioner’s DSM-III diagnoses in psychiatric inpatients. J Am Acad Child Adolesc Psychiatry 28:53–60PubMedCrossRefGoogle Scholar
  8. 8.
    Aronen ET, Noam GG, Weinstein SR (1993) Structured diagnostic interviews and practitioner’s discharge diagnoses in hospitalized adolescents. J Am Acad Child Adolesc Psychiatry 32:674–681PubMedCrossRefGoogle Scholar
  9. 9.
    Jensen AL, Weisz JR (2002) Assessing match and mismatch between practitioner-generated and standardized interview-generated diagnoses for clinic-referred children and adolescents. J Consult Clin Psychol 70:158–168PubMedCrossRefGoogle Scholar
  10. 10.
    Hawley KM, Weisz JR (2005) Youth versus parent working alliance in usual clinical care: distinctive associations with retention, satisfaction and treatment outcome. J Clin Child Adolesc Psychol 34:117–128PubMedCrossRefGoogle Scholar
  11. 11.
    Basco MR, Bostic JQ, Davies D, Rush AJ, Witte B, Hendrickse W et al (2000) Methods to improve diagnostic accuracy in a community mental health setting. Am J Psychiatry 157(10):1599–1605CrossRefGoogle Scholar
  12. 12.
    Horvath AO, Luborsky L (1993) The role of the therapeutic alliance in psychotherapy. J Consult Clin Psychol 61:561–573PubMedCrossRefGoogle Scholar
  13. 13.
    Jensen Doss A, Weisz JR (2008) Diagnostic agreement predicts treatment process and outcomes in youth mental health clinics. J Consult Clin Psychol 76:711–722PubMedCrossRefGoogle Scholar
  14. 14.
    Goodman A, Heiervang E, Collishaw S, Goodman R (2011) The ‘DAWBA bands’ as an ordered categorical measure of child mental health: description and validation in British and Norwegian samples. Soc Psychiatry Psychiatr Epidemiol 46:521–532PubMedCrossRefGoogle Scholar
  15. 15.
    Goodman R, Ford T, Simmons H, Gatward R, Meltzer H (2000) Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample. Br J Psychiatry 177:534–539PubMedCrossRefGoogle Scholar
  16. 16.
    Goodman R (2001) Psychometric properties of the Strengths and Difficulties Questionnaire (SDQ). J Am Acad Child Adolesc Psychiatry 40:1337–1345PubMedCrossRefGoogle Scholar
  17. 17.
    Wolpert M, Fuggle P, Cottrell D, Fonagy P, Phillips J, Pilling S, Stein S, Target M (2006) Drawing on the evidence, vol 2. CAMHS Publications, London, p 17Google Scholar
  18. 18.
    Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia S (1983) A children’s global assessment scale (CGAS). Arc Gen Psychiatry 40(11):1228–1231CrossRefGoogle Scholar
  19. 19.
    Sourander A, Helenius H, Piha J (1996) Outcome of short-term child psychiatric hospitalization (teacher evaluation at 5-month and 12-month follow up). Eur J Child Adolesc Psychiatry 5:204–211CrossRefGoogle Scholar
  20. 20.
    Matts JP, Lachin JM (1998) Properties of permuted-block randomization in clinical trials. Control Clin Trials 9:327–344CrossRefGoogle Scholar
  21. 21.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  22. 22.
    Dewey ME (1983) Coefficients of agreement. Br J Psychiatry 143:487–489PubMedCrossRefGoogle Scholar
  23. 23.
    Department of Communities and Local Government (2007) The English indices of multiple deprivation. HMSO, LondonGoogle Scholar
  24. 24.
    Hunter J, Higginson I, Garralda E (1996) Systematic literature review: outcome measures for child and adolescent mental health services. J Public Health Med 18(2):197–206PubMedCrossRefGoogle Scholar
  25. 25.
    Meltzer M, Gatward R, Goodman R, Ford TJ (2000) The Mental Health of children and adolescents in Great Britain. The Stationery Office, LondonGoogle Scholar
  26. 26.
    Meltzer H, Lader D, Corbin T, Goodman R, Ford T (2004) The mental health of young people looked after by local authorities in Scotland. The Stationery Office, EdinburghGoogle Scholar
  27. 27.
    Gelman A, Hill J (2006) Data analysis using regression and multilevel/hierarchical models. Cambridge University Press, cambridgeGoogle Scholar
  28. 28.
    Schenker N, Gentleman JF (2001) On judging the significance of differences by examining the overlap between confidence intervals. Am Statist 55(3):182–186CrossRefGoogle Scholar
  29. 29.
    Last A, Ford T, Henley W, Norman S, Goodman R. Feasibility of the Development and Well Being Assessment as an adjunct to clinical assessment in child and adolescent mental health services. Child Adoles Mental Health (submitted 16 July 2012)Google Scholar
  30. 30.
    Norman SM, Dean S, Hansford L, Ford T. Clinical practitioner’s attitudes towards the use of routine outcome monitoring within Child and Adolescent Mental Health Services: a qualitative study of two Child and Adolescent Mental Health Services (in submission)Google Scholar
  31. 31.
    Aebi M, Kuhn C, Winkler Metke C, Stringaris A, Goodman R, Steinhausen HC. The use of the Development and Well-Being Assessment in clinical practice: a clinical trial. Eur Child Adolesc Psychiatry (submitted 20 February 2012)Google Scholar
  32. 32.
    Ferrante di Ruffano L, Hyde CJ, McCaffery KM, Bossuyt PMM, Deeks JJ (2012) Assessing the value of diagnostic tests: a framework for designing and evaluating trials. BMJ 344:18–22CrossRefGoogle Scholar
  33. 33.
    Norman SM (2011) Factors influencing the outcomes of children utilizing CAMHS. PhD Thesis, Peninsula College of Medicine and Dentistry, University of Exeter, ExeterGoogle Scholar
  34. 34.
    Martin AM, Fishman R, Baxter L, Ford TF (2011) Practitioner Attitudes to Standardised Diagnostic Assessment: a qualitative study in two CAMHS. Clin Child Psychol Psychiatry 16:407–420PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Tamsin Ford
    • 1
  • Anna Last
    • 1
  • William Henley
    • 1
  • Shelley Norman
    • 1
  • Sacha Guglani
    • 3
  • Katerina Kelesidi
    • 2
  • Anne-Marie Martin
    • 2
  • Pippa Moran
    • 2
  • Harriett Latham-Cork
    • 1
  • Robert Goodman
    • 2
  1. 1.Peninsula Medical SchoolUniversity of ExeterExeterUK
  2. 2.Department of Child and Adolescent PsychiatryKings College London, Institute of PsychiatryLondonUK
  3. 3.South London and Maudsley NHS TrustCroydon CAMHSCroydonUK

Personalised recommendations