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Children and Youth at Risk Branch

Ministry of Children and Youth Services

March 2012

Working Together for Kids’ Mental Health:

Screening tools for early identification

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Learning Objectives

Participants will:• Understand the goals of Working Together for Kids’ Mental Health

• Develop common understanding and language

• Understand which screening tool should be used when

• Learn how to administer, score and interpret information from the tools

• Understand how to communicate results effectively to parents/youth

• Work together to know what to do / where to go to support children and youth

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Agenda

• Brief orientation to Working Together for Kids’ Mental Health (10 min)

• Exploring the use of tools to support identification of children and youth with potential mental health needs and effectively responding (15 min)

• Overview of the four screening tools:Name of tool, purpose/intended use, target population (10 min)Tool selection process (15 min)

• Strengths and Difficulties Questionnaire (SDQ)

• Global Assessment of Individual Needs-Short Screener (GAIN-SS)

• Health of the Nation Outcome Scales – Child and Adolescent Mental Health (HoNOSCA)

• Child and Adolescent Needs and Strengths – Education version (CANS-EI)

• Training on each screening Tool (130 min), including:The completion of each Tool (using case example)Recommended scoring of each Tool (based on the case example)Understanding results derived from the Tools

• Team processes for formulating/reviewing results/making decisions (20 min)

• Referral processes and recommended pathways for service (20 min)

• Effective communication of results with parents and youth (20 min)

• Limitations of screening measures, processes and individual competencies (10 min)

• Data collection expectations, methods and processes (30 min)

• Wrap-up/Discussion/Next Steps (15 min)

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Use of Tools and Information in supporting effective decision making and the service planning process

Context for Change:

• A Shared Responsibility: Ontario’s Policy Framework for Child and Youth Mental Health (2006) – goals of coordinated, collaborative sector, access to flexible continuum of services, provision of effective (evidence-informed) services and supports, accountable and well-managed.

• Comprehensive Mental Health and Addictions Strategy - The 2011-12 Ontario budget announced a comprehensive Mental Health and Addictions Strategy, first three years focused on children and youth.

• Educators, health care professionals and agencies have indicated the need to develop common language, understanding, processes and procedures so that children and youth receive appropriate mental health services and supports when required, based upon their presenting needs.

• The use of evidence to inform service decisions and treatment practices has the potential to enhance service provision and outcomes for children and youth with mental health needs.

• A priority activity is to improve the capacity of professionals across sectors to identify and respond early to indicators of mental health needs in children and youth; this priority arose from the evidence that children may not be receiving the most appropriate service based on their needs.

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Working Together for Kids’ Mental Health

• Four communities (Belleville, Haliburton, Niagara, Sudbury) participated in year one (2010/11) of Working Together for Kids’ Mental Health (Working Together) to focus on improving child and youth mental health outcomes by helping professionals within schools, agencies and the health sector support children and youth with mental health needs.

• Working Together is being expanded to an additional seven communities in (2021/12) leading towards provincial implementation by 2013-14.

• From the perspective of children, youth and families, this will help identify mental health needs of children and youth earlier, direct them to appropriate services, promote their involvement in decision making processes and reduce the need for repetitive “story-telling”.

• Teams of professionals in these communities are provided with training, tools and resources to: • identify potential mental health needs of children and youth in an informed way; • know what to do and where to go to address a child or youth’s mental health needs;• facilitate getting the child or youth to the right service in a timely way.

• Participating communities are:

– implementing new screening tools;

– using existing and/or new needs assessment tools;

– working to enhance procedures to support the identification of, and appropriate response to, potential mental health needs in children and youth across three sectors (education, health, community-based mental health).

• The work is being implemented in stages in communities across the province to further the development and implementation of best practices, and to enhance the service system.

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Screening Tools - Overview

Strengths and Difficulties Questionnaire (SDQ)•Brief behavioural screen (5 minutes to complete)•Appropriate for ages 3 to 16 years•Ratings indicate if behaviours are ‘not’, ‘somewhat’ or ‘certainly’ true of the individual based on observations•25 items include emotional symptoms (5), conduct problems (5), hyperactivity/inattention (5), peer problems (5) and positive prosocial behaviours (5 items)•Items are scored and compared to norms•Versions for parent and teacher (3-4 and 4-16 years) and youth self-report (11-16 years)•Available in wide range of languages; some include impact and follow-up questions•Available in public domain (via internet) free of charge

