L. Bickman et al., CLINICIAN RELIABILITY AND ACCURACY IN JUDGING APPROPRIATE LEVEL OF CARE, Journal of consulting and clinical psychology, 65(3), 1997, pp. 515-520
Accurately assigning children to the most appropriate level of care is
widely recognized as important. Managed care companies conduct utiliz
ation reviews in which they monitor the level of care to which clients
are assigned using written placement criteria. However, no research h
as examined the ability of clinicians to perform this task. In the pre
sent study, 47 child and adolescent clinical profiles consisting of 48
variables were developed. Eighteen clinicians, trained to use their a
gency's level-of-care guidelines, made level-of-care decisions on thes
e profiles. Their interjudge reliability in assigning a child to an ap
propriate level of care was close to zero (kappa =.07). There was a sm
all, statistically significant correlation between client placement an
d actual placement, but chance-corrected agreement between client plac
ement and actual placement was very low (kappa =.09). Implications of
these findings for clinical research, practice, policy, and training a
re discussed.