How should quality psychiatric and mental health care for children, adolescents, and their families be defined? How should it be measured? The APA Task Force on Quality Indicators for Children is busy tackling these questions as it puts together its first report, which APA hopes will continue to evolve as a clinically based guide. The task force is also inerested in hearing from the APA membership about defining quality care for children and adolescents as they develop the report.

According to James C. MacIntyre II, M.D., chair of the task force, the guide will ultimately be used to determine the quality and effectiveness of organized systems of care that serve children, adolescents, and their families.

The Task Force on Quality Indicators for Children met for the first time in February 1999 and began its work with a careful review of the final report of the APA Task Force on Quality Indicators, which focused on the general population. The newly assembled group set out to develop clinically based, patient-focused quality indicators using existing and ongoing research, as well as expert clinical consensus.

"A major challenge for the task force is to anchor quality indicators for children with the emerging scientific evidence base as much as possible," MacIntyre told Psychiatric News. For example, the task force focused on recent reviews on the efficacy of various treatments such as medications and intervention-program models for children and adolescents.

The task force also agreed on a set of principles to guide in the selection of quality indicators:

• The indicator will address an important aspect of care.

• The indicator will be useful in identifying opportunities for improvement of care.

• The indicator will be practically quantifiable.

• Where possible, the indicator will be documented by an evidence-based practice guideline (for example, APA’s practice guidelines and the practice parameters of the American Academy of Child and Adolescent Psychiatry).

• The indicator will minimize the potential for unintended adverse consequences.

According to MacIntyre, the group also identified five areas in which to concentrate the development of sample indicators: prevention, access, quality, satisfaction/perception of care, and outcomes/effectiveness.

MacIntyre is chief of psychiatry for the Bureau of Children and Families in the New York State Office of Mental Health and an associate professor of psychiatry at the Albany Medical College in Albany, N.Y

The final report on quality indicators for children will contain a workbook of many sample indicators. Each quality indicator will have sample measures and standards, which are recommended to health plans considering the use of the indicator for the treatment of patients. The report will contain a descriptive narrative providing detail and establishing the context for each indicator. The narrative will also include references to scientific literature and the existing evidence that supports the indicator. In the final report, sample standards will be based on the current scientific-evidence base and the expert professional consensus.

The completed report requires approval by APA’s Board of Trustees before it is finalized and available for release in 2001. Even after its completion, the report of the Task Force on Quality Indicators for Children will be a "work in progress" undergoing continued refinement and revision as more data emerge defining the quality of care for children and adolescents.

AACAP/APA members on the APA task force are Regina Bussing, M.D., Gabrielle Carlson, M.D., Helen Egger, M.D., Emily Harris, M.D., Joseph Mawhinney, M.D., and Andres Pumariega, M.D. Barbara Burns, Ph.D., and Kelly Kelleher, M.D., are consultants.

"With this task force, we have close collaboration between AACAP and APA," stated MacIntyre. "Many of the members of the task force and myself were active within the AACAP and see this as an important and unique opportunity to bridge the organizations and come up with a piece of work that benefits all concerned."