Child And Adolescent Functional Assessment Scale Research Articles

Identifying Youth Problem Profiles and Predicting Remission Following Mental Health Treatment.

This study utilized latent profile analysis to categorize youth served by a public mental health setting into homogenous classes. Then, associations between class membership and meeting clinical criteria by the latest assessment were examined. Caregiver responses to the Ohio Scales, Short Form, Problem Severity Scale for 1090 youth completed at entry into this public mental health system were subjected to latent profile analysis. This method classifies youth into categories based on mental health problem profiles, in order to determine the degree to which these groupings are related to later mental health outcomes. The classification of youth cases that emerged was then used to predict clinical remission at or nearest end of treatment, including final Ohio Scales Problem Severity scores and a measure of day-to-day functioning, the Child and Adolescent Functional Assessment Scale (CAFAS). A four-class model was identified as best representing the data, reflecting a relatively low-risk class (63.3% of the sample), an internalizing class (23.2%), a delinquency class (8.8%), and a high-risk class (4.7%). Individuals in the internalizing and high-risk classes had lower likelihoods of achieving problem remission than those in the low-risk and delinquencyclasses at the time of their last completed Ohio Scales. Additionally, youth assigned to the delinquency and high-risk classes had lower likelihoods of reaching functional impairment remission than those in theinternalizing and low-risk classes. Youth membership in a class based on initial problem scores can be utilized to predict clinical remission over the course of treatment in public mental health care. Such class-based predictions support other methods of predicting outcomes and can be used by clinicians to develop more informed treatment plans and to adjust treatment based on such classifications.

Predictors of functional improvement in children and adolescents at a publicly funded specialist outpatient treatment clinic in a Canadian Prairie City

Children's mental health problems substantially impact their functioning. For clinically treated children and adolescents, we explored the impact of mental health treatment on functioning and identified predictors of functional improvement. Outpatient clinical data from a regional publicly funded specialist outpatient treatment clinic were analyzed. The Child and Adolescent Functional Assessment Scale (CAFAS) was used to assess outcomes. Non-parametric tests were used to compare baseline and exit scores. Logistic regression analysis was used separately for children and adolescents to examine predictors of improvement. Total CAFAS scores at exit showed a significant decrease from initial scores for both age groups, indicating improvements in clients’ functioning. Children and adolescents had shared predictors for initial level of dysfunction, length of treatment and the presence of pervasive behavioral impairment (PBI). Primary presenting problem, caregiver support and area of residence were only associated with outcome among children. Clients with higher initial levels of dysfunction and PBI require longer treatment cycles to reach an acceptable outcome. Shortening the length of treatment cycles may improve the efficiency of resource use but can be detrimental to some clients. Personalized treatment should be tailored to the clients with specific characteristics and needs.

Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes

ObjectiveTo examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). DesignCross-sectional evaluation of pretreatment data from a randomized controlled trial. SettingFour children's hospitals and 1 general hospital, with level 1 trauma units. ParticipantsYouth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Main Outcome MeasuresProblem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. ResultsThe TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23–.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001). ConclusionsProblem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes.

The Child and Youth Mental Health Assessment (ChYMH): An examination of the psychometric properties of an integrated assessment developed for clinically referred children and youth

BackgroundThe Child and Youth Mental Health (ChYMH) assessment system was developed by interRAI (i.e., an international collective of researchers and clinicians from over thirty countries) in response to the unprecedented need for a coordinated approach to delivery of children’s mental health care. Many interRAI instruments are used across Canada and internationally, but the ChYMH represents the first assessment specifically for children and youth. In the present paper, a short overview of the development process of the ChYMH is provided, and then the psychometric properties of several embedded scales on the ChYMH are examined.MethodsParticipants included 1297 children and youth and their families who completed the ChYMH after being referred to mental health agencies within Ontario, Canada. In addition, smaller subsets of participants (N = 48–53) completed additional criterion measures, including the Social Skills Improvement System (SSIS), the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist (CBCL), and the Brief Child and Family Phone Interview (BCFPI).ResultsResults demonstrated that the ChYMH subscales had strong internal-consistency (Cronbach’s higher than .70), and correlated well with the criterion measures.ConclusionsFindings support the clinical utility of the ChYMH for use among clinically referred children and youth. Implications for children’s mental health assessment and practice are discussed.

