[MUSIC PLAYING] We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. Hi, I'm Sue Fenton. I'm one of the NIHR academic clinical Fellows in child and adolescent mental health and I currently work in Nottingham. Hi, I'm Salah Basheer. I'm an NIHR academic clinical lecturer working in the University of Nottingham. So my work in child and adolescent mental health research and clinic as well. Today we'll be answering some questions around standardised diagnostic assessment tools. Standardised diagnostic assessments, or SDA, tools are structured and comprehensive tools designed to systematically collect information about a child or young person's symptoms, functioning, and development. This is to assess a broad range of mental health disorders and assign symptoms to a diagnostic category according to established diagnostic manuals like the DSM or ICD. In the UK, NICE recommends using SDA tools as an adjunct to detect depression in children and young people. SDA tools involve administering validated questionnaires, interviews, or rating skills to a single or multiple informants. So this is useful in CAMHS, as young people may not always be able to verbalise or communicate their difficulties, and having a structured tool together, collateral history is useful. Some of the more commonly used SDA tools include the development and well-being assessment, DAWBA, mini-international neuropsychiatric interview for children and adolescents, MINI-KID, and Kaufman schedule for affective disorders and schizophrenia, K-SADS. So there are different kinds of SDA tools which are used. Commonly used ones are DAWBA, K-SADS, and MINI-KID. There are other tools as well which are used both in research and clinical practise. These tools have been developed earlier as a research tool, but it is being considered to be used more and more in different clinical settings. Sometimes it can be considered used in referral triaging or it can be used considered used in specialist clinical settings. So when I talk about different tools, there are common things in these tools, like, for example, it collects information from multiple sources, tries to map that into different diagnostic categories, and gives an output for the clinician to consider. But there are differences as well. So for example, MINI-KID is a tool which is more structured in its format with very little place to write open-ended comments. While when you look at DAWBA and K-SADS, it is more semi-structured in its format. And when you consider the use of K-SADS, it is more clinician-led. So there is more clinician time involvement required. But when you consider use of DAWBA, it can be used in a way that parent can fill it up and clinician can get the output of it. And then that can be used for further down the line. One of the most important factor we should remember is the assessment does not just use these tools, it is a part of the whole assessment. It is not just using this tool and making a diagnosis. SDA can be particularly useful at the referral stage. They have the potential to identify which children are most likely to benefit from specialist CAMHS input, support triage process, and pick up missed diagnosis. For example, DAWBA improved referral decision accuracy from our review, meaning children, young people who need CAMHS input were more likely to be accepted, although the use of SDA did not seem to affect overall acceptance rates. When we compare the diagnosis assigned by DAWBA with diagnosis assigned by clinicians in their routine clinical practise, we saw that the diagnosis had fair agreement. And in terms of early identification of diagnosis, our review also showed that MINI-KID can identify more diagnoses, for example, anxiety, OCD, tics, and behavioural disorders. K-SADS, on the other hand, could identify anxiety disorders even when children, young people did not present with anxiety symptoms. However, if children and young people's presentation are too complex and they have multiple mental health comorbidities, SDAs might not be able to correctly identify the diagnosis, which is why clinicians acumen is still vital. Yeah, that's an interesting question. Even though SDA tools has potential to identify misdiagnosis, there is lots of challenge in implementing it to routine clinical CAMHS care. One of the challenges which we identified from clinicians is the concerns around feasibility of doing these tools in their routine practise. So if these tools are not a part of their routine clinical work, that makes it more challenging for clinicians to adopt it. There are also aspects of training. For example, we found that certain professions like psychologist and psychiatrist, who are more used to using diagnostic framework in their assessment, find it more acceptable compared to clinicians who might not be quite used to this diagnostic framework. There is, again, concerns around the value of diagnosis as well among clinicians. Some of the clinicians might not really be using diagnosis much in their assessments and practise. So these are some concerns which can impact the way these tools are used during clinical practise. But as Sue was saying, there is lots of evidence in terms of this being used as an adjunct to clinical assessment and helping people identify misdiagnosed or missed problems which they don't present with initially. And there is also value in this as a referral triage tool, which can help in identifying which service might be best suited for a young person and their families. That is a great question. And despite the benefits and the effectiveness, there are real challenges of embedding SDA tools into everyday practise. For example, time and workload pressures make clinicians feel that they don't have enough time to complete structured assessments if we were to use it in busy clinics. The issue of training and confidence can also be a barrier. For example, certain health professionals, as Salah mentioned, who do not have adequate training with diagnostic frameworks, may need more support to integrate and interpret SDA results into care planning. I think without digital integration, it can often feel clunky to administer and score SDA assessments. And we also have to look at whether this is a good fit in terms of different cultures and different CAMH services around the world. Some tools may not be appropriate across all populations, and some people might find them too lengthy or impersonal. So with respect to professionals, as I said earlier, there are different people with different clinical training which work in CAMHS. So as I said, psychiatrists and psychologists who are more familiar with diagnostic framework are finding it more acceptable to use these tools compared to other professionals who work in CAMHS And the recent study which was done, which was a large scale study in CAMHS, actually reported that the professionals who work in triaging the referrals also found it more acceptable to use these tools. Apart from that, when you look at acceptability to young people and families, there is limited literature out there. Again, the same study also, where they also interviewed families who use these tools, actually reported positive experience, as if they found it more validating to have certain diagnoses or labels, which helps in their care-seeking. Well, we need to look beyond do SDAs work and to ask, how do we make them work in real CAMH settings? I think key areas to consider would be to develop digital platforms that integrate SDA seamlessly into electronic health records. So this could be less clunky and easier to administer. We can also test out shorter, more adaptive tools that balance accuracy with feasibility. And more importantly, we need to start evaluating the impact on outcomes and whether children assessed with SDAs get quicker, more accurate diagnoses and better long-term care. And we also need more studies looking at the cost effectiveness of SDA tools. I think we need more training for health professionals to be able to use the SDA tools more confidently in their clinical practise. Yeah, so as we were discussing, there is some potential for SDA tools in terms of improving referral outcomes. There is also some acceptability in clinicians working in certain professionals and also working in certain areas of the care pathway, like referral, triaging, where there is some acceptance. And patients and families do find it quite acceptable as well, But I think there's more research needed into how this can be embedded in practise-- how this can be implemented in practise by working on co-designing these tools and working with families and other professionals about how to integrate that in their own daily practise. And as I said, there are different kinds of tools as well. So we might have to look at which tool would be working in which part of the care pathway. And some tools are digitally available, some tools are less clinician-led. So it can work in different settings as well. So where the pathway this would work is something which we need to look at. And as Sue was saying, whether we can use digital means or digital solutions to make it easier for clinicians and the families and patients to use these tools. These are some of the things I think we need to look in terms of future work. Yeah, as we were discussing about standardised diagnostic assessment tools, one of the things which I wanted to emphasise is the fact that while these tools are being considered now is due to the increasing waiting times, which is causing a lot of pressure. And we are looking at all options how to improve the efficiency in terms of how CAMH's work is happening. And that's one of the reasons which these tools was considered. And I also wanted to clarify that these tools are just a part of the clinical assessment. And this should be used as an adjunct to it. And I, being psychiatrist, may be having more diagnostic framework, but I think there is a usefulness to this framework in getting the care, the evidence-based care for the young people. [MUSIC PLAYING]