Use of the Strengths and Difficulties Questionnaire to identify treatment needs in looked-after children referred to CAMHS

• Published in: Developmental child welfare Vol. 1; no. 2; pp. 159 - 176
• Main Authors: Wright, Hannah, Wellsted, David, Gratton, Jacqui, Besser, Sarah Jane, Midgley, Nick
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2019; SAGE PUBLICATIONS, INC
• Subjects: Child & adolescent mental health; Mental health; Looked-after children; SDQ; Strengths and Difficulties Questionnaire; mental health
• ISSN: 2516-1032; 2516-1040
• DOI: 10.1177/2516103218817555

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.