Advancing equity in access to school mental health through multiple informant decision-making.

There has been a substantial increase in the number of students with mental health needs, yet significant discrepancies exist in access to timely intervention. Traditional gatekeeping to intervention has been the provenance of single information sources. Multi-informant decision-making is a promising mechanism to improve equitable access. However, critical advancements are necessary to improve decision-making relating to (a) who is identified, (b) what type of need is determined, (c) the type of intervention necessary, and (d) where or under what circumstances to implement the intervention. We review critical components of effective mental health decision-making, contributors to inequities in school mental health services, and offer future directions for research and practice to increase equitable student outcomes.

The Needs-to-Goals Gap: How informant discrepancies in youth mental health assessments impact service delivery.

Over 60 years of research reveal that informants who observe youth in clinically relevant contexts (e.g., home, school)-typically parents, teachers, and youth clients themselves-often hold discrepant views about that client's needs for mental health services (i.e., informant discrepancies). The last 10 years of research reveal that these discrepancies reflect the reality that (a) youth clients' needs may vary within and across contexts and (b) informants may vary in their expertise for observing youth clients within specific contexts. Accordingly, collecting and interpreting multi-informant data comprise "best practices" in research and clinical care. Yet, professionals across settings (e.g., health, mental health, school) vary in their use of multi-informant data. Specifically, professionals differ in how or to what degree they leverage multi-informant data to determine the goals of services designed to meet youth clients' needs. Further, even when professionals have access to multiple informants' reports, their clinical decisions often signal reliance on one informant's report, thereby omitting reports from other informants. Together, these issues highlight an understudied research-to-practice gap that limits the quality of services for youth. We advance a framework-the Needs-to-Goals Gap-to characterize the role of informant discrepancies in identifying youth clients' needs and the goals of services to meet those needs. This framework connects the utility of multi-informant data with the reality that services often target an array of needs within and across contexts, and that making decisions without accurately integrating multiple informants' reports may result in suboptimal care. We review evidence supporting the framework and outline directions for future research.

Comparing Multi-Informant Assessment Measures of Parental Monitoring and Their Links with Adolescent Delinquent Behavior.

OBJECTIVE: Parents' poor monitoring of adolescents' whereabouts and activities is commonly linked to adolescents' increased engagement in delinquent behaviors. Yet, different domains of parental monitoring (parental monitoring behaviors vs. parental knowledge) and reports from multiple informants (parent vs. adolescent) may vary in their links to delinquent behavior. DESIGN: Seventy-four parental caregivers and 74 adolescents completed survey measures of parental monitoring and knowledge, and adolescents completed self-report surveys of delinquent behavior. RESULTS: We observed low-to-moderate magnitudes of correspondence between parent- and adolescent-reports of parental monitoring behaviors and parental knowledge. Adolescent self-reported delinquent behavior related to parent and adolescent reports of parental monitoring behaviors and parental knowledge, with adolescents who self-reported engagement in delinquent behaviors evidencing lower levels of parental knowledge and higher levels of poor monitoring compared to adolescents who did not self-report engagement in delinquent behaviors. Adolescent self-reported engagement in delinquent behaviors evidenced stronger links to parental monitoring when based on adolescent reports of monitoring (relative to parent reports), whereas stronger links held between adolescent self-reported delinquent behavior and parental knowledge when based on parent reports of knowledge (relative to adolescent reports). CONCLUSIONS: Links between monitoring and adolescents' delinquent behavior vary by the kind of monitoring measure completed as well as the informant completing the measure. These findings inform measurement selection in research and clinical assessments of parental monitoring and adolescent delinquent behavior.

Commentary: moving toward cost-effectiveness in using psychophysiological measures in clinical assessment: validity, decision making, and adding value.

Psychophysiological measures offer a variety of potential advantages, including more direct assessment of certain processes, as well as provision of information that may contrast with other sources. The role of psychophysiological measures in clinical practice will be best defined when researchers (a) switch to research designs and statistical models that better approximate how clinicians administer assessments and make clinical decisions in practice, (b) systematically compare the validity of psychophysiological measures to incumbent methods for assessing similar criteria, (c) test whether psychophysiological measures show either greater validity or clinically meaningful incremental validity, and (d) factor in fiscal costs as well as the utilities that the client attaches to different assessment outcomes. The statistical methods are now readily available, along with the interpretive models for integrating assessment results into client-centered decision making. These, combined with technology reducing the cost of psychophysiological measurement and improving ease of interpretation, poise the field for a rapid transformation of assessment practice, but only if we let go of old habits of research.

The longitudinal consistency of mother-child reporting discrepancies of parental monitoring and their ability to predict child delinquent behaviors two years later.

This study examined the longitudinal consistency of mother-child reporting discrepancies of parental monitoring and whether these discrepancies predict children's delinquent behaviors 2 years later. Participants included 335 mother/female-caregiver and child (46% boys, >90% African American; age range 9-16 years [M = 12.11, SD = 1.60]) dyads living in moderate-to-high violence areas. Mother-child discrepancies were internally consistent within multiple assessment points and across measures through a 2-year follow-up assessment. Further, mothers who at baseline consistently reported higher levels of parental monitoring relative to their child had children who reported greater levels of delinquent behaviors 2 years later, relative to mother-child dyads that did not evidence consistent discrepancies. This finding could not be accounted for by baseline levels of the child's delinquency, maternal and child emotional distress, or child demographic characteristics. This finding was not replicated when relying on the individual reports of parental monitoring to predict child delinquency, suggesting that mother-child reporting discrepancies provided information distinct from the absolute frequency of reports. Findings suggest that mother-child discrepancies in reports of parental monitoring can be employed as new individual differences measurements in developmental psychopathology research.

Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study.

Discrepancies often exist among different informants' (e.g., parents, children, teachers) ratings of child psychopathology. Informant discrepancies have an impact on the assessment, classification, and treatment of childhood psychopathology. Empirical work has identified informant characteristics that may influence informant discrepancies. Limitations of previous work include inconsistent measurement of informant discrepancies and, perhaps most importantly, the absence of a theoretical framework to guide research. In this article, the authors present a theoretical framework (the Attribution Bias Context Model) to guide research and theory examining informant discrepancies in the clinic setting. Needed directions for future research and theory include theoretically driven attention to conceptualizing informant discrepancies across informant pairs (e.g., parent-teacher, mother-father, parent-child, teacher-child) as well as developing experimental approaches to decrease informant discrepancies in the clinic setting.

Applying depression-distortion hypotheses to the assessment of peer victimization in adolescents.

This study examined whether adolescents' depressive symptoms and aggressive behavior were associated with discrepancies between self- and peer-reports of peer victimization experiences. A sample of 203 10th-grade adolescents completed self-report measures of victimization and depressive symptoms as well as peer nominations of victimization and aggression. Residual scores were computed as a measure of discordance between peer- and self-reported peer victimization. Adolescents' aggressive behavior was associated with underestimations of peer victimization on self-reported measures, as compared to peer-reports, whereas depressive symptoms were associated with overestimations of peer victimization on self-report, as compared to peer-reports. Different patterns of findings were revealed for different forms of victimization (overt, relational, reputational) and by gender. Findings have implications for studies of adolescent peer victimization using multiple reporters and suggest that adolescents with high levels of depressive symptoms may be vulnerable to misperceptions of their social experiences among peers.