(PS2-35) Does Structure Come at a Cost? Evaluating Feasibility and Impact of Structured Diagnostic Interviews on Alliance and Satisfaction

Abstract Text: Standardized assessment methods are recommended for evidence-based assessment and reliable diagnosis, yet many clinicians continue to rely on unstandardized methods (Cook et al., 2017). Past research has documented practical concerns (e.g., time demands) and fears that clients may not find structured interviews acceptable as potential barriers to their use (Bruchmüller et al., 2011). Despite these concerns, few studies have examined the implementation of structured interviews to assess their practicality and impact on alliance and satisfaction. This study evaluates the feasibility and barriers to using a structured intake interview in a university clinic and the subsequent clinician- and caregiver-reported alliance and satisfaction.

Therapist-caregiver pairs (n = 50) at a university training clinic completed surveys after intake sessions where the Parent-Children's Interview for Psychiatric Syndromes (PChIPS), a highly structured diagnostic interview for assessing psychiatric disorders in children, was used. Measures included clinician-reported session plans and barriers, alliance ratings from clinicians and caregivers, and caregiver satisfaction ratings. Feasibility was assessed by calculating the percentage of therapists who planned to complete the PChIPS and did so, compared to those who planned but partially completed or did not complete. Independent samples t-tests were conducted to compare the completion groups on alliance and satisfaction, while qualitative responses were coded to identify themes.

Thirty therapists fully completed the PChIPS (60%), while 20 (40%) partially or did not complete the PChIPS. Reported barriers for those who did not complete the PChIPS included time constraints (n = 13), which were due to parents arriving late or leaving early (n = 7), difficulty staying on topic or redirecting parents (n = 5), parent uncooperativeness (n = 2), and clinical crises (n = 1). There was no significant difference in therapist-rated alliance scores between the completion groups (t(48) = -1.27, p = .210). Caregiver-reported alliance scores were high, averaging between “Quite a Bit” and “Totally” on a 5-point scale (M completed = 4.54, M not completed = 4.14), with no significant difference between groups (t(48) = -1.83, p = .073). Caregivers' satisfaction scores fell between “Yes, Generally” and “Yes, Definitely” (M = 3.92 and M = 3.83, respectively) on a 4-point scale, with no significant difference between groups (t(48) = -1.17, p = .249). Qualitative responses indicated positive experiences with staff (n = 21), the assessment process (n = 7), and overall services (n = 4). No negative feedback on the PChIPS was reported.

Results suggest that PChIPS can be feasibly implemented, and barriers were primarily related to completing the assessment within the allotted time. This highlights the need for structured interview training that includes techniques for client redirection and session management. The ratings from caregivers provide promising evidence that standardized assessment tools can be used without disrupting alliance or satisfaction with services and clients may perceive these methods more positively than expected. Limitations include reliance on self-report measures and the single-site design.