When and how assessment matters: An update on the Treatment Utility of Clinical Assessment (TUCA)

The Treatment Utility of Clinical Assessment (TUCA) has long been a controversial topic, with arguably more (strong) opinions than relevant, well-designed empirical research. We argue that this question has been tackled too broadly and that a more contextualized approach would likely be more informative. Instead of asking "what is the treatment utility of assessment," we suggest specifying and examining more closely the conditions by which assessment can-or cannot-contribute to treatment process and ultimately patient benefit. To this end, we present a heuristic model for conceptualizing the conditions under which clinical assessment may have treatment utility and illustrate its use by distinguishing four specific classes of assessment-driven interventions. We distinguish direct benefits from assessment from indirect TUCA as two principal pathways, emphasize the importance of having some a priori theory regarding working mechanisms, and stress the requirements of ensuring adequate variability of the presumed mediating variables. These considerations in turn argue for a broader view of pertinent outcome measures, the use of more powerful designs in TUCA research, and the implementation of some form of stepped assessment in clinical practice.