Child wellbeing assessment in child welfare: A review of four measures

Child wellbeing is identified as one of the three primary goals for child welfare outcomes, thus strong wellbeing assessment tools are crucial to the monitoring of child welfare success. Data from wellbeing measures can serve to identify child needs, inform case planning, monitor change over time, and evaluate intervention impact at the individual, local, state, and national levels. This paper examines the goals, strengths, and challenges of four wellbeing measures currently used with child welfare populations, namely: the Child and Adolescent Functional Assessment Scale (CAFAS), the Child and Adolescent Needs and Strengths Assessment Tool (CANS), the Child Behavior Checklist and related tools from the Achenbach System of Empirically Based Assessment (CBCL/ASEBA), and the Treatment Outcomes Package (TOP). For each measure, we describe the content, practical attributes, clinical applications, and evidence of reliability and validity. We explore implementation considerations and provide recommendations for system changes to ensure the optimal use of each instrument. Agencies are encouraged to carefully consider their needs, goals, capacities, and implementation infrastructure to inform selection of tools that will aid them in successfully supporting and monitoring child wellbeing over time.

Social Environmental Moderators of Long-term Functional Outcomes of Early Childhood Brain Injury.

Pediatric traumatic brain injury (TBI) contributes to impairments in behavior and academic performance. However, the long-term effects of early childhood TBI on functioning across settings remain poorly understood. To examine the long-term functional outcomes of early childhood TBI relative to early childhood orthopedic injuries (OIs). We also examine the moderating role of the social environment as defined by parent report and observational measures of family functioning, parenting practices, and home environment. A prospective, longitudinal, observational cohort study conducted at each child's home, school, and hospital, including 3 children's hospitals and 1 general hospital in the Midwest. Patients were enrolled in the initial study between January 2003 and October 2006. Follow-ups were completed between January 2010 and April 2015. Fifty-eight children who sustained a TBI (67% of original enrolled cohort) and 72 children who sustained an OI (61% of the original enrolled cohort) were prospectively followed up from shortly after injury (between the ages of 3 and 7 years at enrollment) to an average of 6.7 years after injury, with assessments occurring at multiple points. Long-term functional outcomes in everyday settings, as assessed through the Child and Adolescent Functional Assessment Scale (CAFAS). Of the 130 children included, the median age for those with OIs was 11.72 years and 11.97, 12.21, and 11.72 years for those with complicated mild, moderate, and severe TBIs, respectively. Children with moderate and severe TBI were rated as having more functional impairments in multiple domains than those with OIs (P < .05). Children with complicated mild TBI had greater impairments in school (odds ratio = 2.93; 95% CI = 1.10-7.82) and with thinking (odds ratio = 15.72; 95% CI = 3.31-74.73) than those with OIs. Functional impairments in children with TBI were more pronounced among children from families with higher levels of permissive (mean CAFAS of 49.71, 35.74, 58.14, and 16.16 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 33.55; P < .001] and complicated mild TBI and OI [difference = 41.98; P < .001]) or authoritarian (mean CAFAS of 56.45, 41.80, 54.90, and 17.12 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 39.33; P < .001], moderate TBI and OI [difference = 24.68; P = .003], and complicated mild TBI and OI [difference = 37.78; P < .001]) parenting or with fewer home resources (mean CAFAS of 69.57, 47.45, 49.00, and 23.81 for severe TBI, moderate TBI, complicated mild TBI, and OI, respectively, with significant difference between severe TBI and OI [difference = 45.77; P < .001], moderate TBI and OI [difference = 23.64; P < .001], and complicated mild TBI and OI [difference = 25.20; P < .001]). Even children with relatively mild early TBI experience long-term functional impairments, particularly in the context of less favorable home environments. These findings suggest that improving parenting skills and the quality of the home environment may promote functional recovery following early TBI.

