Empowering Therapists With Better Tools

New research director sets out to improve mental and behavioral health care with assessments. 

Providing mental or behavioral health care without simple, effective clinical assessment tools is like trying to lose weight without access to a bathroom scale, says Eric Youngstrom, PhD, the new director of the Institute for Mental and Behavioral Health Research at Nationwide Children’s Hospital and an expert in clinical assessment. 

Dr. Youngstrom learned this lesson early in his career when he presented his paper on a new assessment tool to his wife, Jen Youngstrom, PhD, who was then a clinical psychologist in a community health center. There was no way she’d use it. 

“Come back to me when it’s one page and free,” she said. 

That conversation about diagnostic assessments was one of many over their decades of marriage and professional collaboration. The two have spent years discussing how to:  

• Make short assessment forms 
• Make diagnostic tools free 
• Identify and share the best tools so clinicians can find them 
• Simplify scoring so clinicians can determine results and reduce errors 

Today, Dr. Eric Youngstrom continues collaborating with Dr. Jen Youngstrom, now a clinical professor and director of clinic services and assessment at the University of North Carolina Department of Psychology and Neuroscience. There, she often consults her husband about referrals to determine the best diagnostic measurement tool. 

“We were buying tools and expanding on a referral-to-referral basis, but the literature grows very fast, and there’s no way any director could keep up with it,” she says. 

Jen, in turn, was shaping Dr. Youngstrom’s focus on research with practical clinical application. 

How the Right Assessment Tools Can Improve Pediatric Mental Health Outcomes Overall

Dr. Eric Youngstrom, who is now a nationally renowned psychologist specializing in the relationship between mood and psychopathology and the clinical assessment of children and families, considers standardized assessment tools the secret sauce to achieving better behavioral and mental health outcomes.

“If we get the assessment and diagnosis wrong, we have no prayer of picking the best treatment,” he says.  

The challenge to assessments is identifying which tool is ideal for the symptoms with which patients present. While there are hundreds of diagnoses in the DSM-5, even a common diagnosis, like depression, has 300 different assessment questionnaires.  

“A busy clinician just wants someone to identify which tools are best,” says Dr. Youngstrom.  

Identifying the best evidence-based screening tools is even more essential among less common diagnoses. Clinicians are experienced at recognizing typical diagnoses, such as anxiety and depression. Many clinicians could get through clinical training and even be on the job for a few years before seeing someone with rare conditions such as obsessive-compulsive disorder or emerging psychosis.  

Clinicians learn about many diagnoses in graduate school, but they may not have a template for what rare disorders look like in practice. 

“If you don’t have a screener for those things, you could easily misattribute what you see. That’s where developing a robust set of screening tools becomes helpful,” says Mary A. Fristad, PhD, ABPP, director of academic affairs and research development at the Big Lots Behavioral Services at Nationwide Children’s Hospital.  

‘Knocking at the Door’ of Common Problems

Families often have more than one problem, says Dr. Youngstrom. They may come in asking for help with one issue, but a good assessment could uncover a different root of the problem, such as trauma, abuse or substance misuse. 

Without standardized assessments, it’s possible to miss important issues that can get in the way of treatment. One such case stands out for Dr. Youngstrom. A patient has mood swings and extreme irritability. Dr. Youngstrom nearly diagnosed the patient with ordinary oppositional defiant disorder but first did a trauma screening. 

It turned out the patient was being sexually abused. 

“I never would have asked if I wasn’t using a more structured approach with a script because I already thought I had the smoking gun and knew what was going on,” says Dr. Youngstrom.  

That case became a lesson Dr. Youngstrom often repeats about standardizing screening and following a script to rule out other possibilities. “We have to knock at the door of those eight to 10 vital possibilities that might reveal plot twists,” he says.  

Bringing Big Assessment Goals to an Institute That Will Help Him Deliver

Dr. Eric Youngstrom joined Nationwide Children’s Hospital in early 2024 as the inaugural director of the new Institute for Mental and Behavioral Health Research. The Institute is located in the Big Lots Behavioral Health Pavilion – home of the country’s largest pediatric-affiliated behavioral health system.  

“We have depth and breadth of clinical services, and the volume of clinical services is simply massive. We provide over a quarter of a million outpatient visits and over 8,000 psychiatric crisis department visits a year,” says Dr. Fristad. 

Affiliated partners with Nationwide Children’s treat nearly half-a-million kids in 47 Ohio counties.  

While Nationwide Children’s mental and health care reach is wide, so is the need. 

Depression is the number one cause of disability among teenagers in the United States, according to the National Institute of Mental Health. 

