The following is a framework for the development of quality indicators in the treatment of children and adolescents, as well as a list of sample indicators that will be assessed in clinical treatment. Both the framework and sample indicators are concentrated around certain areas of care, as shown below.

1. Universal

2. Selected

3. Indicated

4. Prevention-minded treatment

1. To appropriate evaluation

2. To appropriate treatment

3. To appropriately qualified clinician

4. To continuum of coordinated care

5. To culturally and linguistically competent services and providers

1. Comprehensive evaluation

2. Appropriate and effective treatment

3. Coordination between different levels of care

4. Continuity of care

1. Patient

2. Family

3. Clinician (provider)

4. Other children’s systems

1. Maximize treatment participation

2. Reduction and/or stabilization of symptoms

3. Improved level of functioning for child

4. Improved quality of life for child

5. Improved quality of life for family

6. Minimization of social and economic costs

7. Minimization of restrictive care

The following excerpts from the draft report of the APA’s Task Force on Quality Indicators for Children show two examples of the domains, goals, indicators, measures, and standards to assess the quality of mental health care provided by a health plan.

Domain: Outcomes/Effectiveness

Specific Area: Reduction and/or stabilization of symptoms

Recommendation/Goal: Children and adolescents receiving treatment known to be clinically effective for their condition(s) should experience a significant reduction in symptoms/signs after receiving appropriate treatment for a reasonable period of time.

Sample Indicator: Reduction in severity of symptoms of inattention, impulsivity, and hyperactivity among patients with the diagnosis of attention-deficit/ hyperactivity disorder who are receiving treatment for the disorder in a health plan.

Sample Measure: Score on a standardized ADHD rating scale.

Sample Standard: Estimate 80 percent of patients receiving treatment will show a significant improvement in their score on a standardized rating scale within four months. The numerator is the number of children receiving treatment for ADHD who show significant improvement on the rating scale. The denominator is the total number of children receiving treatment for ADHD in the health plan.

Domain: Access

Specific Area: Access to appropriate treatment—medications

Recommendation/Goal: Medications, including newer antidepressant and antipsychotic medications, should be included in the formulary of a given health plan and should be used in an appropriate dosage and duration for those disorders for which they have been shown to be clinically effective.

Sample Indicator: Access to an antidepressant medication (specifically SSRIs) for adolescent patients with a major depressive disorder.

Sample Measure: Percentage of adolescent patients in a health plan with major depressive disorder who are receiving an appropriate dose of antidepressant medication.

Sample Standard: Estimate 75 percent of patients will receive an appropriate dose of medication. The numerator is the number of adolescents with major depressive disorder who are receiving antidepressant medication. The denominator is the total number of adolescents diagnosed with major depression in the health plan.

• Children of adults hospitalized with schizophrenia, affective, anxiety, or substance abuse disorders should receive appropriate assessment for behavioral disturbances, psychopathology, and functional impairment.

• Annual survey of adolescent members using services who are either very satisfied or highly satisfied with overall mental health or substance abuse services.

• Children with Axis I psychiatric disorder(s) and a coexisting speech and language deficit will receive speech and language services provided by speech and language therapists.