Of course credentials in health care matter! They provide necessary proof that qualified professionals are engaged to deliver competent and effective services to consumers. Just as critical medical procedures such as surgery should be performed by licensed and certified surgeons, so should mental health and substance abuse treatment be delivered by those who have met professional standards of practice.

     Or maybe they don’t matter at all. Credentials are a process indicator, not an outcome indicator. Process indicators are often necessary, but they have limited roles in developing good outcome indicators. Rehabilitation and recovery are the primary service goal; does it follow that only credentialed professionals ought to deliver quality screening and assessment? With in-service training, could others do as good a job?

     At the heart of this discussion lies the issue of how quality is to be perceived, defined, and measured. Credentials alone do not guarantee a high-quality outcome, but only permit it as a possibility. Other elements, such as active consumer participation or the specific content of screening and assessment can contribute as much, or even more, to the quality of screening and assessment. One national trend, for example, is that more and more screening and assessment instruments are standardized, and include consumers’ self-reporting as an integral part of information gathering.

     There is a clear place for credentialed professionals to perform assessment – in diagnostic evaluation (including psychosocial assessment) to assist service planning and intervention. Ideally, the same professional is engaged with the consumer throughout the process and is accountable for service outcomes. However, information gathering can sometimes be performed by others, as long as interpretation for evaluation rests with the credentialed professional. A recent study by the Center for Social Work Practice at Columbia University found that standardized screening and assessment information gathered by consumers and non-credentialed professionals can be used effectively by credentialed personnel in making sound assessment and service plans.

     The idea that only credentialed professionals can provide high-quality behavioral health screening and assessment is one of the tenets of mental health and substance abuse services, based on the assumption that credentialed professionals can help ensure accountability and quality of screening and assessment.

     Yet one troubling phenomenon that has permeated public behavioral health systems is the repetitive assessments performed at each referral. As a consequence, in addition to the constraint of relying on credentialed professionals to perform various service tasks, barriers to service – not to mention additional cost – are further created by repetitive assessments.

     What do you think? Read a complete discussion of credentials in behavioral health screening and assessment in the new MHDNA Issue Brief on our web site at www.azmentalhealth.org/issue-brief.html, or request a copy by calling 602-385-6500 or by e-mail at info@azmentalhealth.org. In addition, click on the newly created section entitled "A Different Point of View" for comments by the Executive Director of the Board of Behavioral Health Examiners.

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