Scenario:

A parent asks, "Where should I go if I want my child to have the best chance of feeling and doing better?"
A clinician asks, "How am I doing in helping families?"
A program director asks, "Are kids in our program getting better?"
An administrator asks, "Which services can we learn from to help kids get better, faster?"

For all of these questions, we need to know whether children and youth are getting better, and at what pace.

Steps in the process:

To know the answer to any and all of these questions, we have to have a comparable measure broad enough to gauge progress across diverse populations in diverse treatment settings. The measure must capture clinical symptoms, functioning in important life domains such as home, school, and community, and context (such as acculturation, trauma history, and family resources). The measure needs to be given across programs in a system. This information when collected and rapidly fed back to providers, can help us understand what services have the most potential for addressing clinical needs and restoring functioning. This information can also help us understand when it's important to change providers, or to move to a different intensity of care ('step-up' or 'step down').


How do I use this?

This information tells you where to look to identify actions that are effective in reducing mental health symptoms and improving functioning. The goal in the use of this information is twofold: first, to spread the use of effective local practices and two, to empower people to choose to access more effective practices.

To achieve the first requires delving deeper into practices that seem to be working. There are a number of ways to find out what actions underlie successful outcomes. The methods for doing so range from identifying whether a documented practice is being implemented (i.e., a treatment with a treatment manual and well-defined practices) to using file review, narrative and observational methods to identify effective actions.

Achieving the second requires sharing the information that you have collected. Providing easy-to-understand representations of programs' clinical and functional outcomes allows parents and youth to consider how to best spend their limited help-seeking resources.

The goal of these two actions together is to create a virtuous cycle: providers learn from each other what practices are most effective, families go to more effective providers; as providers take on more effective practices, families are able to choose from more providers who are effective.

What do I still not know?

Collecting and feeding back information about clinical and functional effectiveness can tell you what services are working, and how quickly. What is doesn't tell you is why a service works. To understand why a service works, you have to dig deeper and find out the actions that providers are taking which are most effective with families.