Structured interview and uniform assessment improves diagnostic reliability

Objective: To compare a Childhood Uniform Assessment Package (CUAP), includ ing a computerized structured diagnosis, with routine assessment and treatm ent in public mental health settings. Data Sources/Study Settings: Data was collected prospectively on 250 childr en and adolescents in both public mental health inpatient and outpatient se ttings in a large metropolitan area and a rural area. Study Design: Subjects were randomized to either routine assessment and tre atment as usual (ATU) or ATU plus an additional "gold standard" assessment battery Childhood Uniform Assessment Package (CUAP). Outcome measures were taken at admission (baseline), discharge, and again 6 months later. Methods: The study was conducted at a State Hospital (CUAP, n = 75; ATU, n = 75) and a Community Mental Health center (CUAP, n = 50; ATU, n = 50). The "gold standard" diagnostic process was established at the Children's Medic al Center-Dallas. Research focused on a comparison of the CUAP diagnostic p rocess to the existing diagnostic process (ATU) and the service delivery sy stem of an inpatient and outpatient public sector clinical treatment settin g. Principal Findings: A bachelor's level individual can be trained to adminis ter a highly reliable diagnostic battery to meet a "gold standard," suggest ing a possible cost-effective way to assist in diagnostic evaluations. High er reliability was found between this standardized assessment package (CUAP ) and inpatient physicians than for outpatient physicians. The highest inte rrater reliabilities were found for attention deficit and substance abuse d isorders, less so for the other behavior disorders. The use of CUAP results in more reliable diagnoses in public settings than those provided by typic al clinical staff by identifying mood and anxiety disorders (disorders with the lowest reliability) with better reliability. The addition of "gold sta ndard" diagnostic assessments (CUAP) did not appear to affect length of sta y, number of medication changes, use of seclusion or restraints, and other behavioral interventions in the inpatient setting. Outpatient follow-up ser vices did not differ for CUAP versus ATU either. Conclusions: A standard uniform assessment package that includes a structur ed diagnostic instrument can improve overall diagnostic reliability but may not have a significant overall impact in clinical treatment strategies or outcomes without additional intervention to assure proper use of the inform ation. A well-trained bachelor's level assistant can administer such a batt ery.