The C-DISC in Clinical Services: A Progress Report

William Bacon, Ph.D.

This multi-year, NIMH-funded study examines the impact of introducing a standardized, computerized assessment procedure into the intake process of community-based mental health clinics. The study was described in the 1994 issue of Practice & Research. This article summarizes the study’s subsequent progress through early 1997. 

The Computerized Diagnostic Interview Schedule for Children (C-DISC) was developed by NIMH and has proven its usefulness for research purposes. It is a reliable, valid, and inexpensive means of identifying mental disorders and psychological symptoms in children and adolescents. The present study is designed to determine whether the instrument is useful in clinical services. It involves implementing the instrument in seven of the JBFCS Madeleine Borg clinics.

The study design calls for the C-DISC to be administered to children and their caretakers prior to their being seen for an intake by a clinician. A printout of the results of the C-DISC, including probable and possible diagnoses and endorsed symptoms, is made available to the intake clinician, who then meets with the child and caretaker for a clinical intake interview. The chief question for the study is whether clinicians find such reports helpful and useful. Along with assessing subjective usefulness, the study will also examine whether clinicians’ diagnostic practices or treatment recommendations are influenced by the C-DISC reports.

Study procedures were redesigned this year responding to field requirements of a large, ambitious research protocol being introduced into an agency undergoing rapid change related to the transformation of the mental health service field. Protocol revisions included streamlining the procedures for identifying cases, reducing burden on clinic staff, and providing resources to the clinics to help implement the study. The changes have been effective. All of the participating clinics have made significant progress in completing the study’s baseline phase. Several are finished or nearly finished with baseline. The experimental phase is beginning in December 1997, initially at one clinic, and then at the other clinics as they complete the baseline phase.

A significant addition has been the appointment of a talented group of doctoral students (mostly NIMH Predoctoral Fellows) who serve as Site Managers and Research Advisors to the clinics. They work with clinic personnel devising practical procedures in the individual clinics, and they troubleshoot local problems. They are James Catalano, S.J., M.S.W., Rachelle Kammer, M.S.W., Steven Lohrer, M.S., Leslie Pereira, M.S., Hilda Rivera-Rodriguez, M.S.W. and Anne Singh Stephan, M.S. The study benefits from the diligence of Donald McVinney, M.S. and Gretchen Borges, M.S., Research Assistants. Most critically, the progress of the study has depended on the support of the many clinicians and administrative personnel of the participating JBFCS clinics.

The study is being conducted under a subcontract with the New York State Psychiatric Institute. The research staff includes Principal Investigator David Shaffer, M.D. and Co-lnvestigators Prudence Fisher, M.S., C.S.W. and Christopher Lucas, M.D. (from NYSPI) and from the Center Principal Investigator Edward Mullen, D.S.W. and Co-lnvestigators Bruce Grellong, Ph.D., Robert Abramovitz, M.D., and William Bacon, Ph.D.