Technical Assistance Partnership for Child and Family Mental Health |
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Mental Health and Systems of Care Frequently Asked Questions |
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April 2006 Screening vs. Assessment: What is the Difference? What is the difference between a screening instrument and an assessment instrument? This is often a confusing issue, although it is not necessarily asked frequently because people assume to know the answer. There is no absolute clarity about the difference between the two processes because the distinction depends on who you ask and what instrument you are referring to, as some instruments are not clearly one or the other. Screening Screening, as defined by AACAP, is the identification of “immediate/current” behavioral health (mental health or substance use) needs. A screening process, usually documented in the form of a standardized instrument, is typically quick, easy to administer and score, and can be reported and/or documented by the child/youth, family member/caregiver, teacher, clinician or other reliable source who knows the child/youth. Screening is usually based on clinical, behavioral, or functional status that is 1) immediate or current; 2) observable; 3) includes the family with their informed consent ; and 4) is dependent on state law of the minor youth. One goal of screening is to address emergent or urgent needs in an identified population such as children recently removed from their homes due to abuse/neglect or youth that have recently been incarcerated or detained. Due to the circumstances involved in either scenario, the child/youth is typically under stress and warrants screening to determine the need for further evaluation and possible immediate treatment or intervention such as suicide precautions. Another goal of screening is to determine if the child/youth meets a clinical/behavioral/functional threshold to receive services and supports from a system of care or provider agency. This is the typical purpose for screening in a system of care. If a child/youth is screened and determined to meet the clinical/behavioral/functional criteria to enter services, the child/youth would then be referred for an assessment, or possible immediate intervention if warranted. Whenever we screen and identify behavioral health needs, we have an ethical responsibility to either provide the necessary next steps (assessment or intervention) or refer to an appropriate source for follow up. Assessment Assessment is a process that is more comprehensive, includes the family, and as AACAP recommends, assesses the child in all life domains including evaluating the strengths of the child/youth and family. The assessment usually takes place within 30 days of intake and screening and must contain certain components:
In general, assessment must be individualized to meet the needs and identify the strengths of the child/youth. As with all interventions, informed consent must be sought and properly documented. A third process that is often confused with screening is “eligibility determination,” which is part of an intake procedure. The distinction between these two is clearer than the distinction between screening and assessment. Eligibility may be determined from the results of an intake form that is a checklist of criteria that the child and/or family may need to meet. Eligibility criteria may include age; diagnosis to determine if the child qualifies as an individual with a serious emotional disturbance; involvement in two or more systems; zip code to determine if they live in the catchment area; income, etc. Choosing an Instrument Some instruments are clearly for screening, and others are clearly for assessment. Still others are sometimes used for either purpose. Before choosing an instrument, read its stated purpose, statistical properties (norming and standardization populations, reliability, validity) and know your population of focus and purpose (eligibility determination, screening or assessment). Individualize your choices based upon your population, purposes, and circumstances. On the TA Partnership’s Mental Health Web page, there is a list of Mental Health and Substance Abuse Screening Instruments. The page lists screening instruments, the developer/publisher, purpose, age of the covered population, and where to obtain further information. The following list of screening instruments is in addition to those mentioned above.
The following are a sample of assessment instruments:
Reference: American Academy of Child and Adolescent Psychiatrists. (2001, September). Psychiatric care of children in the foster care system. Retrieved from http://www.aacap.org/publications/policy/ps45.htm |
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