Strengths and Difficulties Questionnaires Why they are important

Strengths and Difficulties Questionnaires Why they are important? How can we make them meaningful? What do you need to do?

Leon Crook • Therapeutic Practitioner, Early Help Team • Background - Registered Mental health Nurse (RMN) for 26 years • Person-Centred Counsellor • Systemic Practitioner • Used SDQs daily between 2002 and 2008 (continuing, less frequently, to date)

History • Care Matters: Time for Change (2007) highlighted the need to improve the mental health of young people in care. • ‘Looked after’ children are 4 -5 times more likely to have a mental health disorder than those living at home. • Recommended a new local government indicator (NI 58) be used to show emotional well-being of children in care. • This indicator was withdrawn in 2010 but the Department for Education still require Local Authorities to provide the ‘Total Difficulties Score’ annually, for each child (over 4 year old) they have been looking after for 12 continuous months or more.

• A standard measure, the Strengths and Difficulties Questionnaire (SDQ), was identified as the most appropriate tool to describe the level of emotional wellbeing among the LAC population • The Strengths and Difficulties Questionnaire (SDQ) is a screening tool which will be used to identify Looked after Children who are at risk of developing emotional and behavioural difficulties and who are likely to benefit from early intervention. • Statutory Guidance on Promoting the Health and Well-being of Looked After Children (DCSF, DOH 2009) advocates that both local authorities and health trusts ensure that SDQ’s are built into the annual health assessments for Looked After Children and are used when placements commence.

Why use this measure? • The SDQ is an internationally validated measure, appropriate for all BME groups. • It is publicly accessible and can be downloaded from www. sdqinfo. com • The same questions can be answered from three sources – PARENT (or CARER); TEACHER; CHILD (self-rated) • Inexpensive to score and easy to use • SDQplus lets you track a child’s progress over time

What is it? The Strengths and Difficulties questionnaire has two parts: A 25 item tick-box questionnaire which incorporates four areas of difficulties: emotional difficulties; conduct problems; hyperactivity or inattention; peer relationships along with positive strengths: pro-social behaviour. It also has an ‘impact score’ to assist in the prediction of emotional health problems. This section is extremely important.

How is it useful? The SDQ provides a useful way of indicating the emotional wellbeing and mental health needs of both the overall population of Looked After Children (LAC) and of individual children and young people. The SDQ is not a diagnostic tool; which means it will not say if a child has a particular mental health disorder. It does, however, give an indication of the extent of the child’s difficulties (overall stress score)and how much this affects them (impact score). Accurate scoring provides opportunity both to match supports with individual children and to develop service strategy for all Looked After Children.

What are local authorities expected to do? SET UP A PROCEDURE THAT WILL: - Collect the appropriate information - Inform all participants what their role is and why it is important - Collate the information (marking and scoring it) and send to the Df. E - Triangulate data and liaise with other agencies as required - Use the information to develop strategies to identify and support looked after children who have emotional and behavioural problems. (See Appendix A: Guidance)

Which children? Children between 4 and 17 years old … … who have been in local authority care for 12 continuous months or more. However, best practice would be to include all children in care over 3 years, since we cannot accurately predict if a child will be in care for 12 months and a ‘comparison’ SDQ can be very useful, to show any change. Some authorities complete for all children but only submit scores for children who meet requirements. *(There are separate SDQs for pre-school age children)

How does the SDQ work? CONDUCT HYPERACTIVITY TOTAL DIFFICULTIES PEER RELATIONSHIPS EMOTIONAL PRO-SOCIAL ……… …. …. ……… ……… STRENGTHS IMPACT SCORE 25 ITEMS: 5 FOR EACH DIFFICULTY AREA AND 5 FOR STRENGTHS ARE PRESENTED IN MIXED ORDER. EACH AREA GENERATES A SCORE. DIFFICULTY AREAS ARE TOTALLED, GIVING THE OVERALL STRESS SCORE