Outcomes of an Agency-Developed Treatment Foster Care Model for Adolescents

Adolescents constitute a large proportion of youth in foster care, but few foster care models specifically concentrate on their developmental or treatment needs. This study examined outcomes for an agency-developed, theoretically based treatment foster care (TFC) model using de-identified administrative data from 612 youth discharged from care over a 3-year period using a structural equation modeling path analysis. Results indicate that youth enrolled in Pressley Ridge Treatment Foster Care (PR-TFC) improve in functioning from entry to discharge and that, overall, youth in PR-TFC treatment typically improve in day-to-day functioning as they age, and youth who enter the PR-TFC homes at an older age generally function better at discharge than younger youth who stayed comparable amounts of time. Additional results indicate that older youth, youth with a greater number of clinical diagnoses, youth with a lower pre-test Child and Adolescent Functional Assessment Scale (CAFAS) score, and youth of color spent more time in care, while older youth, youth with fewer clinical diagnoses, youth with lower pre-test CAFAS scores, and European American youth had lower post-test CAFAS scores, indicating better functioning at discharge. This article also provides an example of how administrative data can be used to develop practice-based evidence for a treatment model.

Training and Maintaining System-Wide Reliability in Outcome Management

The Child and Adolescent Functional Assessment Scale (CAFAS) is widely used for outcome management, for providing real time client and program level data, and the monitoring of evidence-based practices. Methods of reliability training and the assessment of rater drift are critical for service decision-making within organizations and systems of care. We assessed two approaches for CAFAS training: external technical assistance and internal technical assistance. To this end, we sampled 315 practitioners trained by external technical assistance approach from 2,344 Ontario practitioners who had achieved reliability on the CAFAS. To assess the internal technical assistance approach as a reliable alternative training method, 140 practitioners trained internally were selected from the same pool of certified raters. Reliabilities were high for both practitioners trained by external technical assistance and internal technical assistance approaches (.909–.995, .915–.997, respectively). 1 and 3-year estimates showed some drift on several scales. High and consistent reliabilities over time and training method has implications for CAFAS training of behavioral health care practitioners, and the maintenance of CAFAS as a global outcome management tool in systems of care.

Service Coordination and Children’s Functioning in a School-Based Intensive Mental Health Program

Coordination of mental health services in children with serious emotional disturbance (SED) has shown a preliminary relationship to positive outcomes in children. Yet, research in this area is sparse. Therefore, the relation between service coordination activities and adaptive functioning was examined for 51 children SED who were treated in the school-based Intensive Mental Health Program for elementary school students (IMHP; average treatment length was 12 months; mean age 9.37 at intake). Systematic review of detailed case records identified 16,669 episodes of service coordination that could be coded reliably for frequency, quality, and purpose (planning, linking, monitoring) of the service coordination component. Adaptive functioning was measured by Child and Adolescent Functional Assessment Scale (CAFAS) ratings and daily points earned on the behavior management system of the IMHP at intake, 6, 12 months, and discharge. Findings indicated that the frequency, quality, and purpose of the service coordination component varied from case to case and by time in treatment. Although service coordination activities overall decreased as treatment progressed, concentrated high quality service coordination (measured by frequency, quality, and component of service coordination) consistently predicted improved functioning on both CAFAS ratings and daily points earned. Results have both practice and policy implications for training interagency teams and clinicians on when and how to optimally coordinate services.

Using agency data for evidence-based programming: A university–agency collaboration

Agencies providing residential treatment are encouraged, or even mandated, to collect outcomes data and to implement evidence based practices, yet little guidance has been provided on how to do so using agency administrative data that are collected on an ongoing basis. We examined data on Child and Adolescent Functional Assessment Scale (CAFAS) scores for 1608 admissions to a residential treatment center from 2002 through 2008. CAFAS scores were measured every 90 days, providing multiple CAFAS scores for each individual. Results demonstrated that on average residents improved in functioning over time. Sensitive to the evolving needs of residents who had been entering the program, the treatment center made significant program changes in 2006 to attempt to better serve residents through a broad array of specialized programming. Compared to the overall results, the analysis suggested that residents who entered the program since October 2006 appeared to have made larger improvements in their CAFAS scores. Results were derived by employing multilevel models appropriate for estimating growth trajectories with repeated measures data. Conversations with agency staff suggested that using administrative data, and advanced statistical models, were extremely helpful for organizational decision making and evidence-based programming.

