University of California, Los Angeles (UCLA), Semel Institute for Neuroscience and Human Behavior (Zima, Marti) and UCLA Center for Health Policy Research, Fielding School of Public Health (Lee, Pourat), UCLA.
Psychiatr Serv. 2019 May 1;70(5):381-388. doi: 10.1176/appi.ps.201800424. Epub 2019 Feb 28.
This study describes the process of choosing a clinical outcome measure for a statewide performance outcome system for children receiving publicly funded mental health services in California.
The recommendation is based on a five-phase approach, including an environmental scan of measures used by state mental health agencies; a statewide provider survey; a scientific literature review; a modified Delphi panel; and final rating of candidate measures by using nine minimum criteria informed by stakeholder priorities, scientific evidence, and state statute.
Only 10 states reported use of at least one standardized measure for outcome measurement. In California, the most frequently reported measures were the Child and Adolescent Needs and Strengths (CANS) (N=33), the Child Behavior Checklist (N=14), and the Eyberg Child Behavior Inventory (N=12). Based on modified Delphi panel ratings, only the Achenbach System of Empirically Based Assessment, the Strengths and Difficulties Questionnaire, and the Pediatric Symptom Checklist (PSC) were rated on average in the high-equivocal to high range on effective care, scientific acceptability, usability, feasibility, and overall utility. The PSC met all nine minimum criteria for recommendation for statewide use. In its final decision, the California Department of Health Care Services mandated use of the PSC and CANS.
There is a lack of capacity to compare child clinical outcomes across states and California counties. Frequently used outcome measures were often not supported by scientific evidence or Delphi panel ratings. Policy action is needed to promote the selection of a common clinical outcome measure and measurement methodology for children receiving publicly funded mental health care.
本研究描述了为加利福尼亚州接受公共资金资助的精神健康服务的儿童选择全州绩效结果系统的临床结果测量指标的过程。
该建议基于五阶段方法，包括对州心理健康机构使用的措施进行环境扫描；全州范围内的供应商调查；科学文献综述；经过修订的 Delphi 小组；以及使用利益相关者的优先事项、科学证据和州法规通知的九条最低标准，最终对候选措施进行评分。
只有 10 个州报告至少使用了一种标准化的结果测量方法。在加利福尼亚州，报告最频繁的措施是儿童和青少年需求与优势（CANS）（N=33）、儿童行为检查表（N=14）和 Eyberg 儿童行为清单（N=12）。根据修订后的 Delphi 小组评分，只有 Achenbach 基于经验的评估系统、优势和困难问卷以及儿科症状清单（PSC）在有效护理、科学可接受性、可用性、可行性和整体实用性方面的评分平均处于高到高的范围内。PSC 符合推荐全州使用的所有九条最低标准。加利福尼亚州卫生保健服务部最终决定要求使用 PSC 和 CANS。
各州和加利福尼亚县之间比较儿童临床结果的能力不足。常用的结果测量指标往往没有科学证据或 Delphi 小组评分支持。需要采取政策行动，以促进选择一种常见的儿童接受公共资金资助的精神健康护理的临床结果测量指标和测量方法。
