Understanding the Different Types of Mental Health Assessments and Screening Tools for Behavioral Health Clinicians PDF

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Understanding the Different Types of Mental Health Assessments and Screening Tools for Behavioral Health Clinicians

Identifying and treating behavioral and mental health disorders is not as straightforward as treating bodily illness or injury. Mental illness symptoms manifest in cognitive, emotional, behavioral and sometimes physical ways, making it challenging to grasp the complete diagnosis at a glance. Mental health assessments are valuable tools for practitioners to help fill in these gaps and provide a better-rounded picture of a patient’s status.

What Is a Behavioral Health Assessment? Behavioral and mental health assessments include a combination of tests, examinations and screenings that provide information about how a patient is functioning. These assessments help identify mental health problems, differentiate between mental and physical health problems and give insight into patients who received their referral due to issues at work, school or home. Understanding the methods and practices associated with mental health assessments can help you take practical diagnostic and treatment approaches with each client.

What Does a Mental Health Assessment Include?

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Interview: General interviews allow you to note your patient’s mood and presentation. Asking questions about the patient’s symptoms and concerns, as well as their life situation and thought patterns, can help reveal initial areas on which to focus. Physical exam: To help distinguish between symptoms resulting from a mental disorder and symptoms related to bodily illness, you may need to complete a physical exam. Ask about your patient’s personal and family medical history, as well as any medications they may take. Lab tests: Some symptoms may prompt the need for lab tests or scans. Blood or urine samples and MRI, EEG or CT scans may be helpful when assessing a patient. Written or verbal tests: You may want to administer a test to help identify specific problems, test certain functions or further assess a patient’s well-being.

Mental and behavioral assessment tools can help assist and guide your assessments by pinpointing symptoms and providing valuable data.

What Are Mental and Behavioral Assessment Tools? Assessment tools are specific methods of gathering information to help understand a patient, their symptoms, their life situation and more. These tools may come in the form of tests or examinations and typically target certain disorders. When assessing a patient, you’ll likely use multiple approaches and compile the data to create a comprehensive observation. Assessing each patient’s overall mental health status is key to providing quality, effective treatment.

How Do You Assess Mental Health Status? Determining how you assess your patient’s mental health status will depend on the types of assessment and screening tools you use. Consider the following factors when selecting a tool:    

Reliability: Does the test have the reliability to produce consistent results? Validity: Does the test have the validity to differentiate between a patient with a problem and one without? Sensitivity: Does the test have the sensitivity to identify a problem accurately? Specificity: Does the test have the specificity to identify individuals who do not have a problem?

Selecting a test that conforms to the above factors will help make your results as accurate and helpful as possible. Disorder-specific assessments are valuable tools when working with patients, but how can you know which areas to test for? Screening tools can be the starting point that illuminates these risk areas.

What Is the Difference Between a Screening Tool and an Assessment Tool? At nearly 1,000 pages, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains hundreds of potential disorders you may see in your facility. Administering detailed assessments for all possible problems would be illogical and timeconsuming, which is why clinicians use screening tools.

Here are some crucial differences between screening and assessment tools. 

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Screening tools identify the possible presence of specific problems: Usually given in a checklist or questionnaire format, screening tests may be broader in scope than assessments. Clinicians typically use screening tools early on when working with a patient to help focus on potential disorders. Assessment tools provide a complete picture: Assessment tools tend to focus on determining the presence of a specific disorder and its nature and severity. Clinicians typically use assessment tools to dig deeper into screening results. Assessment tools are available for a range of topics and come in a wide variety of formats.

Mental health screening and assessment tools are beneficial because they help clinicians diagnose and treat patients quickly and accurately. Understanding the different types of screening and assessment tools available allows you to make an informed decision for each patient.

7 Types of Screening Tools for Behavioral Healthcare The appropriate screening tool depends on your patient’s self-awareness level and evident symptoms. If mental illness is present in your patient’s family medical history, you may also wish to screen for those disorders. Here are seven common types of screening tools to consider using.

