Professor Andres De Los Reyes – Professor Elizabeth Talbott | Transforming Youth Mental Health Through Evidence-based Assessment

Youth mental health in the USA is in crisis, having steadily worsened over the past ten years. To tackle this crisis, we have to understand it. Evidence-based assessment is key to this understanding. Professor Andres De Los Reyes at the University of Maryland and Professor Elizabeth Talbott at William and Mary lead the study of mental health assessment designed to advance outcomes for all children and youth.

Understanding the Mental Health Challenge

According to the Centers for Disease Control and Prevention, almost 1 in 5 children in the USA experience a mental health or behavioural disorder. Children with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), externalising problems, and anxiety or depression benefit from evidence-based practices designed to meet their needs. Gathering and interpreting data about a child’s condition from different informants is central to the delivery of these evidence-based practices. These assessment data include ratings from parents, teachers, and youth themselves. Yet, in both education and health care, research on assessment has not kept pace with research on interventions. This gap persists even as research shows that parents, teachers, and youth disagree in their ratings.

To address this gap and understand these disagreements, Professor Andres De Los Reyes at the University of Maryland and Professor Elizabeth Talbott at William and Mary use innovative approaches, all guided by the Operations Triad Model (OTM). As a framework, the OTM allows researchers to account for the different perspectives of informants and the contexts where informants observe youth behaviour (i.e., in the home, school, and community). Recent research guided by the OTM gives professionals a vision and a method for using informant ratings to make decisions, especially when these ratings disagree. This is because the disagreements capture the unique nature of the perspectives from informants, depending on where behaviour happens. In surprising ways, disagreements among informants allow professionals to understand youth mental health.

The Impact of Attention Deficit Hyperactivity Disorder

ADHD is one of the most common diagnoses among children and youth, affecting around 10% to 12% of young students. According to the 2018 National Health Survey, the percentage of youth identified with ADHD has doubled over the last two decades. Symptoms can include talking too much, finding it hard to resist temptation, taking unnecessary risks, having trouble taking turns, and having trouble getting along with others. Children and youth with ADHD often experience complex problems that need comprehensive interventions at home and at school.

Team-Based Collaborative Care

Young people receive their ADHD diagnoses and evidence-based practices in healthcare settings. They also receive services in school. Yet, healthcare and school providers do not always share youth and family data. Professors Talbott and De Los Reyes proposed a team-based collaborative care model (TBCCM) to promote communication and collaboration among healthcare and education leaders to advance evidence-based assessment. Their model has three key features: (a) effective teamwork between leaders in health care and education, (b) the use of data from different informants (parents, teachers, and youth), and (c) the adaptation of evidence-based practices using those data.

Based on pioneering work conducted by their colleagues in pediatric health care, Professors De Los Reyes and Talbott anticipate that the TBCCM will improve the uptake of evidence in assessment by health care and education teams. The result will be a better understanding of youth mental health and better outcomes.

The Needs-to-Goals Gap

Sound assessment tools are essential for evidence-based practice within the TBCCM. Assessment involves gathering, interpreting, and using evidence to guide mental health services. This is the bedrock for evidence-based practices in youth mental health care.

Although collecting data from multiple informants is best practice in healthcare and education, professionals have little guidance on how to use these data, with disagreements among ratings playing a vital role in the need for guidance. The result is a Needs-to-Goals Gap that limits the quality of youth mental health services. To close this gap, Professors De Los Reyes and Talbott embrace (not erase) informant disagreements. When they account for the different perspectives of informants and the contexts where they observe behaviour, professionals can identify youth needs, establish goals for mental health, and find evidence-based practices to meet those goals.

Evidence-Based Assessment in Special Education

Gaps also emerge in the assessment of youth academic skills. Gaps occur when we don’t know where and how youth are struggling with what academic skills. Nor is there consistent empirical guidance about how to interpret results and make decisions when different academic data sources disagree. Guided by the previously mentioned OTM, Professors Talbott, De Los Reyes, and their colleagues advance EBA in special education research. The OTM framework helps investigators decide what domains to measure, how and when to measure them, and how to interpret results. The OTM and EBA work across special education, such as in reading for youth with dyslexia and EBA for English learners. To support researchers in using the OTM, the research team compiled a set of open data resources and articulated future directions for research.

Optimising Mental Health Assessment

We know that EBA in youth mental health must account for the different perspectives of informants and the contexts where informants observe youth behaviour (i.e., in the home, school, and community). Professor De Los Reyes and his team devised and tested CONTEXT―a methods-focused extension of the OTM―to increase the accuracy of data from multi-informant assessment. Whereas current approaches force researchers to assume that informant disagreements cannot contain useful information, CONTEXT provides users with an evidence-based approach to decide what combination of informant ratings best describes a young person’s mental health status. With CONTEXT, professionals boost the accuracy of informant ratings, thereby allowing them to understand the mental health of the youth they serve.

The Next Steps

Having developed, tested, and validated new approaches for making sense of mental health data, we are overdue to tackle the role of sound assessment in the mental health crisis. We must learn what professionals in the field are doing right now to serve the needs of children and youth. What informants do professionals use? Do they rely on one, two or three informants to understand the needs of youth? When do professionals use informants – at the beginning or throughout service delivery? We do not know.

To answer these and other questions, Professors Talbott and De Los Reyes seek funding for a national survey of youth mental health leaders in education and health care. These leaders guide intervention teams in making decisions for youth with a range of mental health problems – from externalising and internalising to symptoms of ADHD and ASD. How do they use informant data to make decisions for these youth? The answer to this question is key to understanding youth mental health and improving evidence-based practice. Evidence-based assessment is the first step to tackling the mental health crisis.