A behavioral health assessment is a screening tool that gives clinicians an overview of their patients’ mental and behavioral health, including maladaptive behaviors and substance use. Behavioral health assessments are not standalone diagnostic tools, but rather are used to gather the data that can guide clinicians towards accurate diagnoses.
Misdiagnosis is a common reality for patients with mental health disorders, with rates reaching up to 65.9% for major depressive disorder, 92.7% for bipolar disorder, and 71.0% for generalized anxiety disorder, according to research on misdiagnosis rates. Behavioral health assessments can help facilitate dialogue with patients and clearly identify symptoms of these mental health conditions.
These assessments offer time-saving measures for mental health professionals, such as psychiatrists and psychologists. They also help primary care clinicians more accurately screen for mental health conditions in the process of making referrals.
In this post, we include a comprehensive list of assessment and screening tools, as well as:
- What’s included in a behavioral health assessment
- How to evaluate the quality of these assessments
- The best digital tools to improve assessment workflows
Article Highlights
A behavioral health assessment is a screening tool that gives clinicians an overview of patients’ mental and behavioral health. It is not a standalone diagnostic tool; it gathers the data that can guide clinicians towards accurate diagnoses.
- Research has found misdiagnosis rates of up to 65.9% for major depressive disorder, 92.7% for bipolar disorder, and 71.0% for generalized anxiety disorder.
- A behavioral health intake assessment typically involves questionnaires, alongside a patient interview, family and caregiver interviews, a physical exam, and cognitive testing.
- Common screeners include the GAD-7 for anxiety, the PHQ-9 for depression, the MDQ for bipolar disorder, the AUDIT and DAST-10 for alcohol and drug use, and the PCL-5 for post-traumatic stress disorder (PTSD).
- Good screeners offer validity, reliability, administrative ease, specificity, and sensitivity, and evidence-based assessments include both objective and subjective measurements.
Why use a behavioral health assessment?
Behavioral health assessments identify symptoms of mental health conditions such as depression, anxiety disorders, and more. They help behavioral health specialists narrow down conditions, and give general practitioners an idea of when a referral for a more serious mental health disorder might be valuable.
Often, patient health questionnaires are completed alongside interviews with patients and their families, a physical health assessment, and more, as we explore below.
One comparison of research interview results found that 30–70% of patients with mental health disorders had them go undetected by their general practitioners. Conducting regular mental health screenings can help identify symptoms and significant mental health changes early, and get patients on the road to treatment.
What is included in a behavioral health assessment?
A behavioral health intake assessment typically involves questionnaires, and takes place alongside a patient interview, family and caregiver interviews, a physical exam, and cognitive testing. We’ll go into more detail on each of these below.
Questionnaires
An efficient way to go through behavioral health screening questions is using a patient health questionnaire. These questionnaires can be completed verbally, on paper, or digitally, and can give either an overall look at patients’ mental health or screen for specific conditions.
Creyos behavioral health questionnaires can be administered in clinic or remotely, and integrate the results directly into patients’ electronic health records. This maximizes face-to-face appointment time and reduces the amount of time providers spend writing session notes.
Patient interviews
Under the patient-centered care model, the role of clinicians is to get a full view of an individual patient’s needs and goals. Patient interviews give patients the opportunity to self-report their symptoms, and give clinicians a chance to examine a patient’s behaviors during the conversation.
In a patient interview, a clinician might ask about the patient’s:
- Personal history
- Family history
- Lifestyle
- Relationships
- Trauma background
- Mental health symptoms
- Sources of stress
- Current emotional state
Family and caregiver interviews
Patients with major health conditions often benefit from social care, and family interviews give clinicians extra context and perspective about patients’ social environment and behavioral health.
Why are family and caregiver perspectives important? In the cognitive health field, for example, many people with dementia experience denial or lack of insight about their symptoms, according to the Alzheimer’s Society. In these cases, interviews with a family member can reveal the extent to which cognitive impairment is impacting patients’ lives.