1. General In some situations, your patient may not recognize the symptoms and disorders they are experiencing. General mental health screenings like the Kessler Psychological Distress Scale, Patient Stress Questionnaire or My Mood Monitor checklist check for early signs of mental health symptoms. Primary care doctors may also use these screenings during regular checkups to refer at-risk patients to behavioral and mental health specialists.

2. Depression If your patient shows signs of depression or has a family history of depression, screenings like the Patient Health Questionnaire (PHQ) may help give a more definitive answer.

3. Drug and alcohol use Screenings for drug and alcohol use may help identify destructive habits or addictions in patients. For example, the World Health Organization’s Alcohol Use Disorders Identification Test checks for hazardous or harmful alcohol use. Other common drug and alcohol screenings include the Drug Abuse Screening Test and the Tobacco, Alcohol, Prescription Medication and Other Substance Use test.

4. Bipolar disorder

To help identify symptoms of bipolar disorder, clinicians may use the Mood Disorder Questionnaire. Because bipolar disorders exist on a spectrum, it may also help to use the Bipolar Spectrum Diagnostic Scale to determine where or if your patient registers.

5. Suicide risk You can help determine if your patient is at risk for suicide by using the Suicide Assessment Five-Step Evaluation and Triage, Columbia-Suicide Severity Rating Scale or Ask SuicideScreening Questions. To promote your patient’s safety and reduce risk, screening for suicide risk is an essential preventive measure.

6. Anxiety disorders Anxiety disorder screening can help you determine if your patient exhibits symptoms of generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder (PTSD) or social phobia. Some relevant anxiety screenings include the Generalized Anxiety Disorder seven-item (GAD-7) scale, the Post-Traumatic Stress Disorder Checklist for DSM-5 and the Hamilton Anxiety Rating Scale.

7. Trauma To screen for potentially traumatic events in your patient’s life, you may use the Life Events Checklist for DSM-5. This tool checks for common sources of PTSD or extreme distress. Talk to your patient to determine which screenings may be necessary. After you have highlighted areas of concern, you can use assessment tools to understand the depth and scope of individual problems.

6 Mental Health Assessment Examples for Behavioral Health Practitioners Mental and behavioral health assessments serve many purposes when working with a patient. Assessments can help you through the diagnosis and treatment-planning process, inform your decision-making and enable you to track patient progress. Unlike screenings, free mental health assessment tools come in various formats. Regardless of the method you choose, a behavioral assessment can help you understand, diagnose and treat your patients.

Here are six common behavioral assessment methods to consider using.

1. Observation Observation can help you uncover clues to a patient’s condition. Note your patient’s attitudes, expressions, words and actions in various surroundings to develop an understanding of their situation beyond what they communicate. To use this tool well, pay close attention to your patient and observe them with a professional, neutral demeanor.

2. Interview Psychiatric interviews can help you establish a relationship with your patients and collect information about their symptoms and experiences. Allow your patients to speak without interruption and guide their responses with open-ended questions. Keep diagnostic reasoning in mind while you ask questions. If you want to build trust with your patients, ensure they feel validated and understood. Allowing your patients to present their feelings and experiences can reveal the factors contributing to their symptoms.

3. Family interview

In some scenarios — especially when working with younger children — you may opt to interview a patient’s family members. Family interviews can provide additional insight into a patient’s condition and help the family better understand what the patient is experiencing. You may want to review the Health Insurance Portability and Accountability Act before getting family members involved.

4. Checklists Like many screening tools, assessment tools feature checklists to provide insight into a patient’s mental health status. A targeted list can be a quick and efficient way to supplement your knowledge. The DSM-5 contains lists to identify and classify patient symptoms, but you should use these lists with caution. Checklists do not consider all biological, psychological, sociological and cultural variables possible in a patient’s life. However, checklists can be appropriate tools when used in conjunction with other assessment methods.

5. Rating scales Rating scales provide numerical data and help patients sort confusing feelings and emotions into simple responses. They can be valuable when working with patients who have difficulty communicating about their illness or as a general assessment tool to determine the severity of symptoms at a given point.