Meanwhile, there are no standardized assessment tools to diagnose even the most common pediatric diagnoses among the hundreds in the DSM-5.  

“If you took your child to a therapist, they’d say what they think is going on, and if you got a second opinion, the chances that a second opinion would agree with the first one is slightly better than chance,” says Dr. Youngstrom. 

Evidence-based universal screeners are key to identifying the appropriate diagnoses and determining the best treatment plan. Throughout that plan, using micro assessments to measure results over time should mean kids get better faster, says Dr. Fristad.  

“We want these tools to assist clinicians in diagnosis and ongoing treatment planning – without taking away decision making or clinical judgment.” 

Clinical judgment remains essential, but improving the assessment process can help clinicians meet the growing demand. “Everyone is so busy because there are so few of us. Anything that can facilitate that process is incredibly important,” says Dr. Findling. 

The Process to Standardize Assessment Tools

Identifying the best assessment tools for the hundreds of pediatric behavioral and mental health diagnoses is a massive undertaking, but Dr. Youngstrom says he is up for the task. With the help of a team of interns, he’s concentrating on the vital few that meet the biggest needs of families in Ohio.  

These include: 

• Oppositional behavior 
• Aggressiveness 
• Mood problems 
• Depression 
• Bipolar disorder 
• Anxiety 
• Autism 
• Sleep hygiene 
• Substance misuse 
• Trauma 

Dr. Youngstrom and his team started by mapping what Nationwide Children’s clinicians already use. A second team scores those tools to determine whether they are equally accurate for different ages and demographic groups.  

Once he and his team identify the best assessment tools for common diagnoses, they plan to promote them across the clinical service line. They also hope to build the tools into MyChart, making them accessible to even more families. Eventually, the goal is to build them into the electronic health record tool Epic, which is used by hospitals across the country. 

“This is the first time I’ve ever had the resources and institutional support to build a team and do whatever will help solve these problems faster,” says Dr. Youngstrom. 

Standardizing Assessment Tools Across Pediatric Mental and Behavioral Health Care

With the help of statistical research and meta-analysis, Dr. Youngstrom is confident he can make a difference in standardizing diagnostic tools. He and a team are running four meta-analyses on the following tools: 

• Scales to measure therapeutic relationships 
• Treatment options for bipolar disorder in kids and teenagers 
• Bipolar disorder screening scales 
• Depression screening scales 

Dr. Youngstrom hopes to complete an assessment of ADHD screening scales and autism screening tools by the summer of 2025. 

Closing the Science-Practice Divide

Dr. Youngstrom acknowledges that his roadmap at Nationwide Children’s will change as he identifies clinicians’ needs. “I ask them what questions they have and promise our teams in the Abigail Wexner Research Institute will take those questions seriously. If it’s something I can use science to answer, I promise to try,” he says. 

Bringing evidence-based medicine to a traditional psychological assessment is not easy. Research typically occurs under controlled conditions, while working in a clinic can be vastly different.  

“I’m not interested in doing research under best-case scenarios and pristine track conditions. I want to test in the real, much messier reality, which is where families need us,” says Dr. Youngstrom. 

The leadership at Nationwide Children’s agrees. ” If you can’t use whatever we develop from a research perspective for assessment or treatment — if it isn’t functional in a typical clinic setting — you haven’t done much good,” says Dr. Fristad.

Dr. Jen Youngstrom, who spends her days in what she calls the “messy trenches of the real world,” has high hopes for what Eric can accomplish at Nationwide Children’s with the help of the team. “Having Nationwide Children’s do the background work to determine wat is best makes it so much easier for people to use and implement these tools,” she says. 

Giving Away Science to Help Kids Everywhere

While Nationwide Children’s has a wide reach in central Ohio and beyond, the goal of standardizing assessment tools is to become a national model for improving diagnostic tools.  

Before coming to Nationwide Children’s, Dr. Youngstrom founded a nonprofit, Helping Give Away Psychological Science (HGAPS), to make the most effective assessment tools widely available to therapists who need them. With the help of student volunteers, Dr. Youngstrom identifies the best tools and builds new ones when necessary. They offer the tools for free so they’re accessible to everyone. 

Dr. Fristad says her goal in the next five years is for everyone in behavioral health at Nationwide Children’s to feel more confident in the diagnosis and initials treatment plan they develop. If they get stuck in treatment, as everyone does with various cases over time, the assessment process embedded into the system will help therapists identify treatment modifications.  

“Our goal is to help kids get better faster,” she says.  

This article appeared in the 2024 Fall/Winter issue. Download the issue here. 

Image credits: Nationwide Children’s (header and portraits for Drs. Fristad and Youngstrom); Dr. Findling provided his portrait, used with permission