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

Andres De Los Reyes, Elizabeth Talbott, Thomas J. Power, Jeremy J. Michel, Clayton R. Cook, Sarah J. Racz, Olivia Fitzpatrick

Research output: Contribution to journalReview articlepeer-review

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Article number102114
JournalClinical Psychology Review
Volume92
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
Efforts by the first and fifth author were supported by the Institute of Education Sciences, U.S. Department of Education , through Grant R324A180032 to University of Maryland at College Park. The opinions expressed are those of the authors and do not represent views of the Institute or the U.S. Department of Education. Efforts by the third and fourth authors were funded in part through a Patient Centered Outcomes Research Institute (PCORI) Award ( AD-2018C1-10869 ). The statements in this article are solely the responsibility of the authors and do not necessarily reflect the views of PCORI, its Board of Governors, or its Methodology Committee.

Publisher Copyright:
© 2021 Elsevier Ltd

Keywords

  • Converging Operations
  • Diverging Operations
  • Mental health services
  • Multiple informants
  • Operations Triad Model

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

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