Patients will frequently present in the primary care setting asking for an assessment for a mental health or behavioral concern. It can be confusing to know which direction to send a family in and/or what type of assessment to refer for.
There are some clarifying questions that a primary care provider can ask to better help direct families on next steps.
- What are the specific concerns? Are they mood concerns, behavioral concerns and/or developmental concerns?
- Are the problems occurring at home or school/work or both?
With this information and the age of the child, a primary care provider can help a family navigate next steps. It is also helpful for primary care providers to have a brief understanding of different types of assessments so that patients are directed in the right direction.
A mental health (or behavioral health) assessment is a clinical assessment and can be conducted by a variety of clinicians, including psychologists, marriage family therapists, and licensed clinical social workers. A mental health assessment is important as the beginning for engaging in therapy services. The clinician obtains information about current presenting concerns, past treatments and response to treatments and goals for therapy. Screeners can sometimes be used but a mental health assessment does not involve a lot of objective testing per se.
A psychological assessment or evaluation refers to a clinical psychologist conducting a more extensive assessment with some objective testing and more in depth questions about different psychiatric conditions. This type of assessment is requested sometimes if there is a concern about diagnostic clarification in a complex situation or if there is limited progress with treatment thus far.
A developmental evaluation (or neuropsychiatric evaluation as they are called with patients are older, typically older than age 6/7 years old) is typically conducted by a clinical or developmental psychologist and includes assessments of different developmental domains (speech and language, cognitive skills, fine motor and gross motor skills) as well as emotional/social/behavioral domains.
Autism assessments fall under the category of developmental evaluations but it is important to make sure the clinical psychologist is trained in the objective testing for autism and has experience to tease out the nuanced cases which might otherwise fall through the cracks.
There are some psychologists in outpatient practice who specialize in doing “ADHD assessments”. They fall into the category of developmental evaluation/neuropsychiatric evaluation. These are more extensive than the brief clinical assessments (with or without questionnaires) that are sometimes done to diagnose ADHD in other settings. These assessments typically include a clinical assessment of ADHD symptoms in the home and school setting and also include a cognitive assessment as well as an assessment for learning disabilities and executive functioning concerns.
A psycho-educational assessment is typically done by an educational psychologist in the school setting as part of the process to determine if a child qualifies for an Individualized Education Plan. The purpose is to look for learning or attentional issues that could be affecting a child’s academics for which accommodations could be put in place. A child has to qualify for one of 13 designations to qualify for an IEP but technically the educational psychologist is not making a diagnosis for the child.
A psychiatric assessment is conducted with a psychiatrist and the primary purpose is for diagnostic clarification and/or to consider psychotropic medication for a mental health concern. For most people, this is not a first step into the world of mental health treatment but rather a step further down the line if there is limited progress with other non-medication treatments and/or a question about diagnosis. It can be frustrating for families to be waiting for months to see a psychiatrist only to find out that the recommendation is therapy or another type of assessment (for example a preschool age child with ADHD should be referred to parent management behavioral therapy and/or to consider an IEP evaluation before referring to a psychiatrist).
It is our hope that this primer on the different assessments available when it comes to mental health and behavioral health concerns is helpful. As always, for assistance in specific clinical situations please call the SmartCare BHCS Provider Line 858.880.6405 or have families call the SmartCare BHCS Parent Line 858.956.5900 for more individualized recommendations.