Re: Risk asst vs clinical judgement

[Neil B Guterman <nbg2@xxxxxxxxxxxx>]

Fiona, in response to your quesions about risk assessment versus clinical
judgement, you might find helpful a recent meta-analysis I completed
examining enrollment strategies in early home visitation programs to
prevent maltreatment, and which takes a critical look at psychosocial risk
assessment screens employed for the purposes of enrolling families for
services.   The findings of the meta-analysis indicate that programs using
psychosocial risk assessment screens have had difficulty reporting
positive outcomes in comparison to programs that enroll families according
to population-based parameters.  Among the several likely reasons for this
discussed in the article and related to your questions about "clinical
judgement", is the importance of differentiating risk screening for the
purposes of deciding whom to enroll for services, from clinical assessment
for the purposes of tailoring services to families' needs, once they are
enrolled.   The article should be out later this summer in _Child Abuse
and Neglect_ journal, or if you wish, I would be happy to forward an "in
press" version to you directly. 

* Neil B. Guterman, Ph.D.
* Columbia University School of Social Work
* 622 West 113th Street
* New York, NY 10025 U.S.A.
* neil.guterman@columbia.edu

On Fri, 18 Jun 1999, Fiona McCrimmon wrote:

> My area of research is secondary prevention services to prevent poor
> outcomes for children vulnerable to poor outcomes. I am interested to hear
> what people think about the use of checklists / screening tools versus the
> use of clinical judgement as a means of assessing a family's need for
> additional care and support services. Clearly a host of instruments have
> been developed and been validated to a greater or lesser degree- Kempe's
> Family Stress Checklist, Milner's CAPI, the HOME Scale, the Michigan
> Screening Profile of Parenting etc etc etc. Does anyone know of any
> re-visiting of clinical judgement as means of assessment of need? Any
> studies / current research comparing clinical judgement with risk
> assessment tools? Do you have any views on the role of clinical judgement
> in these matters? Are people generally comfortable with the various
> instruments around or is there a remaining or even resurging interest in
> the role of clinical judgement?
> 
> By way of background to my questions, so often when a midwife or social
> worker refers someone to the randomised trial I'm running there are
> comments made such as "this person doesn't really fit the criteria, but I
> just KNOW the family needs extra support/ that the lives are chaotic / that
> things are not stable / that this parenting situation is not looking good.
> And it would be reasonable to say that by and large such concerns often
> prove justified.
> 
> So, ....What role gut feeling / informed clincal judgement in this era of
> risk scores?
> 
> Dr Fiona M.V. McCrimmon
> MBChB, LLB(Hons)
> 
> Senior Lecturer in Healthcare Law & Ethics,
> School of Pharmacy,
> Division of Health Sciences
> 
> Principal Investigator
> Family Link Project
> 
> 
> University of Otago,
> P.O Box 913,
> Dunedin,
> New Zealand.
> Ph (03) 479 7272
> Mobile 021 665710
> Fax (03) 479 7034
> Email
> office: fiona.mccrimmon@stonebow.otago.ac.nz
> home: mccrimn@es.co.nz
> 
> 
> 
> 
> 
>