Physical exams
A physical exam can help rule out physical illnesses that may be causing behavioral health problems. For example, conditions such as thyroid disorders, vitamin deficiencies, and diabetes can present with similar symptoms to clinical depression, according to an AARP guide to conditions that mimic depression. If clinicians suspect a physical condition, they can order lab tests such as blood work, urine tests, or MRIs.
Checking in about patients’ current medication, substance use, and physical wellness gives a more complete picture of patient health.
Cognitive assessments
Many cognitive health disorders have behavioral symptoms. In fact, behavioral and psychological symptoms of dementia (BPSD) affect 40–80% of people with dementia and are associated with the likelihood of being placed in a nursing home, according to Canadian dementia care guidance.
Including cognitive assessments alongside behavioral and mental health screenings gives clinicians essential patient data that can impact the direction of treatment.
Common behavioral health assessments by condition
Here are some common behavioral health assessments for:
- ADHD in children and adults
- Addiction
- Anxiety
- Autism
- Bipolar disorder
- Depression
- Pain
- PTSD
- Stress
ADHD
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), attention-deficit/hyperactivity disorder (ADHD) is “a neurodevelopmental disorder defined by impairing levels of inattention, disorganization, and/or hyperactivity-impulsivity.”
Since the COVID-19 pandemic, patient inquiries about ADHD and the use of ADHD medication have significantly increased, according to research on pandemic-era ADHD trends. Behavioral health assessments and screening tools help general practitioners and psychologists provide accurate diagnoses and appropriate treatment.
Creyos ADHD Assessment tool
The Creyos ADHD Assessment and Report is a scientifically-backed protocol that evaluates objective cognitive markers of ADHD. It includes five tasks that assess 14 specific markers, and can be completed in-clinic or at home in under 25 minutes.
Along with the cognitive assessment, the protocol has several age-appropriate questionnaires, allowing for an accurate look into the ways patients experience their symptoms. This helps physicians and behavioral health specialists not only diagnose ADHD, but also monitor how symptoms and behaviors evolve over time.
SWAN ADHD assessment
The Strengths and Weaknesses of Attention-Deficit/Hyperactivity Symptoms and Normal Behavior (SWAN) Scale is an 18-item screening tool designed to evaluate ADHD symptoms in children and teens. The SWAN combats social-cultural and statistical biases by addressing a greater range of strengths and weaknesses in attention-based skills and behaviors.
Vanderbilt ADHD Diagnostic Rating Scale (VADRS)
The Vanderbilt Assessment (VADRS) for childhood ADHD is a 55-item diagnostic aid for parents, teachers, and clinicians to screen children between the ages of 6 and 12. The VADRS takes about 10 minutes to complete, and includes additional items regarding school performance and relationship skills.
Adult ADHD Self-Report Scale (ASRS) Part A
The ASRS Part A is a six-question screening tool designed to help identify ADHD in adults, based on DSM diagnostic criteria.
Addiction
According to the World Health Organization (WHO), an estimated 39.5 million people are affected by substance use disorders worldwide. Addiction screening tools help physicians, mental health professionals, and behavioral health specialists monitor patients’ drug and alcohol use.
Alcohol Use Disorders Identification Test (AUDIT)
The AUDIT questionnaire contains 10 questions that help identify hazardous alcohol consumption. The AUDIT only takes two minutes to complete, and can be administered either remotely or in person.
Drug Abuse Screening Test (DAST-10)
Similar to the AUDIT questionnaire, the Drug Abuse Screening Test (DAST-10) is a two-minute questionnaire that contains 10 questions that help identify signs of drug abuse.
Anxiety
Anxiety disorders are the most common mental disorders, affecting 4% of the world’s population, but only one in four people receive treatment, according to the World Health Organization. Behavioral health assessments can screen for symptoms of anxiety and identify when patients might benefit from further assessment for a diagnosis.
GAD-7 questionnaire
The Generalized Anxiety Disorder (GAD-7) questionnaire is a seven-question, self-administered screening tool for symptoms of generalized anxiety disorder. Brief and able to be taken from home, this behavioral health assessment can reduce patient anxiety regarding the process of assessment itself.
