Use of the Strengths and Difficulties Questionnaire to identify treatment needs in looked-after children referred to CAMHS. (June 2019)

• Record Type: Journal Article
• Authors: Wright, Hannah; Wellsted, David; Gratton, Jacqui; Besser, Sarah Jane; Midgley, Nick
• Is Part Of: Developmental child welfare. Volume 1:Number 2(2019)
• Page Start: 159
• Page End: 176
• Publication Date: 2019-06
• Subjects: Looked-after children -- mental health -- Strengths and Difficulties Questionnaire -- SDQ; Child welfare -- Periodicals; Poor children -- Social conditions -- Periodicals; Poor youth -- Social conditions -- Periodicals; Poor children -- Health and hygiene -- Periodicals; Poor youth -- Health and hygiene -- Periodicals; Poor youth -- Social conditions; Poor children -- Social conditions; Poor children -- Health and hygiene; Child welfare; Electronic journals; Periodicals; 362.705
• DOI: 10.1177/2516103218817555
• Languages: English
• ISSNs: 2516-1032

Abstract

Background: In England and Wales, the single-informant Strengths and Difficulties Questionnaire (SDQ) is used to assess and monitor looked-after children's (LAC) mental health; and some targeted Child and Adolescent Mental Health Services (CAMHS) include a minimum SDQ score in their acceptance criteria. However, its ability to identify LAC who need mental health treatment is insufficiently understood. Methods: One hundred and forty four LAC referrals to a Targeted CAMHS Team were screened as part of a larger study. To establish how well the SDQ identified children who required treatment, Total Difficulties Scores from single-informant SDQs submitted at referral were compared to treatment recommendations following routine CAMHS assessment in a real-world setting. To explain the results, clinicians ( n = 9) from the team were interviewed and key themes identified using thematic analysis. Results: AUROC analysis found that the single-informant SDQ discriminated between children who were assessed as needing a mental health intervention and those who did not with low accuracy when SDQs were completed by carers or young people themselves, and moderate accuracy for teacher-completed SDQs. Optimal cutoff scores are calculated and are lower than advised in scoring guidance. Key themes from clinician interviews identified possible gaps and limitations: Developmental trauma and attachment difficulties, A different kind of patient?, Seeing the "bad" but neglecting the sad, and The importance of clinical judgment. Conclusions: Contrary to current UK Government policy, this study suggests that the single-report SDQ should not be relied upon as a sole means of identifying mental health difficulties in this vulnerable, high-risk population.