Barriers and facilitators to using standardised diagnostic assessments in child and adolescent mental health services: a qualitative process evaluation of the STADIA trial

The STADIA trial aimed to assess the effectiveness of a standardised diagnostic assessment tool (Development and Wellbeing Assessment, DAWBA) in aiding clinician-made diagnosis decisions in Child and Adolescent Mental Health Services (CAMHS). This study reports the qualitative process evaluation of the STADIA trial, which aimed to identify barriers and facilitators to using the online-completed DAWBA in CAMHS. Qualitative data were collected through 109 semi-structured interviews with young people, parents/carers, healthcare professionals and service commissioners/funders in 8 CAMHS sites across England. Deductive thematic analysis was guided by the domains of the Consolidated Framework for Implementation Research. Young people and parents/carers showed high levels of engagement with the DAWBA. They perceived a validation of symptoms from the generated DAWBA report, which they actively used as 'evidence' when seeking help from other services. Clinicians involved in determining referral acceptance/rejection decisions were positive about its use and saw benefits in aiding decision-making. In contrast, however, barriers to clinicians engaging with the DAWBA report during the assessment stage arose from limited awareness and accessibility to the report, a context of high workload and pressure, and general concerns about the value of a diagnosis. The DAWBA was not widely used by clinicians in the expected way to aid diagnostic decision-making. However, it may offer children and young people much-needed engagement during long waiting times for initial assessment in CAMHS. The DAWBA may be more acceptable to clinical teams in triaging referrals to help with timely decisions about the most suitable services.Trial registration ISRCTN15748675 (29/05/2019).