[MUSIC PLAYING] We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hello, my name is Dr. Eva Sprecher. And I'm a research fellow at UCL in the child trauma and recovery group. I'm going to speak to you a little bit about our paper, the sufficiency of current practise, how well does the strengths and difficulties questionnaire detect clinically elevated post-traumatic stress, anxiety, and depression symptoms in children living in care? We know that children living under the care of the state or the local authority are at far greater risk of mental health difficulties than their peers. So the research suggests that children living in care have a five times higher likelihood of fitting criteria for a psychiatric diagnosis compared to their peers who haven't spent time living in care. These mental health conditions include common mental health conditions like anxiety and depression and also trauma-specific mental health conditions like post-traumatic stress disorder, or PTSD. Some estimates suggest that children living in care may have as much as a 12 to 13 times higher risk of developing PTSD compared to their peers who haven't spent time in care. But long-term poor mental health is absolutely not inevitable for young people who have spent time in care. And a really important aspect of preventing poor mental health difficulties in the long-term is by identifying mental health difficulties early, accurately, and making sure young people get the appropriate evidence-based support. In England, one way that local authorities aim to detect mental health difficulties amongst children living in care is that once per year carers will complete a questionnaire called a strengths and difficulties questionnaire about young people's mental health. The strengths and difficulties questionnaire is designed to detect general mental health difficulties rather than specific mental health disorders. In this study, we wanted to understand whether the carer report strengths and difficulties questionnaire is enough to detect common and trauma-related mental health concerns amongst children currently living in care or whether some young people are being missed by this approach. It's also really important to note that in Wales, Scotland, and Northern Ireland, they don't use the strengths and difficulties questionnaire in this way. But there is no other screening approach which is used in a statutory manner. In this project, we worked with 491 children living in care who were 10 to 18 years old. And we also collected data from their carers from 342 carers who included foster carers, kinship carers, and residential key workers where children were living in residential children's homes. Children and caregivers both completed the strengths and difficulties questionnaire. And children also completed standardised self-report questionnaires looking at anxiety, depression, and PTSD symptoms. And we used really well-established clinical cutoffs to look at where young people had potentially clinically concerning levels of anxiety, depression, or PTSD symptoms. We found that most of the children who took part in our study did score above clinical threshold on at least one of our questionnaires. We also found that, unfortunately, a large proportion of young people who were scoring in the clinical range on the disorder-specific questionnaires about anxiety, depression, and PTSD symptoms, were not picked up by the carer report strengths and difficulties questionnaire. So they actually scored in the normal range on the carer report strengths and difficulties questionnaire. But their scores on those anxiety, depression, and PTSD questionnaires were elevated. To be more specific, the carer report strengths and difficulties questionnaire did not detect 44% of children reporting clinically elevated anxiety symptoms, 46% of children reporting clinically elevated depression symptoms, and 48% of children reporting clinically elevated post-traumatic stress symptoms. We found similar patterns when we looked at the child report strengths and difficulties questionnaire, which was a little bit better at detecting children with elevated anxiety and depression symptoms, but equally poor at detecting children with elevated PTSD symptoms. We found somewhat better detection rates when we triangulated and looked at, did children score above threshold on either the child report strengths and difficulties questionnaire or the carer report strengths and difficulties questionnaire to make it a bit of a lower bar? But it's really important to remember that local authorities don't ask children to complete strengths and difficulties questionnaires routinely or it's not a statutory requirement. So that was above and beyond what's currently done in most local authorities. The message we want to share from these findings is not to criticise the strengths and difficulties questionnaire. The strengths and difficulties questionnaire is not designed to detect very specific symptoms of disorders like PTSD, anxiety, or depression. However, it does highlight concerns about how the strengths and difficulties questionnaire is being used and the fact that we're often solely relying on that questionnaire completed by carers to detect mental health difficulties amongst children living in care. We really would recommend on the basis of these findings that we need to start including symptom or condition-specific mental health screening as part of good practise in local authorities to support us to really detect or identify young people who are living in care and may be really struggling with some symptoms of anxiety, depression, or PTSD, which have really good evidence-based treatments and to support these young people to access those treatments at an appropriate time, rather than waiting until their mental health difficulties reach crisis point. We are now testing this approach in a study funded by the NIHR called the MyVoice trial. Thank you for listening. And we really hope that you enjoy this paper. [MUSIC PLAYING]