1. Copyright © The REACH Institute. All rights reserved. Tools to Know and Love

2. Copyright © The REACH Institute. All rights reserved. Learning Objectives Distinguish the differences between tool types State the advantages and disadvantages of different types of tools Identify tools that might work in your practice Use the Pediatric Symptom Checklist (PSC)

3. Copyright © The REACH Institute. All rights reserved. Hidden Slide: Time Table Total time: 20 minutes Goals and Objectives: 1’ Advantages and disadvantages of different types of screening tools – 6’ Review PSC-17: 3’ Table Activity: Identify tools that might work in your practice: 8’ Debrief, summarize, and wrap up: 2’ Unit C: Tools to Know and Love

4. Copyright © The REACH Institute. All rights reserved. Screening Test IS Used across populations to identify issues in an individual that need further follow-up Best if brief, inexpensive, can lead to intervention if something is identified Better positive predictive value with higher prevalence IS NOT Diagnostic Examples: Pediatric Symptom Checklist (PSC), Screen for Child Anxiety Related Disorders (SCARED)

5. Copyright © The REACH Institute. All rights reserved. Behavioral Checklist IS NOT Brief Diagnostically based Specific enough to confirm a diagnosis IS Summary of a diverse set of symptoms across domains Examples: Child Behavior Checklist (CBCL), Behavior Assessment System for Children (BASC)

6. Copyright © The REACH Institute. All rights reserved. Rating Scale IS A questionnaire that has been well-tested to measure symptoms & help predict a specific diagnostic entity May (or may not) track treatment response Example: Vanderbilt for ADHD IS NOT A diagnostic tool that will provide a diagnosis based on a score on a rating scale Website Screening Tool and Rating Scale Reference: http://www2.massgeneral.org/schoolpsychiatry/screeningtools_table.asp

7. Copyright © The REACH Institute. All rights reserved. Diagnostic Test IS Manualized Uses DSM-5 criteria to review major disorders Diagnostic Example: Diagnostic Interview Schedule for Children (DISC IV) IS NOT Short, brief Not useful in PC settings

8. Copyright © The REACH Institute. All rights reserved. Pediatric Symptom Checklist (PSC) Psychosocial screen Designed for busy pediatrics office Widely used Time < 5 minutes English, Chinese, Spanish, other Cost: Free

9. Copyright © The REACH Institute. All rights reserved. Pediatric Symptom Checklist (PSC) 17 item or 35 item formats –PSC 17 or PSC 35 12% middle income children “screen- in” or have positive scores; higher for lower income children 17 item format is often sufficient

10. Copyright © The REACH Institute. All rights reserved. Parent and Youth versions Parent Version –Parent C 1.2 & 1.6 Youth C 1.3 & 1.7 –Ages 4 and up –Parent completes Pediatric Symptom Checklist (PSC)

11. Copyright © The REACH Institute. All rights reserved. Example: Youth Version of PSC (PSC17-Y) –C1.3 –Ages: used in studies with ages 9 and up –Youth self-report –Newer than original PSC-35 –Scoring same as parent form Pediatric Symptom Checklist (PSC-17)

12. Copyright © The REACH Institute. All rights reserved. Scoring – quick, easy C1.1 Total score – used to “screen-in” or “screen-out” a child 3 subscale scores –Attention –Externalizing – disorders with “acting out” symptoms. Example: conduct disorder –Internalizing – disorders with “quieter” symptoms. Example: anxiety, depression Scoring a PSC-17

13. Copyright © The REACH Institute. All rights reserved. Scoring a PSC-17 Each item is rated as “Never,” “Sometimes,” or “Often” present and scored 0, 1, or 2, respectively The total score is calculated by adding together the score for each of the 17 items –Positive PSC-17 score ≥ 15 Attention, Externalizing, and Internalizing subscale scores are calculated by adding the score for each corresponding symbol:  = Attention, positive score ≥ 7  = Externalizing, positive score ≥ 7  = Internalizing, positive score ≥ 5

14. Copyright © The REACH Institute. All rights reserved. Attention Subscale l  Fidgety, unable to sit still  Daydreams too much  Has trouble concentrating  Acts as if driven by a motor  Distracts easily PSC-17 Subscales

15. Copyright © The REACH Institute. All rights reserved. 6 Attention C 1.1

16. Copyright © The REACH Institute. All rights reserved. PSC-17 Subscales Externalizing Subscale  Refuses to share  Does not understand other people’s feelings  Fights with other children  Blames others for his/her troubles  Does not listen to rules  Teases others  Takes things that do not belong to him/her

17. Copyright © The REACH Institute. All rights reserved. 6 0 Externalizing

18. Copyright © The REACH Institute. All rights reserved. Internalizing Subscale  Feels sad, unhappy  Feels hopeless  Is down on him/herself  Seems to be having less fun  Worries a lot PSC-17 Subscales

19. Copyright © The REACH Institute. All rights reserved. 6 15 0 9 Internalizing C 1.1a

20. Copyright © The REACH Institute. All rights reserved. Case Cutoff Score +/-+/- Total Score 15 + Attention Subscale 67 - Externalizing Subscale 07 - Internalizing Subscale 95 + Scoring a PSC-17

21. Copyright © The REACH Institute. All rights reserved. Hidden Slide Presenter explains table activity: –Show where the PSC and SDQ is in their workbook –Ask each table to determine how they might use scales in daily practice, which one the group likes best, and justify why chose that scale. Each table uses scribe to summarize recommendations on flipchart. Unit C: Tools to Know

22. Copyright © The REACH Institute. All rights reserved. Table Activity Review Strengths and Difficulties Questionnaire (SDQ – C 1.9), and PSC (C1.5) in workbook As a group: Determine how you might use these tools efficiently in your practice for screening, then pick the scale your group likes the best. SCRIBES: On your flipchart, write the scale your group likes best, that might work in your practice. Indicate why and justify your choice: –Who might hand the scale out to parents/patients? –When during the visit (beginning, middle, end), –Who might score it?

23. Copyright © The REACH Institute. All rights reserved. Wrapping Up Reliable and valid tools are available to improve identification and assessment of mental health problems Can be used efficiently in clinical practice Can improve reliability of diagnosis Can be used to track clinical course and outcomes Part of the “Standard of Care” Look at your Mental Health Card during the break!

24. Copyright © The REACH Institute. All rights reserved. REMINDER: REMINDER: Please fill out Unit C evaluation