Accuracy of a Proactive Case Detection Tool for Internalizing and Externalizing Problems Among Children and Adolescents

Abstract

Lack of identification and referral of children and adolescents with mental health problems contributes to the treatment gap in low-and middle-income countries, and especially in humanitarian settings. The Community Case Detection Tool (CCDT) is developed to improve community-based detection and increase help-seeking among children and adolescents in need of mental health care. The CCDT uses brief, easily understood pictorial vignettes that represent common symptoms of childhood internalizing and externalizing problems. The tool is developed for gatekeepers to support proactive detection of children in need of mental health care and to subsequently encourage help-seeking. This study evaluates the accuracy of the CCDT in detecting children and adolescents aged 6e18 years with significant mental health care needs in a conflict-affected setting: the occupied Palestinian territory. Methods: Teachers and community workers were trained to use the CCDT. Children detected using the tool were invited for a structured clinical interview with a psychologist using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, as well as the Strengths and Difficulties Questionnaire, to test the accuracy of CCDT-based detection. Results: Our sample consists of 52 children positively detected as matching with one of the vignettes. Approximately three of four detected children were indicated for psychological treatment based on the clinical interview (positive predictive value ¼ .769), and 64.6% returned 'borderline' or 'abnormal' total difficulty scores on the Strengths and Difficulties Questionnaire. Conclusions: The CCDT offers a promising low-cost solution to mitigate underdetection of mental health problems in challenging settings.

Proactive detection of people in need of mental healthcare: accuracy of the community case detection tool among children, adolescents and families in Sri Lanka

“…This study demonstrated that just over two-thirds of all children and families detected using the CCDT were correctly detected as in need of mental health treatment based on a clinical interview. This is line with the results of proactive case detection among adults in Nepal and children in Palestine and can be regarded as a moderate to high PPV since the CCDT was used among the general population [15,19].…”

“…A likely explanation for this is their more informal contacts within their daily routine and familiarity with families in their village. In our previous study in Palestine, in which teachers used the CCDT, the results were slightly better (PPV = 0.769) [19]. This may be because of teachers' relevant educational background and training, and shows the importance of the selection of suitable gatekeepers in each new context.…”

“…Building on these positive findings among adults, a child-focused Community Case Detection Tool (CCDT) was developed and evaluated in schools in Palestine. Using the CCDT, teachers accurately detected children in need of mental healthcare in three out of four cases (positive predictive value [PPV] = 0.77) [19]. Drawing on these promising findings, we applied the same tool and procedures to community settings as part of the current study.…”

Psychological interventions for children with emotional and behavioral difficulties aged 5–12 years: An evidence review

“…Two studies examined the EASE intervention among Syrian refugee adolescents in Jordan (n=471) (Bryant et al 2022), and Lebanon (n = 198) (Jordans et al 2023). The intervention consisted of seven 90-minute group sessions for adolescents and three sessions for caregivers, delivered by non-specialist providers provided with brief training and regular supervision.…”

Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize

“…The CCDT is a vignette-based 'proactive detection' tool that describes symptoms of mental disorders like anxiety and depression [21]. It was adapted, for use among adolescents in Belize, from a version developed for proactive case detection among adults in Nepal, aiming to increase help seeking and mental healthcare utilization among individuals with mental disorders [22] and has been previously used with youth in Sri Lanka and the occupied Palestinian territories [21,23]. The CCDT language and visuals were culturally and contextually adapted [24] with inputs from mental health experts from the Ministry of Health in Belize.…”