An Approach to Screening for Mental Health Needs

Among Children and Youth Involved in Child Welfare Services

Brent Crandal, PhD

Child Welfare/Mental Health Learning Collaborative (Katie A) Webinar for Statewide Leadership Team

February 11th, 2014

Screening

Assessment & Triage

Treatment

Screening

Assessment & Triage

Treatment

Screening • Widely Administered • Brief • Easy to Complete • Gives ‘Yes’ or ‘No’ Information • Focused on a Specific Topic

Screening

Assessment & Triage

Treatment

Screening • Widely Administered • Brief • Easy to Complete • Gives ‘Yes’ or ‘No’ Information • Focused on a Specific Topic

Assessment • Targeted Administration • In-Depth • Requires Training • Gives Unique Client Picture • Informs Treatment • Completed Over 1-3 Visits

Common Examples Screening

Among CW-Involved Kids

•What? •Where? •When? •How?

Screening

What do we Screen?

• Mental Health vs. Trauma-Specific Symptoms

Screening

Attention Conduct

Depression Anxiety Hyperactivity

Anger Trauma &

PTS

Post-Traumatic Stress • Intrusive Thoughts • Re-experiencing • Avoidance • Hyperarousal • Negative Thoughts/Mood

What do we Screen? • The 3 E’s of Trauma

– Event • Exposure to Traumatizing Event (e.g., Domestic Violence, Neglect, Physical Abuse, Sexual Abuse, Community and School Violence, Traumatic Grief)

– Experience

• Trauma-Specific Reactions (e.g., Avoidance of triggers, Intrusive thoughts, Nightmares about the event)

– Effect

• Indirect Trauma-Related Reactions (e.g., Generalized Anxiety, Behavior Problems, Depression)

Screening

Adapted from Griffin, E., (2012). Presentation at the NIDA/ACYF experts meeting on trauma and child maltreatment.

Exposure to Potentially Traumatizing Events (PTE) and Prevalence of PTSD

0%10%20%30%40%50%60%70%80%90%

100%

≥1 PTE Lifetime Prevalance of PTSD

62%

5%

Screening

McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. Trauma Exposure and Posttraumatic Stress Disorder in a National Sample of Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry.

How do we Screen?

Acceptability and Feasibility Appropriateness

Screening

How do we Screen?

Acceptability and Feasibility

Screening

How do we Screen? Screening

Appropriateness

• Type of Tool – Evidence for:

• Reliability and Validity • Sensitivity and Specificity

Measurement Matters

• Use of Tool – You get out what you

put in

• MH Symptoms: – Strengths and Difficulties Questionnaire (SDQ)

• 25 Items • Goodman (1997)

• Trauma-Related Symptoms:

– Screen for Child Anxiety Related Disorder (SCARED) Brief Assessment of Post-Traumatic Stress Symptoms

• 4 Items • Muris, Merchelbach, Korver, & Meesters (2000)

• Tools to Bolster Accurate CW Worker Decision-Making

Screening Current Approach

Contact Information

Brent Crandal, PhD Chadwick Center for Children and Families Rady Children’s Hospital – San Diego E-mail: bcrandal@rchsd.org