Innovations in Practice: Piloting a new child and adolescent risk assessment suite in the <scp>UK</scp>

Tiffin, Paul A.; Kitchen, Charlotte; Weir, Steven

doi:10.1111/camh.12110

Cited by 4 publications

(3 citation statements)

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“…The tool was designed for a youth mental health setting; the mean age of original sample was 15.94 (range 12.23-18.71) with 36 males/69 participants. 157 Predictive ability was tested with a sample of 123 young people with clinician-completed FACE-CARAS ratings. These were examined in a retrospective file review to extract data on a relevant list of adverse outcomes at 3 and at 6 months following the assessment.…”

Section: Functional Analysis Of Care Environments (Face-caras) Suite ...mentioning

confidence: 99%

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Cantrell,

Sworn,

Chambers

et al. 2024

Health Soc Care Deliv Res

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Background Risk assessment is a key process when a child or adolescent presents at risk for self-harm or suicide in a mental health crisis or emergency. Risk assessment by a healthcare professional should be included within a biopsychosocial assessment. However, the predictive value of risk-screening tools for self-harm and suicide in children and adolescents is consistently challenged. A review is needed to explore how best to undertake risk assessment and the appropriate role for tools/checklists within the assessment pathway. Aims To map research relating to risk assessment for child and adolescent mental health and to identify features that relate to a successful risk assessment. Objectives To review factors within the clinical encounter that impact upon risk assessments for self-harm and suicide in children and adolescents: to conduct a realist synthesis to understand mechanisms for risk assessment, why they occur and how they vary by context to conduct a mapping review of primary studies/reviews to describe available tools of applicability to the UK. Data sources Databases, including MEDLINE, PsycINFO®, EMBASE, CINAHL, HMIC, Science and Social Sciences Citation Index and the Cochrane Library, were searched (September 2021). Searches were also conducted for reports from websites. Review methods A resource-constrained realist synthesis was conducted exploring factors that impact upon risk assessments for self-harm and suicide. This was accompanied by a mapping review of primary studies/reviews describing risk-assessment tools and approaches used in UK child and adolescent mental health. Following piloting, four reviewers screened retrieved records. Items were coded for the mapping and/or for inclusion in the realist synthesis. The review team examined the validity and limitations of risk-screening tools. In addition, the team identified structured approaches to risk assessment. Reporting of the realist synthesis followed RAMESES guidelines. Results From 4084 unique citations, 249 papers were reviewed and 41 studies (49 tools) were included in the mapping review. Eight reviews were identified following full-text screening. Fifty-seven papers were identified for the realist review. Findings highlight 14 explanations (programme theories) for a successful risk assessment for self-harm and suicide. Forty-nine individual assessment tools/approaches were identified. Few tools were developed in the UK, specifically for children and adolescents. These lacked formal independent evaluation. No risk-screening tool is suitable for risk prediction; optimal approaches incorporate a relationship of trust, involvement of the family, where appropriate, and a patient-centred holistic approach. The objective of risk assessment should be elicitation of information to direct a risk formulation and care plan. Limitations Many identified tools are well-established but lack scientific validity, particularly predictive validity, or clinical utility. Programme theories were generated rapidly from a survey of risk assessment. Conclusions No single checklist/approach meets the needs of risk assessment for self-harm and suicide. A whole-system approach is required, informed by structured clinical judgement. Useful components include a holistic assessment within a climate of trust, facilitated by family involvement. Study registration This study is registered as PROSPERO CRD42021276671. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135079) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 1. See the NIHR Funding and Awards website for further award information.

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Section: Functional Analysis Of Care Environments (Face-caras) Suite ...mentioning

confidence: 99%

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Cantrell,

Sworn,

Chambers

et al. 2024

Health Soc Care Deliv Res

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“…The original content for the nine scales was drawn from published literature and findings from a series of focus groups (Daniel, Weir, & Tiffin, ). Subsequent work has established the interrater reliability of the scales in a field pilot (Tiffin, Kitchen, & Weir, ) and, in a more limited study, their interrater reliability (Evans & Oswald, ). These studies also provided evidence of content validity.…”

