Distinguishing Between Screening and Assessment for Mental and Behavioral Health Problems

Screening for mental and behavioral health problems is part of comprehensive healthcare and population health as described by the Patient Protection and Affordable Care Act. The associated healthcare regulations, proliferation of online measures and web‐based evaluation systems have created a need to distinguish between screening and assessment in the health arena. Although sometimes used interchangeably, these terms are not synonymous. This brief statement is intended to assist in differentiating between screening and assessment in terms of their respective goals, indicators for use, level of complexity, and outcomes, while recognizing their common properties.

• Is used for the early identification of individuals at potentially high risk for a specific condition or disorder
• Can indicate a need for further evaluation or preliminary intervention
• Is generally brief and narrow in scope
• May be administered as part of a routine clinical visit
• Is used to monitor treatment progress, outcome, or change in symptoms over time
• May be administered by clinicians, support staff with appropriate training, an electronic device (such as a computer), or self‐administered
• Support staff follow an established protocol for scoring with a pre‐established cut‐off score and guidelines for individuals that score positive.
• Is neither definitively diagnostic nor a definitive indication of a specific condition or disorder

• Provides a more complete clinical picture of an individual
• Is comprehensive in focusing on the individual’s functioning across multiple domains
• Can aid diagnosis and/or treatment planning in a culturally competent manner
• Can identify psychological problems and conditions, indicate their severity, and provide treatment recommendations
• Integrates results from multiple psychological tests, clinical interviews, behavioral observations, clinical record reviews, and collateral information
• May include screening measures that are used in conjunction with other information from the assessment, providing a broader context for interpreting the results
• May use screening results to determine the choice of instruments for an assessment
• May cover domains of functioning, such as memory and language, visual and verbal problem solving, executive functioning, adaptive functioning, psychological status, capacity for self‐care, relevant psychosocial history, and others needed to respond to the referral questions

Users of screening and assessment tools must assess the psychometric properties of tests they intend to use and ensure that they meet the criteria for acceptable psychological tests, given their intended purpose. Basic psychometric properties of tests to be evaluated include the following:

• Reliability ‐ the precision of test scores, e.g., to ensure that the repeated administration of the test would yield the same result
• Validity – the extent to which test scores adequately represent a test‐taker’s standing on the psychological variable of interest, e.g., an individual’s level of anxiety
• Classification Accuracy – adequacy of cutoff scores used to indicate whether a test‐taker has, or is at risk for having, a specific condition, e.g., to demonstrate that individuals with depression will score at or above a designated cut off score
• Fairness – the extent to which the test scores are equally reliable and valid for various segments of the population
• Norm Adequacy ‐ whether reference groups used to assist in test score interpretation adequately represent the population for which a test is designated

In addition, the competent administration of screening and assessment measures requires those who use or supervise the use of these tools to have skills and training appropriate for their assigned tasks. Specific training and skills may be in the following areas:

• Knowledge of appropriate measures for the specific referral question (e.g., knowledge of diagnostic systems for psychodiagnostic assessments)
• Relevant information about the specific characteristics of the individual being assessed, e.g., race, gender, language, disability, etc.
• Expertise in test administration and/or scoring

The American Psychological Association and American Psychological Association Practice Organization Work Group on Screening and Psychological Assessment included members of the Board of Professional Affairs, Committee for the Advancement of Professional Practice, and Committee on Psychological Tests and Assessment.

December 2014