Autism
Autism spectrum disorders (ASD) refer to a diverse group of conditions often characterized by challenges with social interaction, communication, and sensory needs, according to the World Health Organization. The needs of autistic patients greatly vary, and diagnoses can often be missed due to masking, as research on autism masking notes.
Autism screening questionnaires assist physicians in diagnosis or the decision to refer patients to a behavioral health specialist for a full diagnostic assessment, opening the way for steps like crucial accommodations in school and the workplace.
Autism Spectrum Quotient (AQ) questionnaire
The Autism Spectrum Quotient (AQ) questionnaire is a self-administered screening tool for patients 16+. The AQ is designed primarily for adults with autistic traits who are not severely intellectually impaired.
Bipolar disorder
Bipolar disorder affects approximately 2.4% of the global population, and is one of the leading causes of disability and suicide risk in young people, according to research on bipolar disorder. Scientifically-backed mental health screenings help identify the state of an individual’s mental health, their family history of mental illness, and when a complete psychological evaluation might be necessary.
Mood Disorder Questionnaire (MDQ)
The Mood Disorder Questionnaire (MDQ) is a self-administered mental health screening tool that can be completed in about five minutes. The MDQ contains 13 yes/no questions that assess a patient’s history and severity of manic or hypomanic symptoms.
If a patient reaches the cut off score for bipolar disorder, physicians are advised to refer them to a mood disorder specialist for more thorough evaluation.
Depression
Globally, an estimated 5% of adults live with depressive disorder, according to the World Health Organization. Depending on the severity and duration of symptoms, depression can be categorized as mild, moderate, or severe. Mental health assessments can identify depression early on, allowing patients to more promptly access treatment.
PHQ-9 measure
The Patient Health Questionnaire (PHQ-9) is a nine-question screening tool that can identify depression symptoms, assist with a diagnosis, and monitor symptoms over time. The PHQ-9 is one of the most commonly used mental health screening tools among clinicians and researchers.
Pain
Chronic pain and pain-related diseases are the leading cause of disability and disease burden worldwide, according to research on chronic pain and the Global Burden of Disease study.
The impact of this pain has led to ongoing epidemics of painkiller abuse; in fact, 70% of people with a prescription drug addiction are addicted to pain medication, according to the National Center for Drug Abuse Statistics. As physicians assess patient pain levels, a drug abuse screening test can identify their risk factors for addiction.
Pain Medication Questionnaire (PMQ)
The Pain Medication Questionnaire (PMQ) is a 26-question self-report for patients who are already taking opioids, designed to measure their risk of misuse and addiction to painkillers.
PTSD
An estimated 6% of the population will experience post-traumatic stress disorder (PTSD) at some point in their lives in response to traumatic events, according to the U.S. Department of Veterans Affairs. PTSD can lead to cognitive impairment, including challenges with memory, attention, planning, and problem solving, according to research on PTSD and cognition.
Behavioral health assessments, combined with cognitive screening tools, can identify when symptoms of cognitive impairment are occurring as a result of trauma.
Connect with Creyos today to learn more about our full suite of cognitive assessment tools.
PCL-5 measure for post-traumatic stress
The PTSD Checklist for DSM-5 (PCL-5) is a 20-item self-report that screens for the presence and severity of symptoms of PTSD. The PCL-5 can be completed in under 10 minutes, and is primarily used to assist in making a PTSD diagnosis and monitor symptom changes during treatment.
Stress
According to the American Psychological Association, chronic stress can lead to challenges with the musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous, and reproductive systems. Screening for stress levels during a patient’s wellness visit helps identify the relationship between their physical and mental health symptoms.
Perceived Stress Scale (PSS)
The Perceived Stress Scale (PSS) is a self-report assessment tool that captures patients’ subjective stress levels. Rather than identify individual stressors, the PSS examines the impact of those stressors on an individual patient’s health and measures improvement over time.