Section: Introductionmentioning

confidence: 99%

Predictive validity and interrater reliability of the FACE‐CARAS toolkit in a CAMHS setting

Evans

Young

Tiffin

2019

Criminal Behav Ment Health

Self Cite

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Background The FACE‐CARAS (Functional Analysis in Care Environments‐Child and Adolescent Risk‐Assessment Suite) toolkit has been developed to support practitioners in Child and Adolescent Mental Health Services (CAMHS) in performing a structured risk assessment. It covers a number of risk domains including violence, suicide, self‐harm, experienced abuse, and exploitation. Interrater and internal reliability has already been established but not predictive validity. Aims/Hypothesis Our aim was to establish the predictive validity of the FACE‐CARAS in a CAMHS population. Methods Records from 123 young people with FACE‐CARAS ratings completed by clinicians were examined in a retrospective file review to extract data on a relevant list of adverse outcomes at three and at 6 months following the assessment. Although this was not a prospective longitudinal study, researchers were blind to the clinicians' ratings, allowing valid testing of predictive power. Cases were drawn from across generic and specialist CAMHS teams in approximately equal proportions. Data were analysed using receiver operator characteristic statistics. Results Areas under the curve values in five of the seven risk areas approached or were greater than 0.8 indicated that the FACE‐CARAS profile score was a good potential predictor of risks of self‐harm, suicidal behaviours, serious self‐neglect, abuse or exploitation by others, and violence to others at both 3 and 6 months. It was weakly “predictive” of accidental self‐harm and no better than chance at signalling physical ill health. Conclusions Findings support the use of the “profile summary” section of the tool as likely to generate clinically useful risk predictions. We were concerned that clinical use of the scale did not conform to research standards and often left subscales incompletely rated; however, the fact that the tool nonetheless proved a good predictor of most key adversities under scrutiny may add weight to its value in clinical practice. Further work with the FACE‐CARAS subscales is recommended.

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“…CAMHS professionals are required to provide an account of these risks using a combination of formal or informal assessment (Aggett & Messent, 2019). Much of the research on risk in CAMHS has focused on developing and sometimes evaluating structured assessment tools (Tiffin et al, 2015). However, the profile of the risks identified by routine CAMHS practice has remained understudied.…”

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confidence: 99%

Risk rates and profiles at intake in Child and Adolescent Mental Health Services (CAMHS): A cohort and latent class analyses of 21,688 young people in South London

Coughlan,

Woolgar,

Hood

et al. 2023

Preprint

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Background Children and young people (CYP) seen by child and adolescent mental health services (CAMHS) often experience safeguarding issues. Yet little is known about the volume and nature of these risks, including how different adversities or risks relate to one another. This exploratory study aims to bridge this gap, examining rates at entry to services and profiles of risk using a latent class analysis. Methods: Data were extracted for CYP who received at least one risk assessment at CAMHs in South London between January 2007 and December 2017. In total, there were 21,688 risk assessments. Latent class analysis was used to identify profiles of risk from the risk assessments. Results: Concerns about parent mental health (n=5,274; 24%), emotional abuse (n= 4,487; 21%), violence towards others (n= 4210; 19%), destructive behaviour (n=4,005; 18%), and not attending school (n=3,762; 17%) were the most commonly identified risks. Six distinct profiles of risk were identified from the latent class analyses: 1) maltreatment and externalising behaviours, 2) maltreatment but low risk to self and others, 3) antisocial behaviour, 3) inadequate caregiver supervision and risk to self and others, 5) risk to self but not others, and 6) mental health needs but low risk. Conclusions: These findings provide fresh insights into adverse experiences and risks identified by CAMHS. For professionals, the profiles identified in this study might provide insights into profiles of identified risks, in contrast to traditional cumulative approaches to risk. For researchers, these profiles may be fertile ground for hypothesis-driven work on the association between adversity and later outcomes.

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Innovations in Practice: Piloting a new child and adolescent risk assessment suite in the UK

Cited by 4 publications

References 10 publications

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis

Predictive validity and interrater reliability of the FACE‐CARAS toolkit in a CAMHS setting

Risk rates and profiles at intake in Child and Adolescent Mental Health Services (CAMHS): A cohort and latent class analyses of 21,688 young people in South London

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