Assessment of Children and Youth

OPTIMAL OUTCOME OF ASSESSMENT

The assessment results in the identification of reasons and factors leading to referral, current level of functioning, significant changes in functioning over time, nature and extent of behavioral and subjective difficulties, and individual, family and/or environmental factors, strengths, challenges and resources, which lead to appropriate DSM-IV diagnoses and treatment goals. During this process, a mutually trusting working relationship with the child/youth, family, and significant others is established for continued planning and treatment.

ASSESSMENT PRINCIPLES

1. Assessment of children and youth is an ongoing process. Initially, based upon presenting information, the evaluator should develop an assessment plan including identification of strategies for collecting information and possible assessment instruments to be utilized. These should be adapted as information becomes available. Reason for referral and present concerns: nature, duration, frequency, precipitants, circumstances, and consequences of the problem(s) as well as other pertinent factors should form the basis for all assessment and subsequent treatment.

2. The assessment process will result in an initial diagnosis and development of treatment goals and strategies. As further data is gathered, the diagnosis and subsequent treatment goals and strategies will be reviewed/revised, as appropriate.

3. Whenever a child/adolescent is seen who has a previous psychiatric diagnosis, the assessing clinician should re-evaluate the appropriateness of the diagnosis(es).

4. Diagnosis(es) should be made with adherence to the DSM-IV diagnostic criteria and not based on idiosyncratic/anecdotal impressions. Full use should be made of DSM-IV criteria for co-morbid conditions, atypical presentations, V codes, deferred and provisional diagnoses.

5. Family/care givers are a primary source of information about the child/youth and should be involved in all aspects of the assessment and subsequent treatment planning and implementation.

6. Mental Health staff should encourage and facilitate parents in signing appropriate "release of information" forms in order to gather critical data from multiple individuals and sources significant to the child/youth. This data is essential in forming an accurate picture of the child/youth's functioning. Whenever possible, the clinician should directly contact the primary source of information, i.e., current school teacher for school functioning, family physician for health status, etc.

7. A thorough assessment of a child/youth should include the following areas:

• developmental milestones to include receptive and expressive language development
• psychiatric and medical history, including vision and hearing problems
• school functioning and performance including any formal testing conducted by the school
• emotional development and temperament
• peer relations
• family relationships, responsibilities, and perceptions of the child/youth and his/her difficulty and the subsequent impact on the family
• strengths, interests, and hobbies
• unusual family or environmental circumstances
• parental/family medical and psychiatric history and impact on child/youth
• substance use
• traumatic circumstances including child abuse, domestic violence, family substance abuse
• legal involvement
• reason for referral and present concerns: nature, duration, frequency, precipitants, circumstances, and consequences of the problem(s) mental status examination including thought (content and process), perception, mood, level of suicidal risk, affect, memory, judgement, appearance, and orientation

8. Assessment will be provided in a culturally sensitive and appropriate manner consistent with the unique characteristics of the child and family taking into consideration factors including, but not limited to: language, socio-economic factors, family and extended family structure, religious practices, geographic location, immediate community, etc. When indicated, the assessor will seek assistance in order to assure that the assessment will be conducted consistent with the language and culture of the child/youth and family.

9. Standardized behavioral assessments such as the Child Adolescent Functional Assessment Scales (CAFAS) and/or Achenbach Child Behavior Checklists (CBCL) for parents, teachers, school-age children or youth may be useful. All evaluation instruments will be selected and administered by appropriately trained personnel in compliance with administration standards provided by their producer(s) as being appropriate for the sex, age, and race of the child/youth. Conclusions derived from any instrument should be made in the context of all information gathered.

10. Depending upon age and developmental factors, the child should be interviewed individually and with the parent(s)/significant others. The setting is critical to the success of the interview and must be sensitive to the need to accommodate for the child's cognitive, language and emotional status. Specific techniques may include interactive play, projective approaches, and direct discussion. Structured observations or other means of seeking information should be utilized. Care should be taken to avoid questions that lead a child to answer in a particular way.

11. The Serious Emotional Disorders (SED) form should be completed.

12. Information about the results of this assessment process, diagnosis(es), and implications for subsequent treatment for the child/youth and family should be shared with the parent(s) or guardian.

THESE GUIDELINES HAVE BEEN DEVELOPED BY:
THE UTAH PREFERRED PRACTICE CONSENSUS PANEL
UNDER THE AUSPICES OF THE UTAH DIVISION OF MENTAL HEALTH

APPROVED SEPTEMBER 19, 1997

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