Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease.
Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the range of disorders. Our objective is to leverage Compass as a means for clinical staging for mental health that can assist the early detection and treatment of mental disorders.
Our strategy is to incorporate a theory-based, automated clinical staging protocol that leverages the clinical validation and evidence base of the staging model through Compass.
This paper extends previous work on developing a clinical decision-making protocol based on the clinical staging framework, by presenting the basic structure of an automated version of this protocol (Algorithms 1 and 2 listed below).
Clinical staging is not meant to replace diagnosis but instead act as an adjunct to it. This means that the automated clinical staging protocol presented here, should not (and is not intended to) be taken as the sole indicator of a young person’s mental health. Instead, the application of the clinical staging model provides the opportunity for it to be used as a standardized and scalable decision support tool in services.
In tandem with a multidimensional intake assessment, the automated clinical staging protocol provides a useful tool for distilling the complex assessment results into a clinical stage that can be used to help clinicians decide about the best care plan and pathway for a member.
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Hickie IB, Scott EM, Hermens DF, Naismith SL, Guastella AJ, Kaur M, et al. Applying clinical staging to young people who present for mental health care. Early Interv Psychiatry. (2013)
Hickie IB, Scott EM, Cross SP, Iorfino F, Davenport TA, Guastella AJ, et al. Right care, first time: a highly personalised and measurement-based care model to manage youth mental health. Med J Austr. (2019)
Quick Inventory of Depressive Symptomatology (QIDS SR-16)
Patient Health Questionnaire - (PHQ-9)
A clinical stage suggested by this protocol represents one source of information that the clinician could use when considering a young person’s case. For those at higher clinical stages or not accessing self-directed or low intensity services, their cases would ideally be flagged and reviewed by the Compass Clinical team to determine the right care plan and pathway.
Leveraging the QIDS SR-16 and PHQ-9 Questionnaires, Compass will create an algorithm to power the screening protocol and dashboard for clinicians to view. With this information, decisions can be made about the need for further assessment, the care or intervention needed to address their needs and the overall intensity of services (i.e., type of service and treatments, minimum duration of care required, treatment frequency). This ensures that members receive the right level of care for an appropriate amount of time to optimize treatment and prevention outcomes.
