This toolkit was compiled by the AES Behavioral Health Toolkit Work Group, which consists of members from the Psychosocial Comorbidities, Practice Management, and Interprofessional Education Committees with expertise in behavioral health in epilepsy. These individuals include psychologists, physicians, advanced practice providers, nurses, and social workers, among others.
Clarification of Terms
Screening Measure– a standard set of questions that a person answers to help check for behavioral health concerns. Provides a measure of the severity and frequency of concerns. Does not provide diagnostic information and should not be used as the sole aspect of clinical information in diagnosing a behavioral health condition.
Diagnostic Measure– a standard set of questions that follow the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for a clinical mental health disorder.
Measures
The measures included in this tool kit are intended for screening, both initial and follow-up, in routine comprehensive epilepsy care by any epilepsy professional caring for epilepsy with seizures. Measures were excluded if they were developed and validated for diagnostic purposes only. I
Screening Measure Inclusion Criteria
Measures were nominated and reviewed by experts providing behavioral health care to adults and youth with epilepsy and met the following inclusion criteria:
- Developed and validated for screening (ie., continuous measures of symptom severity and/or frequency) purposes.
- Information available to support the achievement of basic psychometric standards (e.g., reliability and validity indices, instructions for interpretation with age ranges).
- Feasibly administered in a routine clinic environment by any epilepsy professional providing care to patients with epilepsy
- Published in English in a peer-reviewed journal
Organization of Data for Screening Measures
Structured information on each measure can assist providers in the selection of which measure(s) might be most appropriate for use in their clinical practice. Clinician choice is based on a “Good Enough” approach (Hunsley & Mash, 2018). The “Good Enough” principle considers accuracy, efficiency, and cost-effectiveness of psychological measures and has precedence for evaluating behavioral health measures in epilepsy (Wagner et al 2022). In other words, is a screening measure “good enough” for use with a particular population or in a particular setting? Data is presented on the following indices:
- Psychometric properties (e.g., reliability and validity)
- Length and estimated time to complete/administer
- Age range
- Scoring instructions and interpretation (e.g., cut-off score)
- Cost
- Availability in languages other than English
Recommendations for Effectively Implementing a Screening Tool in Clinical Practice
In many offices, it may require some up-front work to correctly implement screening tools and the proper tracking and handling of their results. In most cases, clinicians will find that the long-term benefits screening provides to patients will far outweigh the work required to install the program.
- Select a screening tool appropriate to your daily practice, accounting for details such as population in your clinic, time to complete the survey, methods for collecting and recording the results, and opportunity to act upon the survey results prior to completion of the appointment. Also consider whether the survey is intended to be used at every visit, or a certain number of times per year, and how the results for individual patients can be tracked and effectively observed over time.
- Once a screening tool is selected, it is essential to understand the scoring method, and interpretation of the results. Most areas of concern identified via screening will need follow-up formal diagnostic approaches. If you are not comfortable or trained for a specific area, it is fine to refer the patient to an appropriate clinician, or otherwise assist them to proper care. In the rare cases of a potentially urgent situation, such as identification of acute suicidality, it is important that somebody in the office be competent and available to assess any patient in whom that issue is identified. This is best done via formal protocols for specific situations, with built-in redundancy to ensure adequate and available staffing.
Disclaimer: Inclusion of a measure is not an AES endorsement of any single measure over another nor a condemnation of any measure that is not listed. The ultimate selection of measure(s) is by the provider based on their service, setting, resources, and needs. Thus, an evaluation was not conducted of the screening measures (e.g., Delphi, Prisma protocols) but rather describe the available information on each measure. To access evaluative information on screening measures, visit the International Consortium for Health Outcomes Measurement (ICHOM) measurement set for Epilepsy XXXX. In addition, the screening tools in this toolkit do not provide treatment for the conditions identified, and it is incumbent on the clinicians to determine appropriate management once a behavioral health concern is identified as present.
References