A Preliminary Investigation of the Effectiveness of Attachment Therapy for Adopted Children with Reactive Attachment Disorder

The purpose of this preliminary investigation was to examine the effectiveness of attachment therapy for adopted children diagnosed with Reactive Attachment Disorder (RAD). Although attachment therapy is widely utilized in the practice community, outcomes of such therapy have not been well documented. In this study a pretest–posttest one-group design was used with a sample of 24 adopted children who received attachment therapy from trained, licensed therapists. Therapy was funded by the Georgia Office of Adoptions under a contract with a non-profit adoptive parent advocacy group which provided training of therapists and direct services to families. RAD was measured with the Randolph Attachment Disorder Questionnaire (RADQ), Third Edition; functional impairment was measured with the Child and Adolescent Functional Assessment Scale (CAFAS). Statistically significant decreases in scores on the RADQ and CAFAS from pretests to posttests indicate improvement for the children who received therapy. In spite of methodological limitations, the current study adds to the limited knowledge about effective treatment for RAD.

Residential Treatment for Sexually Abusive Youth: An Assessment of Treatment Outcomes

Objective: This research study assesses the effectiveness of participation in a multimodal/holistic residential treatment program on changing deviant sexual interests and functional impairment among sexually abusive youth. Method: A one-group pretest posttest design was utilized to examine pretest (intake) and posttest (discharge) scores for 58 youth between the ages of 9 and 18. Outcome measures included Child and Adolescent Functional Assessment Scale (CAFAS) and the Abel Assessment for Sexual Interest—Adolescent (AASI). Results: The results indicate significant improvement from pretest to posttest scores. Length of stay was not found to influence these impacts. Conclusions: The applications of these results to understanding the effectiveness of residential treatment for sexually abusive youth and the assessment of treatment outcomes for these youth are explored and discussed.

Evaluation of Wraparound Services for Severely Emotionally Disturbed Youths

Objectives: Services to children and adolescents with a severe emotional disturbance (SED) have long been inadequate. The wraparound approach has emerged as a promising practice that could address the needs of children with SED and their families through a strength-based, individualized, family-focused team process that emphasizes flexible service planning. This study compares the outcomes of youth receiving the wraparound approach with youth receiving traditional child welfare case management. Method: Child behavior and community integration outcomes were measured at intake and at 6 months in services. Results: Results indicated that youth receiving the wraparound approach showed significant improvement on the Child and Adolescent Functional Assessment Scale (CAFAS) when compared with youth receiving traditional child welfare services. Results also showed that youth receiving traditional child welfare services experienced significantly fewer placements. However, neither group showed significant differences on other clinical or functional outcomes. Conclusions: Results are discussed, as well as applications to social work practice, study limitations, and recommendations for additional research on wraparound.

Functional Impairment in Youth Three Years after Detention

Purpose This article examines functional impairment across global and specific dimensions among youth 3 years after their detention. Methods Functional impairment was assessed using the Child and Adolescent Functional Assessment Scale (CAFAS) in a large, stratified, random sample of formerly detained youth (N = 1653). Results More than one-fifth of the individuals in the sample were scored as having marked impairment that required, at minimum, “multiple sources of care” (CAFAS Total Score of ≥100); 7.0% required “intensive intervention” (CAFAS Total Score ≥140). Most of the sample had impairment; only 7.5% had “no noteworthy impairment” (CAFAS Total Score ≤10). Significantly more males were impaired than females. Among males living in the community at follow-up, African Americans and Hispanics were more likely to be impaired than non-Hispanic whites. In comparison to males living in the community, males who were incarcerated at follow-up were significantly more likely to have impaired thinking and impaired functioning at home (if incarcerated, “home” is the correctional facility) but less likely to have substance use problems. Conclusions Three years after detention, most youth struggle in one or more life domains; more than one in five have marked impairment in functioning. These findings underscore the ongoing costs, to both youth and society, of our failure to provide effective rehabilitation to youth after detention.

