Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale

The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of degree of impairment in functioning. Interrater reliability data are presented for lay raters, graduate students, and frontline staff. Reliability was high for the total score and behaviorally-oriented scales. Construct, concurrent, and discriminant validity were assessed with the sample of children and adolescents evaluated at the Fort Bragg Demonstration Evaluation Project. Youth and their caregivers were evaluated via interview and selfcompleted instruments at four time points. Significant correlations were found between the CAFAS and other related constructs. Concurrent validity was demonstrated by logistic regression analyses examining the relationship between CAFAS ratings and problematic behaviors endorsed on measures completed by parents, teachers, or the youth. Youth with higher CAFAS total scores were much more likely to have poor social relationships, difficulties in school, and problems with the law. Discriminant validity was assessed with a repeated measures analysis of variance with intensity of care at intake and time as factors. Youth who were inpatients or in residential treatment centers at intake had higher CAFAS scores than those who were outpatients. These findings provide strong evidence for the reliability and validity of the CAFAS.     

The Relationship Between the Child and Adolescent Functional Assessment Scale (CAFAS) and Indicators of Functioning

We investigated the relationship between scores on the Child and Adolescent Functional Assessment Scale (CAFAS) and several indicators of functioning assessed in the national evaluation of the demonstration grants funded by the Center for Mental Health Services System of Care Initiative. The sample included 3187 youths, ranging in age from 4 to 23, with serious emotional disturbance (SED) who were evaluated at intake. At 6 month post-intake, 873 of these youths were re-evaluated. As predicted, higher CAFAS scores were associated with previous psychiatric hospitalization, more serious psychiatric diagnoses, and more restrictive living arrangements. Youths in residential inpatient settings were significantly more impaired than youths living in their own home or in regular foster care. Below average school performance, poor attendance, and contact with law enforcement personnel were also associated with greater impairment. Youth's total CAFAS scores decreased significantly from intake to 6 months. These results indicate that the CAFAS is a measure of functioning which has both statistical and clinical significance.     

The Child and Adolescent Functional Assessment Scale (CAFAS): Review and Current Status

Measures of impairment in psychological and behavioral functioning have a long history in the field of children's mental health, and appear particularly useful in eligibility determination, treatment planning, and outcome evaluation of services for children and adolescents with serious emotional disturbance (SED). One recently developed multidimensional measure of functional impairment—the Child and Adolescent Functional Assessment Scale (CAFAS; K. Hodges, 1989, 1997)—has enjoyed widespread use nationwide. It has been adopted as a tool for making treatment eligibility decisions and documenting outcomes on a statewide level in more than 20 states and on a local level in dozens of research and demonstration projects. In this paper, the technical merits of the CAFAS are closely examined, with the conclusion that empirical evidence is lacking to support its valid use in making the types of treatment decisions for which it is currently being employed across the nation. Furthermore, there appears to be little concern among mental health researchers, practitioners, administrators, and state legislators about these apparent limitations of the CAFAS. The potential benefits of establishing objective and valid level-of-need criteria, using the CAFAS are numerous and the interest in doing so is clear; however, the psychometric limitations of the scale identified in this review need to be addressed before its full potential can be realized.     

Psychometric Properties and Clinical Utility of the School Refusal Assessment Scale in a Multiethnic Sample

Kearney and Silverman (1993) developed the School Refusal Assessment Scale (SRAS) to assess the function of and to prescribe treatment for school refusal behavior. The present investigation examined the psychometric properties and clinical utility of the SRAS in a multiethnic sample. Participants were 30 children and their mothers who were identified as school refusers after an initial screening. Results indicated that scales measuring negatively reinforced school refusal were intercorrelated, whereas scales measuring positively reinforced school refusal were not. Concurrent validity of dimensional and categorical scoring algorithms was examined. Although parent–child agreement was relatively low, validity analyses suggested that each reporter contributed important information. Clinical implications and areas for future research were discussed.     

Reliability of the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) Scale

We examined the interrater reliability of the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) scale among researchers and between researchers and clinicians. All children presenting to a treatment facility for either protective or mental health needs were eligible to be included in the study. As part of standard assessment procedure, all children entering the facility were described by caseworkers using the CANS-MH. A random sample of 60 cases was selected and researchers made retrospective assessments using the CANS-MH based on chart review. Results of the interrater reliability support previous findings that the CANS-MH is a reliable measure of clinical and psychosocial needs and strengths. Results also suggest that ratings on the CANS-MH based on medical record abstraction by researchers relate to ratings performed by clinical staff, demonstrating the clinical and research utility of the CANS-MH. The CANS-MH can be used reliably to assess the type and severity of problem presentation, risk behaviors, functioning, care intensity and organization, caregiver capacity and strengths among children with protective and mental health needs. In addition, items of the CANS-MH appear to be reliable supporting the use of these items individually. Findings are relevant to the ongoing delivery of clinical services, monitoring of quality assurance, and outcomes.     

