When one assessment isn’t enough: the strengths and difficulties of the SDQ

It is widely acknowledged that children in care are at greater risk of developing mental health difficulties[1]. Often, this is due to the experiences which have brought them into the care system, which may include abuse, trauma and neglect. Despite this understanding, the emotional wellbeing of those in care is not routinely assessed. Those who do screen often use the Strengths and Difficulties Questionnaire (SDQ)[2].

At Five Rivers, we initially used the SDQ, alongside a brief measure of attachment (the Relationship Problems Questionnaire) to monitor the emotional and behavioural wellbeing of the children in our care. We soon realised that although the SDQ is a validated measure used in the LAC population[3], in isolation the tool cannot accurately assess the needs of a child in care.

In April of 2018, we overhauled our assessment process. We decided to create two different pathways based upon the age of the young people in our care (2-11 years and 12-17). Splitting the age categories allowed us to be more specific in the assessments we use. We introduced a new attachment assessment for the younger cohort (The Attachment Screening Assessment), and for both age ranges we introduced a dissociation scale, a trauma scale and an assessment of general need. If a child presents with a high level of need, additional assessments are introduced to further explore attachment style: an area often underreported and under considered in looked after children.

Recently, a paper was published by the journal Developmental Child Welfare, exploring the use of the SDQ to identify treatment needs in looked-after children referred to CAMHS[4]. Concerns have been raised regarding the effectiveness of the SDQ as the only method of screening for mental health difficulties[5], especially as some CAMHS services use the SDQ to set minimum thresholds for acceptance to their services. The paper discussed several issues, including:

• A low score on the SDQ does not mean that a child isn’t experiencing difficulties with their mental health[6]
• The SDQ is designed to detect common mental health difficulties, not complex ones[7]
• The SDQ does not capture difficulties experienced in relationships, nor does it identify symptoms of adversity in childhood experiences.

The SDQ alone is not designed to measure ways in which early trauma, attachment difficulties and other challenges of the care system are played out in the caregiving relationship. There is a need for clinical judgement when reviewing the outcomes of measures, especially when considering the next steps for a caregiver, the young person and the placement.

Positively, at Five Rivers, our Assessment and Therapy team are an integral part of the assessment process, as are the team around the child, all of whom are invited to take part in an integrated case management meeting (ICMM). The purpose of the ICMM is to explore the assessment outcomes, and how we can provide further support, stability and security for all those involved. The paper discussed provides robust backing for the process we have instilled at Five Rivers, and demonstrates how as a child care provider, we are going above and beyond our competitors to further consider the mental health of all children in our care.

 

 

 

 

References

DeJong, M. (2010) Some reflections on the use of psychiatric diagnosis in the looked after or “in care” child population. Clinical Child Psychology and Psychiatry, 15, 589-599.

Goodman, R. (2001) Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1337-45.

Goodman, R., Ford, T., Corbin, T., & Meltzer, H. (2004) Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked-after children for psychiatric disorders. European Child & Adolescent Psychiatry, 13, 25-31.

Lehmann, S., Heiervant, E.R., Havik, T., & Havik, O.E. (2014) Screening foster children for mental disorders: Properties of the strengths and difficulties questionnaire. PloS One, 9, e102134.

Mental Health Foundation (2015) Fundamental Facts about Mental Health.

SCIE. (2017) Improving mental health support for our children and young people. Expert Working Group final report. Retrieved from https://www.scie.org.uk/children/care/mental-health/report

Wright, H., Wellsted, D., Gratton, J., Besser, S.J., & Midgley, N. (2019) Use of the Strengths and Difficulties Questionnaire to identify treatment needs in looked-after children referred to CAMHS. Developmental Child Welfare, 1-18.

 

 

[1] Mental Health Foundation (2015)

[2] Goodman (2001)

[3] Goodman, Ford, Corbin & Meltzer (2004)

[4] Wright, Wellsted, Gratton, Besser & Midgley (2019)

[5] SCIE (2017)

[6] Lehmann, Heiervang, Havik & Havik (2014)

[7] DeJong (2010)