A measurable treatment plan: Using the Children’s Global Assessment and the Problem Severity scales as outcomes of clinical treatment

Abstract

Objective: To investigate the psychometric properties of the Children’s Global Assessment Scale (CGAS) and the strength/concern (Problem Severity [PS]/Symptom) scale, collectively known as the measurable treatment plan (MTP).
Methods: We draw on a sample of consecutive patients (n = 25,563) enrolled for care between 2002 and 2016 in the Child & Adolescent Addictions and Mental Health Psychiatry Program of the Alberta Health Services, Calgary Health Zone. CGAS reliability was estimated using the Pearson Product-Moment correlation for repeated measures between referral and admission. For the internal consistency of paired referral and admission CGAS scores, α = 0.82. We estimated the predictive validity of the CGAS and the strength/concern scale using analyses of variance with the demographic variables age and sex, and additionally the system variables service level, treatment completion and provisional diagnosis as covariates of analysis in a final reduced model or as independent variables where warranted.
Results: We discovered that there is a high level of agreement between paired referral and admission CGAS scores We also discerned functional improvement and symptom reduction on discharge which was attributable to the effect of treatment alone. Importantly, patients who were categorized at the urgent/emergent service level of care at admission, exhibited more severe provisional diagnoses, and/or discontinued treatment attained lower function and PS ratings at discharge.
Conclusions: Overall, the current study supports the empirical applicability of using the MTP to clinically profile on admission those at risk of poor treatment outcomes and to undertake necessary modifications to the treatment process.