SDQ scoring for 4 -17 year olds close to average slightly raised PARENT-RATED high very high Total Score 0 -13 14 -16 17 -19 20 -40 Emotional 0 -3 4 5 -6 7 -10 Conduct 0 -2 3 4 -5 6 -10 Hyperactivity 0 -5 6 -7 8 9 -10 Peer relationships 0 -2 3 4 5 -10 Pro-social 8 -10 7 6 0 -5 IMPACT 0 1 2 3 -10 TEACHER-RATED Total Score 0 -11 12 -15 16 -18 19 -40 Emotional 0 -3 4 5 6 -10 Conduct 0 -2 3 4 5 -10 Hyperactivity 0 -5 6 -7 8 9 -10 Peer relationships 0 -2 3 -4 5 6 -10 Pro-social 6 -10 5 4 0 -3 IMPACT 0 1 2 3 -10 Total Score 0 -14 15 -17 18 -19 20 -40 Emotional 0 -4 5 6 7 -10 SELF-RATED Conduct 0 -3 4 5 6 -10 Hyperactivity 0 -5 6 7 8 -10 Peer relationships 0 -2 3 4 5 -10 Pro-social 7 -10 6 5 0 -4 IMPACT 0 1 2 3 -10

Which form should be used? • Two-sided Parent version marked for 4 -17 years [P 4 -17] should be used by local authorities. • Teachers will use the Teacher-rated version for 4 -17 year olds [T 4 -17] • the young person will use the Self-rated version [S 11 -17]. • Note – the self-rated version is only for children who are 11 years or older. • All forms are downloadable from: • www. sdqinfo. com

Who should complete the SDQ? It is very important that the SDQ is completed properly by a carer who knows the child well. This should be the main carer (foster carer or residential care worker), following a conversation with the child’s allocated social worker at, or near the time of completion. It is possible that the parent, or a previous foster carer, is the best person to complete the form (if the child has just gone into care, or changed care placement). Accuracy in recording is the most important issue.

When should it be done? • The most appropriate times will be: • • On coming into care (best practice) On the anniversary of the first SDQ (Only the ‘anniversary’ SDQ would need to be submitted to Df. E) As part of the child’s annual statutory health assessment. Within (or part of) LAC Review meeting. • The first completion in any placement should allow a settlingin period of one month before completion (see process map)

How long does it take to complete? • Normally, after conversation with the social worker, the carer should be able to complete a form in 15 - 20 minutes. • There are benefits to spending time discussing the carer’s thinking around the answers given. • The social worker will not be collaborating with the carer in answering the questions, but can ensure accuracy by helping the carer keep in mind the context and rules for completion. • The SDQ can be used as a conversational vehicle to elicit information about the child and their needs : – it is not just a form.

What happens next? • The allocated case worker (ACW) will use the guidelines (see appendix B) to generate scores using https: //sdqscore. org • The ACW will print a copy of the scoring report and discuss with their manager (see Appendix D) • Guidance on how to reach the SDQ Outcome Statement is included in the “Best Practice Guide” • For those with a SDQ Outcome Statement (C), the ACW will contact the Virtual Head Teacher to ensure a Teacher-rated SDQ (T 4 -17) is completed and that the young person completes the Self-rated SDQ (S 11 -17) and that both are returned for the ACW to score. • The ‘triangulated’ scores should be discussed again and a further SDQ Outcome Statement agreed. At, or before, the next LAC Review meeting, any additional supports should be put in place and a ‘Follow-up SDQ’ completed from each respondent (Carer, Teacher and Young Person)

The local authority: has a responsibility to identify and address the emotional needs of the children it has been tasked with caring for. On both theoretical grounds and on practical empirical evidence, the best treatment for attachment disorders is long-term good quality parental-type care with sensitive responding to the child’s needs. Robert Goodman & Stephen Scott (“Child and Adolescent Psychiatry” 2012: Wiley-Blackwell Publishers)

APPENDIX A - Guidance Children looked after by local authorities in England: Guide to the SSDA 903 collection 1 April 2016 to 31 March 2017 https: //www. gov. uk/government/publicatio ns/children-looked-after-return-2017 -to 2018 -guide

: Generating a Report APPENDIX B See “Best Practice Guidance for Allocated Case Workers” Pages 3 – 8

APPENDIX D: SDQ Process Pathway