Parental Monitoring and the Prevention of Child and Adolescent Problem Behavior: A Conceptual and Empirical Formulation

The present report accomplishes three goals. First, to provide an empirical rationale for placing parental monitoring of children's adaptations as a key construct in development and prevention research. Second, to stimulate more research on parental monitoring and provide an integrative framework for various research traditions as well as developmental periods of interest. Third, to discuss current methodological issues that are developmentally and culturally sensitive and based on sound measurement. Possible intervention and prevention strategies that specifically target parental monitoring are discussed.     

校园氛围与青少年问题行为的关系:同伴侵害的中介作用

许多研究表明,青少年感知的校园氛围对其问题行为有重要影响。但是,校园氛围起作用的中介机制仍有待进一步探讨。本研究旨在考察青少年感知的校园氛围与其问题行为(行为不良、抑郁)的关系,以及同伴侵害在其中的中介作用。采用分层整群抽样的方法,选取广东省10所学校2758名初中生作为被试,匿名填写社会经济地位问卷、家庭功能问卷、校园氛围感知问卷、青少年同伴侵害问卷、儿童抑郁调查表、青少年行为不良指数问卷。结果表明:(1)在控制了性别、年龄、社会经济地位和家庭功能后,积极的校园氛围显著负向预测青少年的行为不良和抑郁。(2)同伴侵害在校园氛围与青少年行为不良和抑郁之间具有中介作用。     

Validation of the Preschool and Early Childhood Functional Assessment Scale (PECFAS)

Efforts to determine the prevalence of serious emotional disturbance in preschool-aged children have been hampered by the lack of a validated measure. The Preschool and Early Childhood Functional Assessment Scale (PECFAS) is a multi-dimensional measure that assesses the psychosocial functioning of children aged 3–7 years. The concurrent validity and reliability of the PECFAS were assessed in a sample of 30 preschool-aged children in a large Head Start program in Ventura, California. PECFAS ratings based on in-depth interviews were significantly related to parental ratings that the children had mental health problems, psychiatric diagnoses, teacher ratings of the child's need for mental health evaluations, teacher ratings of behavior problems on a standardized screening inventory (DIAL-R), and actual referrals for mental health evaluations. Interrater reliability for the total PECFAS score was high (r = .90) as was internal consistency of the five subscales (alpha = .86). Using the PECFAS scores as a standard, the weighted prevalence of serious emotional disturbance in this West Coast Head Start program was 17%, at the lower end of the current estimated rate of SED for older children in low income samples (18–26%).     

Reliability of self-reported service use: Test-retest consistency of children's responses to the Child and Adolescent Services Assessment (CASA)

This paper reports on the reliability of children's responses on the Child and Adolescent Services Assessment (CASA) — a self-report instrument for use with 8– to 18-year-olds that gathers information about services used to address mental health problems. Findings were based on interviews completed by 77 children at a one week test-retest interval. Results showed that reports of lifetime service use were as reliable as were reports of service use in the preceding three months. Children reported restrictive and intrusive services more reliably than services that were provided in their natural environment. Reliability appeared to be associated more strongly with characteristics of the type of service than with characteristics of the child. Children also could report reliably on some details about their encounters with service providers (e.g., length of stay, number of visits, and onset of service use).     

Psychometric Properties and Clinical Utility of the Scale for Suicide Ideation with Inpatient Children

The purpose of the current study was to examine the psychometric properties and clinical utility of the Scale for Suicide Ideation (SSI) for children. The SSI was administered to 100 children who were hospitalized. Data were not used from 13 subjects due to the presence of a psychotic disorder or IQ less than 70, leaving 87 participants. The SSI was examined regarding its internal consistency, concurrent validity, construct validity, and factor structure when used with children. Based on the findings, the SSI appears to have adequate psychometric properties and can be used by clinicians and researchers examining children in an inpatient setting. Recommendations for clinicians are included to help make the SSI more functional in use for children.     

Measuring Treatment Outcome for Children with Serious Emotional Disturbances: Discriminant Validity and Clinical Significance of the Child and Adolescent Functioning Assessment Scale

We investigated the use of a popular measure, the Children and Adolescent Functional Assessment Scale (CAFAS), in treatment outcome research. The sample included 70 children who had been discharged from an elementary therapeutic classroom (Intensive Mental Health Program). Significant relationships were found between decreases in CAFAS scores and optimal educational placement, contributing to evidence of the scale’s discriminant validity. Clinically significant change in CAFAS scores was also investigated, with a 30 point change in score most accurately discriminating between placements after discharge. Further investigations of real world outcomes versus changes in score on this measure are warranted.     

Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review

There have been impressive, recent advances in the development of efficacious treatments for child and adolescent behavior problems. However, specific methods for delivering these treatments in a way that amplifies their efficacy have not been well articulated. Although many factors may be involved, attendance and adherence to treatment are arguably the most basic necessities for effective treatment delivery. We provide a conceptual and empirical review of past research on attendance and adherence to child and adolescent therapy, with a special focus on the importance of parents/guardians in managing treatment participation. Our review demonstrates that attendance and adherence are associated with a range of significant methodological, clinical, and financial outcomes. Several pretreatment predictors of attendance and adherence have been identified; however, to date only 12 controlled, clinical trials have evaluated strategies for enhancing attendance and adherence to child therapy. We conclude with an agenda for advancing research on the prediction and enhancement of attendance and adherence to child therapy as a means of improving the efficiency and effectiveness of child treatments.     