Assessments for adults vs. assessments for children
Symptoms of mental health conditions often present differently between children and adults. Choosing age-appropriate behavioral health assessments leads to more accurate data, improving health outcomes in the long-term.
For example, while the Vanderbilt ADHD Diagnostic Rating Scale (VADRS) measures childhood ADHD, the ASRS assessment includes questions that are more relevant to adults. Even though they are different screening tools, providers can bill with CPT code 96127 for both of them.
How do you evaluate behavioral health screeners?
There are a few factors to consider when choosing which screening tools are best for your clinic’s behavioral health assessment:
Criteria
The behavioral health assessment software and screeners should have the following qualities:
- Validity: This one is obvious, but the right tools for behavioral assessments should always be scientifically-backed and measure what they claim to measure. This is key to health outcomes and clinic credibility.
- Reliability: A good assessment minimizes confusing questions or other factors that can make results unreliable from one time to another.
- Administrative ease: 75% of physicians say that unnecessary administrative tasks negatively affect their job satisfaction, according to the Canadian Medical Association. A behavioral screening test should reduce administrative burden rather than add to it.
- Specificity: Certain mental health conditions have overlapping symptoms. The more specific the assessment is, the better it is at correctly screening out patients who do not genuinely have the condition being measured.
- Sensitivity: Health assessments should be able to identify the patients who truly have a condition and would likely benefit from treatment.
Objective and subjective measures
Evidence-based health assessments are most successful when they include both objective and subjective measurements:
- Subjective measurements capture a patient’s individual perception of their symptoms. This data is often captured through self-report questionnaires.
- Objective measurements identify and quantify observable symptoms and gather medical evidence through scientifically-validated tests.
Each of these strategies plays an equal role in measurement-based care. In combination, patients are able to share their unique experience, guiding clinicians towards the tests that can verify the self-reported symptoms.
For example, if a patient is reporting ongoing confusion and forgetfulness, cognitive tests provide objective data to identify the nature and severity of those symptoms.
Screening, diagnosis, and monitoring
Behavioral, cognitive, and mental health assessments serve three different purposes:
- Screening: A screening test should be quick and easy to use. Its purpose is to identify if a patient should be referred to a fuller assessment.
- Diagnostic support tool: Once a patient has completed a screening, a diagnostic support tool confirms if a patient qualifies for a diagnosis. This assessment is longer, and typically performed by a specialist.
- Outcome monitoring: If a patient is showing symptoms of behavioral or mental health conditions, ongoing monitoring quantifies how effective treatment is. Monitoring can also identify when it’s time for a different approach or more serious interventions.
Online tools for enhanced assessment workflows
Research shows that depression and cognitive decline tend to occur bidirectionally, each amplifying the other over time, as a JAMA Network Open study and earlier research describe. Objective measurements of mental health symptoms help clinicians track these patterns and identify comorbidities.
The Creyos suite of mental and behavioral health assessment tools can quickly and accurately assess symptoms of mental health conditions like ADHD, anxiety, and depression. Along with this, they help evaluate the cognitive impacts of mental disorders.
One BJPsych Bulletin study found that as many as one in five newly qualified general practitioners lacked confidence in their ability to assess patients for mental health conditions.
When combined, our self-report questionnaires and cognitive tasks empower patients to share how they experience their symptoms while giving providers objective data.
Complete behavioral healthcare
The best behavioral health assessments are the ones that open the road to diagnosis. Whether you’re a mental health specialist who wants to improve your process or a general practitioner who wants to incorporate screenings into your intake form, there are plenty of tools to support patient outcomes.
Connect with Creyos today to learn what our behavioral health assessments have to offer your medical practice.
Reviewed by Sydni Paleczny, Staff Scientist at Creyos
Sydni earned her MSc in Neurosciences at Western University under Dr. Adrian Owen. Her research explores neuropsychological outcomes after cardiac surgery, with interests in cognitive neuroscience, critical care, and brain health. At Creyos, she supports scientific validity, health technology, and ongoing research.