Validity evidence for the use of the Pediatric Quality of Life Inventory, the Revised Children’s Anxiety and Depression Scale-25, and the Columbia-Suicide Severity Rating Scale in measurement-based care in intensive outpatient child and adolescent mental health care

We sought to evaluate the validity of the interpretations made on the scores from three patient-reported outcome measures (PROMs), the Pediatric Quality of Life Inventory (PedsQL), the Revised Children's Anxiety and Depression Scale-25 (RCADS-25), and Columbia-Suicide Severity Rating Scale-short form (C-SSRS), for use in measurement-based care (MBC) in intensive outpatient child and adolescent mental health services. A mixed-methods, secondary analysis of interview and survey data from an MBC implementation evaluation, as well as PROMs data collected through MBC in routine clinical practice, was performed. The setting was intensive outpatient mental health services for children 6-18 years of age. The Standards for Educational and Psychological Testing argument-based approach to validation was used combining qualitative and quantitative data to evaluate validity. The PROMs appear to comprehensively cover key domains relevant to child and adolescent mental health intensive outpatient treatment. There is preliminary evidence that youth scores accurately reflect their symptoms and functioning and pick up change in these constructs, however, potential issues with response processes were identified with the C-SSRS, the school domain of PedsQL, and for caregiver proxy-reports on the PedsQL and RCADS-25, which warrant further investigation. There is evidence to support the use of these PROMs for MBC in child and adolescent mental health. However, further investigation is needed into response processes, internal structure, and to establish clinically meaningful thresholds to improve interpretability, and ensure the validity of their use.