Assessment and Implications of Social Withdrawal Subtypes in Young Chinese Children: The Chinese Version of the Child Social Preference Scale

The authors’ goals were to evaluate the psychometric properties of the Chinese version of the Child Social Preference Scale (CSPS; R. J. Coplan, K. Prakash, K. O'Neil, & M. Armer, 2004) and examine the links between both shyness and unsociability and indices of socioemotional functioning in young Chinese children. Participants included of two samples recruited from kindergarten classes in two public schools in Shanghai, China. Both samples included children 3–5 years old (Sample 1: n = 350, M_age = 4.72 years, SD = 0.58 years; Sample 2: n = 129, M_age = 4.40 years, SD = 0.58 years). In both samples, mothers rated children's social withdrawal using the newly created Chinese version of the CSPS, and in Sample 2, teachers also provided ratings of socioemotional functioning. Consistent with previous findings from other cultures, results from factor analyses suggested a 2-factor model for the CSPS (shyness and unsociability) among young children in China. In contrast to findings from North America, child shyness and unsociability were associated with socioemotional difficulties in kindergarten. Some gender differences were also noted. Results are discussed in terms of the assessment and implications of social withdrawal in early childhood in China.     

The Assessment of Marital Adjustment with Chinese Populations: A Study of the Psychometric Properties of the Dyadic Adjustment Scale

This article presents findings from a study of the psychometric properties of the Dyadic Adjustment Scale (DAS) with 63 Chinese-Americans. The analysis revealed high internal consistency for DAS scores. Coefficient alpha for the total DAS score was r = .93. Convergent validity was established with the Locke-Wallis Marital Adjustment Scale (LWMAT) (r = .87) and divergent validity by evidence of an inverse relationship with the Marital Disaffection Scale (MDS) (r = –.79). Correlations with each measure were found to be (p = 0.01). The result of factor analysis fail to support the presence of four separate subscales. Results show that the global DAS score is of potential utility with Asian samples.     

Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample

This study examined the psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS) in a clinical sample of 513 youth referred for mental health assessment at a university clinic. Internal consistency and factor analysis provided support for the factorial validity of the RCADS. Convergent and discriminant validity tests against both clinical interview and self-report criteria also suggested favorable properties of the RCADS. In comparative tests with traditional measures of anxiety and depression, the RCADS generally showed greater correspondence to specific diagnostic syndromes. Clinical cutoffs are reported for the purposes of future clinical and research applications.     

Engagement in Child and Adolescent Treatment: The Role of Parental Cognitions and Attributions

Parental engagement in the treatment process is influenced by parents' beliefs about the cause of their children's problems, perceptions about their ability to handle such problems, and expectations about the ability of therapy to help them. This paper examines the role of parental cognitions related to attributions and expectations in relation to engagement in child mental health treatment. Reviewed studies indicate that parental attributions and expectations influence three aspects of treatment: help seeking, engagement and retention, and outcome. This paper integrates findings from developmental and clinical research, highlights gaps in the literature, presents the beginnings of a model regarding the parental attributional process as it relates to engagement in treatment, recommends future research directions, and discusses clinical implications.     

Models of Cultural Adjustment for Child and Adolescent Migrants to Australia: Internal Process and Situational Factors

Building on previous cultural adjustment profile work by Sonderegger and Barrett (2004), the aim of this study was to propose an organised structure for a number of single risk factors that have been linked to acculturative-stress in young migrants. In recognising that divergent situational characteristics (e.g., school level, gender, residential duration in Australia, social support, and cultural predisposition) are selectively paired with internal processing characteristics (e.g., emotional stability, self-worth/acceptance, acculturation/identity, and future outlook), a top-down path model of acculturative-stress for children and adolescents was proposed and validated. Self-report ratings obtained from primary (n=131) and high school (n=142) students of former-Yugoslavian and Chinese backgrounds were analysed for internal reliability. To determine goodness of model fit, path analysis utilising regression procedures was employed. Specific cross-cultural profiles are discussed.     

Assessment of family functioning in Caucasian and Hispanic Americans: reliability, validity, and factor structure of the Family Assessment Device

The purpose of this study was to examine the factor structure, reliability, and validity of the Family Assessment Device (FAD) among a national sample of Caucasian and Hispanic American families receiving public sector mental health services. A confirmatory factor analysis conducted to test model fit yielded equivocal findings. With few exceptions, indices of model fit, reliability, and validity were poorer for Hispanic Americans compared with Caucasian Americans. Contrary to our expectation, an exploratory factor analysis did not result in a better fitting model of family functioning. Without stronger evidence supporting a reformulation of the FAD, we recommend against such a course of action. Findings highlight the need for additional research on the role of culture in measurement of family functioning.