Measuring Serious Emotional Disturbance in Children Workshop Summary (2016) / Chapter Skim
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5 Key Themes and Possible Next Steps
5 Key Themes and Possible Next Steps
Pages 67-80
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From page 67... ...
One of these is that a focus on the two domains, disorder and impairment, is really critical. However, the practice of collecting data on individual disorders with specific diagnostic criteria, which has characterized epidemiological research of mental disorders in the past couple of decades, is unlikely to help advance the goals that SAMHSA has laid out.
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From page 68... ...
The other thread is a broader discussion of how to collect data that provide a more complete picture of child serious emotional disturbance beyond what is required by the legislation, and it might be helpful to distinguish between these two areas of discussion. Dean Kilpatrick recalled that someone once said that mental illness was anything that was significantly disturbing to oneself or anyone else and brought a person to the attention of mental health professionals.
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From page 69... ...
In addition, Visser noted, most instruments do not provide instructions on whether to report symptoms and impairment on or off medications, and this is typically not accounted for in epidemiological studies. When she and her colleagues asked parents whether they were reporting about their children when on or off medication, half of the respondents said that they were reporting off medication or they were reporting based on a mix of what is observed on and off medication.
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From page 70... ...
A Venn diagram would be particularly useful, showing how symptoms, function, and treatment map onto each other. Merikangas said that this overlap issue is the reason that the National Comorbidity Survey Replication Adolescent Supplement (NCS-A)
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From page 71... ...
The impairment is absorbing much broader contextual influences. Merikangas added that she would want to move away from doing prevalence surveys in which the instruments are developed to tap specifically into the DSM and focus instead on getting an index of the disorder, severity, and impairment duration.
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From page 72... ...
Over time, more effective screenings and treatments should make a difference, as they did for more traditional health conditions, such as high blood pressure, but the rates should not be expected to change annually. However, even if SAMHSA concludes that annual data collections are not needed, it does not mean that a large, comprehensive baseline study is not justified.
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From page 73... ...
The discussions about how one could expand on the mandate are interesting and could contribute to the development of a comprehensive research agenda, but they also have cost implications, so the priority should be to consider what would satisfy the requirement to measure serious emotional disturbance and produce state-level estimates at some regular intervals. Replacing annual data collections with the longitudinal follow-ups would be more expensive, even if the number of surveys is the same, because longitudinal surveys have a distinct set of challenges.
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From page 74... ...
Merikangas asked Canino to share her thoughts on the discussions that were centered around impairment throughout the workshop and the possibility of not collecting full DSM diagnoses every year, while still being able to provide estimates that meet the criteria of child serious emotional disturbance. Canino said that based on the mandate, what needs to be measured is DSM disorders and impairment.
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From page 75... ...
If that looks promising, the next step would be to conduct research to determine how it works with younger children, using the instrument that has been adapted from the adult WHO-DAS. Research would also be useful to develop severity scores or cutoff scores for various instruments and to reduce the length of the instruments.
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From page 76... ...
One of the first questions is whether it would be feasible to have a good instrument that could be administered to children on an annual basis, possibly on the internet, with the purpose of measuring the relative levels of serious emotional disturbance across the states. If this is possible without the need for follow-up clinical interviews, it would be the most important parameter to establish first.
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From page 77... ...
Some of these activities would be enormously costly and some might be mutually exclusive, such as combining an internet data collection with a complicated design that requires multiple informants. When grappling with these ideas, Kalton said, perhaps the fitnessfor-use perspective that was mentioned in the presentations would be useful to keep in mind.
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From page 78... ...
What would be the flaws of a model for which the outcome would be serious emotional disturbance based on the CIDI score for the age group that the CIDI covers and the predictor variables? Would a design along these lines pass the laugh test?
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From page 79... ...
Heeringa and his colleagues were able to refine the screening items to obtain these predictions of dementia through that step. Kilpatrick commented that if the ultimate purpose is to establish the relative numbers of cases per state for the allocation of funding, then even if the lack of clinical calibration resulted in elevated prevalence rates -- and it is not clear that it would -- the relative burden per state would presumably still be correct.
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From page 80... ...
How would the disorders be ascertained in this case and how does one ensure that the definition of child serious emotional disturbance is being met? At the minimum, SAMHSA would need to be able to say that the process resulted in a fairly decent proxy measure.
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