Kay Hodges

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. Youths 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.

Use of the Child and Adolescent Functional Assessment Scale to Predict Service Utilization and Cost

The Child and Adolescent Functional Assessment Scale (CAFAS) is a multidimensional measure of impairment that assesses the extent of interference in day-to-day functioning secondary to emotional, behavioral, or substance use problems. Respondents were 984 youths, aged 5 to 17, who were referred for mental health services. They were assessed at intake and at 6 and 12 months postintake with a battery of measures administered by evaluation staff who were independent of treatment. Utilization indicators included restrictiveness of care, total cost, number of bed days, and total number of days of service received. The CAFAS total score at intake was a significant predictor of service utilization and cost determined at 6 and 12 months postintake. The CAFAS score was also the best predictor when compared with other measures of psychopathology. Only the CAFAS and presence of conduct disorder contributed to the prediction of service utilization and cost at 12 months.

Use of the child and adolescent functional assessment scale (CAFAS) as an outcome measure in clinical settings

This article discusses how the Child and Adolescent Functional Assessment Scale (CAFAS) can be used as an outcome measure in clinical settings. Outcome data from two clinical samples are provided: a small community mental health center located in Michigan and a large referred sample from the Fort Bragg Evaluation Project. Outcome indicators for assessing change over time included overall level of dysfunction, percentage of respondents with severe impairment, mean total score, mean scores for individual CAFAS subscales, and change in total score at the client level. Implications of the findings were discussed from several perspectives: improving services to individual clients, developing databases at the local level that can be used for the agencys continuing self-scrutiny, and pooling databases across sites that can be used to study broader issues within a managed care environment.

Predicting service utilization with the Child and Adolescent Functional Assessment Scale in a sample of youths with serious emotional disturbance served by center for mental health services-funded demonstrations.

This study investigated level of restrictiveness of living arrangements and number of days in out-of-family care at six months postintake, based on the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist (CBCL), gender, age, and level of family income at intake. It was composed of youths who met the criteria for serious emotional disturbance (SED) and were for the most part living in families that are described as socioeconomically disadvantaged. A multinomial logit model was used in the analysis of level of restrictiveness of living arrangements, and an ordinary least squares (OLS) regression model was conducted on number of days in out-of-family care. The CAFAS score at intake was found to be a significant predictor of service utilization between intake and six months and was a more consistent predictor than the CBCL. Results suggest that the CAFAS can be used to match service needs with resource allocation and to monitor performance-based outcome indicators.

Psychometric Study of the Child and Adolescent Functional Assessment Scale: Prediction of Contact with the Law and Poor School Attendance

The predictive validity of the Child and Adolescent Functional Assessment Scale (CAFAS) is investigated using the data set generated by the national evaluation of the demonstration service grants funded by the Center for Mental Health Services. Logistic regressions were performed separately for contact with the law and poor school attendance, which were both assessed at 6 months postintake. Other variables included in the model besides the CAFAS total score at intake were age, gender, and family risk factors. The results show that the CAFAS total score at intake was a positive predictor of the likelihood of contact with the law and poor school attendance, even after controlling for age, gender, and risk factors. Furthermore, the CAFAS total score was predictive even after excluding scores on CAFAS subscales, which may have been influenced by absenteeism or delinquency. These findings are consistent with recent research indicating that the CAFAS predicts recidivism in juvenile delinquents.

Client typology based on functioning across domains using the CAFAS: implications for service planning.

Cluster analysis was used to develop a five-group typology based on the eight subscales of the Child and Adolescent Functional Assessment Scale (CAFAS) using data on 4,758 youths referred to Community Mental Health Service Providers in Michigan. The groups are described in terms of clinical diagnoses, overall impairment in functioning, past and current use of services from other agencies (i.e., juvenile justice, social services), and caregiver resourcefulness. From most to least impaired, the clusters were the following: Substance Users/Externalizers, Comorbid/Self-Harmful, Delinquents, Marked/School Problems, and Adjustment Problems with Impairment/Secondary Prevention. The results are being used to help identify the most impaired youths with serious emotional disturbance (SED) youths, develop specific programs and services for the different types of youths being served, determine staff training needs, and foster clinical practice in which the youths progress is continually monitored.

Using assessment in everyday practice for the benefit of families and practitioners

How can assessments be more clinically useful and have more impact on a youths long-term outcome? Assessments can outline a treatment approach in which target problems are linked to goals, client and family strengths, and specific treatment steps. This can be done in a comprehensive way, such that the youths real-life functioning can be assessed across various domains. The initial assessment can serve as the baseline evaluation, with an expectation set for ongoing, periodic monitoring. Parents can be encouraged to be actively involved in setting goals and in assessing their childs progress toward those goals. Outcome data can be aggregated across clients to generate practice-focused studies. These data can also be used to provide supportive evidence on behalf of local clinical programs.

Predictors of Outcome for Children With Behavior Problems Served in Public Mental Health

This study investigated whether pervasiveness of problems across settings predicted successful reduction of impairment in school, home, and interactions with others after controlling for other variables that may be stronger predictors. The data of 4,434 youths between the ages of 7 and 17 years in public mental health services in Michigan were examined employing logistic regressions, with 4 sets of predictors, as follows: demographic characteristics, risk factors, therapists perception of impairment in the youths caregiving environment, and pervasiveness of the youths problems. The results indicated that pervasiveness of problems was the strongest predictor of poor outcomes for each domain. In addition, impaired caregiving environment, previous hospitalization for psychiatric or substance use problems, and placement out-of-home were also negatively associated with successful outcome. The implications of the findings for practice and research are discussed.

Evaluation of Depression in Children and Adolescents Using Diagnostic Clinical Interviews

This chapter will describe five of the most widely used diagnostic interviews and present psychometric data relevant to depression. In addition, a clinician-rated scale that is widely used in depression research—i. e., the Children’s Depression Rating Scale (CDRS) (Poznanski, Cook, & Carroll, 1979)—will be reviewed because it is often used in conjunction with these structured interviews.