Global Appraisal of Individual Needs–Short Screen (GAIN-SS)•Brief behavioural screen (5 minutes to complete)•Appropriate for ages 12 to 18 years•Respondents indicate if behaviours observed ‘never’, ‘1+ years ago’, ‘2-12 months ago’ or within ‘past month’•20 items include internalizing/emotional symptoms (5), externalizing/behavioural (5), substance use (5), and crime/violence (5) (includes self-harm/suicide)•Items rated as occurring within past year are counted to determine risk for disorder•Completed by or with youth (self-report)•Available in English and French•Nominal license fee ($100 over 5 years)

Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA)•Clinical rating scale (20 minutes to complete)•Appropriate for children and youth (no ages specified)•Ratings indicate ‘severity’ of problems over previous two week period (using glossary)•13 + 2 items include emotional, behavioural, overactivity/ inattention, substance use, self-harm, self-care, disabilities, family life, school attendance•Versions for clinical team, parent and youth self-report•Available in English and French•Available free of charge with permission of University of Liverpool

Child and Adolescent Needs and Strengths – Education version (CANS-EI)•Clinical rating scale (30 minutes to complete)•Appropriate for children and youth (no ages specified)•48 items include educational (8), Student (22), life domain Needs (10) and student strengths (8)•Designed to develop shared view of needs and strengths to facilitate communication and service planning•Items rated on degree of problem (or strength) on 4 point scale (using glossary)•Available in English and French•Available free of charge with permission of author

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Completing, Scoring and Interpreting Screening Tools

• Practice Vignette – Ingrid – 7 years old

• SDQ

• GAIN-SS

• HoNOSCA

• CANS-EI

• Practice Vignette – Mike – 15 years old

• SDQ

• GAIN-SS

• HoNOSCA

• CANS-EI

• Reviewing the case, completing and scoring the tools, discussing and communicating results

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Communicating Concerns, Results and Obtaining Consent

Group Discussion:

Practices, issues, barriers and strategies for:

• Identifying and discussing concerns with team members

• Communicating concerns to families about potential mental health needs

• Effectively informing parents/youths to facilitate understanding of concerns, and agreement/consent to do something about the concerns (e.g., screening or Identification Tool, referrals for service)

• Discussing/reviewing/formulating results in a team environment

• Communicating results from tools/measures with team members and families/youth

• Informing parents/youth of their rights to privacy/confidentiality, while describing benefits of sharing results from screening tools with service providers, so that parents/youth can make informed decisions

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Effectively Responding through Working Together

Group Discussion:

• Roles and responsibilities for completing screening Tools within settings

• Types of information provided by the different tools and what to do with the information

• Limitations of the tools and limits to professional competency (i.e., over-interpretation)

• Internal or external referral for support, help or treatment – how to decide?

• How to support children/youth/families while waiting

• Processes within different settings for consulting/facilitating referrals

• Agencies and organizations in the community who receive referrals

• Sharing information – relationships, informed consent, protocols

• Next Steps in your community

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Additional Information and Support

Screening Tools - Resources

• SDQ – forms, instructions and scoring materials: http://www.sdqinfo.com/

• Goodman, Anna & Goodman, Robert (2009), “Strengths and Difficulties Questionnaire as a Dimensional Measure of Child Mental Health”, Journal of the American Academy of Child and Adolescent Psychiatry, 48 (4), 400-403

• GAIN – forms, instructions and manuals: http://www.chestnut.org/LI/gain

• McDonell, Comtois, Voss, Morgan and Ries (2009), “Global Appraisal of Individual Needs Short Screener (GSS): Psychometric Properties and Performance as a Screening Measure in Adolescents”, the American Journal of Drug and Alcohol Abuse, 35: 157-160

• HoNOSCA – forms, information: http://www.liv.ac.uk/honosca/Downloads.html

• Kisely, S., Campbell, L.A., Cartwright, J., Cox, M., Campbell, J (2010), “Do the Health of the Nation Outcome Scales Measure Outcome?”, the Canadian Journal of Psychiatry, Vol. 55, No. 7

• CANS – forms, information: http://www.communimetrics.com/canscentralindiana/about.aspx

• Web-based Training Site for CANS: www.CANSTraining.com. This site contains training on four versions of the CANS (CANS-MH, CANS-EI, CANS-Autism and CANS-Preschool). The site includes information and key principles for CANS, videos, practice vignettes and the reliability vignette.