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
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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.
KeywordsDAWBA 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.
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