Longitudinal evaluation of outcomes for youth with serious emotional disturbance during two years of Children’s Psychosocial Rehabilitation

This study assessed the course, rate, and significance of change in participants’ day-to-day functioning during two years of Children’s Psychosocial Rehabilitation (CPSR). Hierarchical linear mixed models were used to analyze Child and Adolescent Functional Assessment Scale (CAFAS) outcome data for 49 youth with serious emotional disturbance, aged 7 to 17 years. The authors estimated participants’ change trajectory, difference in initial versus 16-month status, and difference in rate of change between the first 12 and last 8 months of the study. Controlling for age, participants improved by 13.73 points on the CAFAS every four months, generating a statistically and clinically significant improvement from intake to 16 months. The rate of change decreased significantly to 1.37 points per wave during the last 8 months of the study. CPSR participants improve significantly during treatment, with the majority of changes occurring in the first year.

Validity of Treatment Target Progress Ratings as Indicators of Youth Improvement

We examined whether clinical progress ratings on the Monthly Treatment and Progress Summary form (MTPS), an idiographic treatment progress measure, were meaningfully related to changes measured by two separate standardized instruments; the Child and Adolescent Functional Assessment Scale (CAFAS) and the Child and Adolescent Level of Care Utilization System (CALOCUS). Validity coefficients were examined at intake and three-, six-, and nine-month follow-up periods. Samples were selected for each measure and follow-up period from the population of youth receiving services through the Hawaii Child and Adolescent Mental Health Division’s (CAMHD) system of care. Significant youth improvement was evident on all three measures across all follow-up intervals. The type of changes measured by the MTPS and CAFAS were more alike over longer follow-up intervals than changes measured by the CALOCUS. The MTPS captures distinct aspects of client change that overlaps somewhat with CAFAS and CALOCUS measures. The MTPS is a brief client-tailored measure that seems to provide valid, sensitive, and nonredundant client specific treatment outcome information that can be collected on a frequent basis within a complex system of care.

Frontline Report

Frontline Report

A School-Based Transition Program for High-Risk Adolescents

A School-Based Transition Program for High-Risk Adolescents

Are CAFAS Subscales and Item Weights Valid? A Preliminary Investigation of the Child and Adolescent Functional Assessment Scale

Presents a psychometric analysis of the Child and Adolescent Functional Assessment Scale (CAFAS), one of the most commonly used measures of functional impairment in youths with emotional and behavioral disorders. Specific aims of the current investigation were to (a) examine the conceptual organization of the CAFAS items, (b) explore its scaling properties, and (c) investigate its construct validity. In Phase 1, a group of advanced graduate students and clinicians rated CAFAS items with respect to the degree that they reflect the originally assigned subscales. In Phase 2, additional raters assigned severity values to the subset of CAFAS items selected from Phase 1. Items were then scaled using simplified successive intervals scaling techniques. Results show differences between new empirically derived item weights and the original scoring method. This investigation highlights the benefits of continued examination and critique of level-of-functioning scaling for diagnosis, treatment, and prognosis in children and adolescents.

An Independent Effectiveness Trial of Multisystemic Therapy With Juvenile Justice Youth

This study examines the effectiveness of an evidence-based practice, multisystemic therapy (MST), conducted in a real-world mental health setting with juvenile justice involved youth and their families. Importantly, this is the first randomized clinical trial of MST with juvenile offenders in the United States conducted without direct oversight by the model developers. This study reports outcomes achieved for 93 youth randomly assigned to MST or treatment as usual (TAU) services through 18-month follow-up posttreatment for offense data and 6-month follow-up posttreatment for ratings of the Child and Adolescent Functional Assessment Scale (CAFAS). Outcomes include significant reduction in rearrest and improvement in 4 areas of functioning measured by the CAFAS for youth who received MST. Implications for delivery of empirically supported treatments in real-world settings are discussed.