6. Questionnaires Assessment questionnaires function like screening questionnaires, except they often go into greater detail about a specific illness and its severity. If screening test results show the potential for particular disorders, a disorder-specific assessment can help you gather further data. One typical standardized assessment includes the Global Mental Health Assessment Tool, which can screen and assess various mental health issues.

Screening Tools for Different Ages

Different age ranges have unique needs regarding screening tools. For example, a young child might lack the vocabulary to describe their symptoms as fluently and accurately as an adult can. They need a screening test they can respond to. Clinicians must consider how age influences each patient’s ability to express their feelings and experiences and choose screening tools accordingly. Here are recommendations for depression and anxiety screening — two of the most common mental disorders — for various age groups.

Children and Adolescents According to the Centers for Disease Control and Prevention, 3.2% of children aged 3 to 17 have received a depression diagnosis. Depression is a risk factor for substance use, suicide, declining academic performance and poor health choices. Despite depression’s severity, it often goes undiagnosed in young patients, partially because children and adolescents may have difficulty expressing how they feel. In particular, teens might repress their feelings or turn to friends rather than adults for help with depression or anxiety. Fortunately, screening tests help physicians and behavioral health professionals catch depression and anxiety early on, so they can begin treatment. The U.S. Preventive Services Task Force (USPSTF) recommends that primary care physicians screen adolescents aged 12 to 18 for major depressive disorder if the clinician can ensure an accurate diagnosis and effective treatment. Effective and widely used screening tools for depression in adolescents are the PHQ-9 and the Patient Questionnaire for Adolescents — a slightly modified version of the PHQ-9. You might also use the Kutcher Adolescent Depression Scale to screen for depression in patients ages 12 to 17. Pediatricians, psychiatrists and other health professionals might use the Pediatric Symptom Checklist, a short questionnaire, to screen for depression and anxiety in children ages 4 to

16. The Child Depression Inventory, a modified version of the Beck Depression Inventory, is another way to screen for depression in children ages 7 to 17. Parents can collect the information to help a young child complete a screening test. Anxiety is even more common than depression in childhood and adolescence, with 7.1% of children aged 3 to 17 having a diagnosis of this condition. To screen for anxiety in children, you might choose the Spence Children’s Anxiety Scale for patients ages 2 to 12, the Screen for Child Anxiety-Related Disorder for patients aged 8 to 18 or the GAD-7 for adolescents.

Adults Anxiety disorders affect about 18% of the adult population every year, and half of those diagnosed with anxiety also have depression. Depression and anxiety can make it challenging for people to meet daily responsibilities, maintain relationships and take care of their health. According to the World Health Organization, depression is the top cause of disability worldwide. Due to the prevalence and severity of depression in adulthood, the USPSTF and American Academy of Family Physicians recommend screening all adults over 18 for depression, regardless of risk factors. PHQs are the most widely used depression screening tools for adults. You might use the PHQ-2 initially and the PHQ-9 or clinical interview if you identify depression. Physicians should also consider screening for depression in pregnant and postpartum women. Postpartum depression can have a cascade of adverse effects on a child’s development and family relationships. The USPSTF, American College of Obstetricians and American Academy of Family Physicians suggest screening all pregnant and postpartum women for depression. You might use the PHQ-2, PHQ-9, Edinburgh Postnatal Depression Scale or the Postpartum Depression Screening Scale. To screen for anxiety in adults, consider the GAD-7 or the Kessler Psychological Distress Scale. According to a review published in BMC Psychiatry, both of these tools were the most commonly validated for anxiety disorders.

Older Adults Screening for depression and anxiety becomes more challenging for older patients. Patients might have a chronic medical condition contributing to a mental disorder and the symptoms they’re experiencing. If a patient has dementia, clinicians must choose an appropriate mental health screening tool. Anxiety is widespread among older adults, affecting as much as 10 to 20% of the older adult population. Anxiety often goes undiagnosed in older adults because patients and doctors might assume a medical condition or prescription medication causes the condition. Older patients may also be more hesitant to discuss mood disorders with their doctor or think it’s normal to feel that way. If left untreated, anxiety can lead to physical health issues, cognitive dysfunction and a lower quality of life. Screening tools designed for older adults can help them get treated. You might use the Geriatric Depression Scale, which features yes-or-no questions, to screen for depression in older adults, including patients with cognitive impairment. For patients with dementia, the

USPSTF recommends the Cornell Scale for Depression in Dementia. The PHQ-2 is another valuable screening tool for depression in older patients. The Geriatric Anxiety Scale is a widely used anxiety screening and assessment tool for older adults. According to a 2019 systemic review, the Rating Anxiety in Dementia scale is a validated screening tool for anxiety symptoms in patients with dementia. We provide a more thorough list of screening and assessment options below.

75+ Rating Scales and Assessment Tools for Adults and Children It’s nearly impossible to deny the impact of behavioral and mental health assessments on helping counselors understand patients in their care. However, clinicians may be hesitant to incorporate specific measures due to the possibility of accumulating excess papers and adding time-consuming tasks to their day. ICANotes’ electronic health record (EHR) software for behavioral health allows you to use more than 75 well-known rating scales and assessment tools electronically. This paperless solution integrates assessment results into your patients’ health charts and treatment plans while keeping data accessible and secure.

Rating Scales and Assessment Tools for Adults The following are the behavior assessment tools for adults ICANotes integrates with:                       

1915(i) Independent Behavioral Health Assessment ACE: Adverse Childhood Experience Questionnaire ANSA: Adult Needs and Strengths Assessments ASI: Addiction Severity Index ASRS: Adult ADHD Self-Report Scale AUDIT-C: Alcohol Use Disorders Identification Test-Concise BSDS: Bipolar Spectrum Diagnostic Scale Brief Addiction Monitor CAGE: Substance abuse screening tool CES: Center for Epidemiological Studies Depression Scale CIWA-Ar: Clinical Institute Withdrawal Assessment for Alcohol CIWA-b: Benzodiazepine Withdrawal Scale Columbia Depression Scale (last four weeks, parent) Columbia Depression Scale (year, parent) COWS: Clinical Opiate Withdrawal Scale C-SSRS: Columbia-Suicide Severity Rating Scale DASS-21: Depression, Anxiety and Stress Scale (21 items) DASS-42: Depression, Anxiety and Stress Scale (42 items) DAST-10: Drug Abuse Screening Test DLA-20: Daily Living Activities DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure EDDS: Eating Disorder Diagnosis Scale Edmonson Psychiatric Fall Risk Assessment

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FAD: McMaster Family Assessment Device (subscales) FARS: Functional Assessment Rating Scale GAD-7: Generalized Anxiety Disorder seven-item scale GAIN-SS: Global Appraisal of Individual Needs Short Screener GDS: Geriatric Depression Scale HAM-A: Hamilton Anxiety Rating Scale HAM-D: Hamilton Depression Rating Scale Kessler Psychological Distress Scale LOCUS: Level of Care Utilization System MAST: Michigan Alcohol Screening Test MDI: Major Depression Inventory MDQ: Mood Disorder Questionnaire MFQ-Parent: Mood and Feelings Questionnaire MSI: Marital Status Inventory ORAS-CST: Ohio Risk Assessment System — Community Supervision Tool Parental Stress Scale PCL-5: Post-Traumatic Stress Disorder Checklist PHQ-9: Patient Health Questionnaire PSWQ: Penn State Worry Questionnaire QIDS-C: Quick Inventory of Depressive Symptomatology — Clinician-Rated SAFE-T: Suicide Assessment Five-Step Evaluation and Triage (SAFE-T) Protocol with C-SSRS-Recent Satisfaction with Life Scale SOCRATES 8A: Personal Drinking Questionnaire South Oaks Gambling Screen SPANE: Scale of Positive and Negative Experience TCU Drug Screen 5: Texas Christian University Drug Screen 5 URICA: University of Rhode Island Change Assessment Scale (alcohol) URICA: University of Rhode Island Change Assessment Scale (drug) URICA: University of Rhode Island Change Assessment Scale (psych...