Reliability Training for
Raters on the CAFAS®
Prepared by Kay Hodges, PhD
Functional Assessment Systems (FAS)
3600 Green Court, Suite 110 Ann Arbor, MI 48105
Phone: 734-769-9725; Fax: 734-769-1434
Email: [email protected]
www.FASoutcomes.com
© 2009 Functional Assessment Systems
1
Agenda for Training
Evidence that the CAFAS is a powerful tool
How to use CAFAS in everyday clinical
practice
Rules for scoring – subscale by subscale
Quiz after each subscale to self-assess
Do 10 reliability vignettes
© 2009 Functional Assessment Systems
2
The CAFAS and PECFAS
 CAFAS: Child and Adolescent Functional
Assessment Scale
 Developed in 1989
 Age: Full time Kindergarten – 17 yrs.
 PECFAS: Preschool and Early Childhood
Assessment Scale (PECFAS)
 Preschool version
 Age: 3-7 yrs., depending on developmental
level
 A self-training manual can be ordered from
FAS
© 2009 Functional Assessment Systems
3
Impairment
“Real World”
Behavior
Symptoms
© 2009 Functional Assessment Systems
Day-to Day
Functioning
4
Uses of the CAFAS
 A criteria to consider in determining
intensity of services needed
 An outcome measure (pre/post)
 An aid to actively managing cases
during course of treatment
 An assessment of strengths and
weaknesses for setting treatment goals
 Agency tracking, quality improvement,
etc.
 A common language for treatment
collaboration and supervisory sessions
© 2009 Functional Assessment Systems
5
CAFAS Tracks Behavior
Across Domains
 Multidimensional: Information generated is
more useful and credible than global scores
 Behaviorally more specific than diagnoses
 Measures behaviors/ symptoms that can be
reasonably expected to change
 Assesses behaviors which lay persons can
understand
 Generates a total score as well as scores for
each subscale.
© 2009 Functional Assessment Systems
6
The CAFAS is a powerful tool
Psychometric Data on
the CAFAS
© 2009 Functional Assessment Systems
7
Research on the CAFAS
 Reliability (stability of score)
 Inter-rater, Test-retest
 Validity (measures what intends to measure)
 Concurrent validity
(Scores differ for subgroups presumably
differing in extent of impairment)
 Predictive validity
(Scores predict behavior/circumstances in the
future)
© 2009 Functional Assessment Systems
8
Concurrent Validity
 Levels of intensity of care
 Inpatients>
home-based services, day treatment>
outpatient care
 Settings differing in restrictiveness
 Residential placements>
Therapeutic foster care>
Regular foster care
(Hodges et al., 1999)
© 2009 Functional Assessment Systems
9
Concurrent Validity (cont’d)
 Severity of psychiatric diagnosis
 Serious psychiatric disorders>
Less serious disorders (e.g., adjustment,
anxiety)
 Specific problematic behaviors and risk factors




Problems in social relationships
Involvement with juvenile justice
School related problems
Child and family risk factors
(Hodges, Doucette-Gates et al., 1999; Manteuffel et al., 2002; Walrath, Mandell, Liao et al., 2001; Hodges
& Wong, 1996; Doucette-Gates, Hodges, & Liao, 1998)
© 2009 Functional Assessment Systems
10
Predictive Validity:
Service Utilization
 Higher CAFAS total score at intake
predicted at 6 and 12 months postintake:




More restrictive care
Higher cost
More bed days
More days of services
(Hodges & Wong, 1997)
© 2009 Functional Assessment Systems
11
Prediction: Comparison to
Child Behavior Checklist (CBCL)
 CAFAS was a significant predictor
of all 4 utilization indicators at
both 6 and 12 months
 Number of problems on the CBCL
was not predictive of any of the
utilization indicators
(Hodges & Wong, 1997)
© 2009 Functional Assessment Systems
12
Prediction: Comparison
to Presence/Absence of Common Diagnoses
 Compared to diagnosis, the CAFAS at intake
was the strongest predictor of all four
utilization indicators at both 6 and 12 months.
 The only diagnosis, which was significant at
both 6 and 12 months, was conduct disorder.
 Even so, the CAFAS was a more powerful
predictor
(Hodges & Wong, 1997)
© 2009 Functional Assessment Systems
13
Prediction: National Evaluation
by CMHS of Youths with SED
 CAFAS predicted:
 Restrictiveness of living arrangement
 Number of days in out-of-family care
 Subsequent contact with the law
 School attendance
(Hodges, Doucette-Gates, & Kim, 2000)
(Hodges & Kim, 2000)
© 2009 Functional Assessment Systems
14
Predicting Recidivism
A higher CAFAS at discharge
from a juvenile justice residential
center predicted recidivism
during the year after discharge.
(Quist and Matshazi 2000)
© 2009 Functional Assessment Systems
15
Generalizability
 CAFAS used to describe the needs of
children with various demographic
profiles who were referred from a wide
variety of agencies, including:
 Mental health
 Schools
 Juvenile justice
 Child welfare
© 2009 Functional Assessment Systems
16
Generalizability (cont’d)
Studies:







Quist & Matshazi, 2000
Rosenblatt & Rosenblatt, 1999
Rosenblatt, Rosenblatt, & Biggs, 2000
Walrath, dosReis et al., 2001
Walrath, Nickerson, Crowel, & Leaf, 1998
Walrath, Sharp, Zuber, & Leaf, 2001
Zima, Bussing, Crecelius, Kaufman, & Berlin,
1999
© 2009 Functional Assessment Systems
17
CAFAS: A
Multidimensional
Measure of Functioning
© 2009 Functional Assessment Systems
18
CAFAS SUBSCALES
School/Work
Moods/Emotions
Home
Self-Harmful
Community
Behavior Toward
Others
© 2009 Functional Assessment Systems
Behavior
Substance Use
Thinking
19
CAFAS Subscales
for the Youth
School/Work
Functions satisfactorily in a
group education
Home
Observes reasonable rules and
performs age-appropriate tasks
Respects the rights of others
and their property and acts
lawfully
Appropriateness of youth’s daily
behavior
Community
Behavior
Toward Others
© 2009 Functional Assessment Systems
20
CAFAS Subscales
for the Youth
Moods/Emotions
Modulation of the youth’s emotional
life
Self-Harmful
Behavior
Extent to which the youth can
cope without self-harmful behavior
or ideations
Substance Use
Youth’s substance use and the
extent to which it is inappropriate
& disruptive
Ability of youth to use rational
thought
Thinking
© 2009 Functional Assessment Systems
21
Administration
 Is not administered.
 Takes about 10 minutes to rate
after training.
 Rater is informed about the child,
has experience working with
children, and is reliable rater.
© 2009 Functional Assessment Systems
22
Rating Procedure
 For each scale, rater reads through the
items until description of the youth (during
the rating period) is found.
 Always start at SEVERE level.
 Rater can go to the next subscale once an
item has been identified (and level of
impairment determined).
© 2009 Functional Assessment Systems
23
Organization of
Problem Behaviors
(Handout: Sample CAFAS)
 Items are behavioral descriptions.
 Items are organized within domains
of functioning (subscales).
 Within each subscale, items are
organized within levels of impairment.
© 2009 Functional Assessment Systems
24
Levels of Impairment
 Severe Impairment
 Severe disruption or incapacitation (30)
 Moderate Impairment
 Major or persistent disruption (20)
 Mild Impairment
 Significant problems or distress (10)
 Minimal or No Impairment
 No disruption of functioning (0)
© 2009 Functional Assessment Systems
25
Clinical Significance
Inherent in CAFAS
 CAFAS scores are “anchored” by the
minimal or no impairment level
 Normative behavior (nonreferred) is
defined by the “no or minimal impairment”
behaviors
 Change in scores can be “translated” to
actual behaviors and “closeness” to
“nonreferred” behavior
© 2009 Functional Assessment Systems
26
Rating: Time Period and
Frequency
 Most severe level of dysfunction occurring at
any time during the time period being assessed.
 Time period: Typically last month or three
months (User group determines).
 Frequency: Entry (intake), every 3 months,
discharge, post-discharge.
 At intake, if the youth was delayed getting to
your agency for services, you may need to rate
back to the time when the youth was exhibiting
behavior for which he/she was referred
© 2009 Functional Assessment Systems
27
Source of Information
 Based on information usually collected as part of the
typical services.
 Raters’ interviewing “clinical skills” are critical to obtain
the information needed to rate the CAFAS.
 Obtains information from various informants (youth,
parents, teachers, etc).
 The following, available from FAS, can help obtain the
information:
 CAFAS structured interview can be used to gather
information (not required).
 CAFAS Checklist for youth and adult informants
© 2009 Functional Assessment Systems
28
Sources of Information (Cont.)
 Base your assessment on all information
known to be true about the youth at the
time of the rating
 If youth denies a problem’s existence
when there is evidence otherwise,
indicate that the problem is present
 For pre-post outcome studies, it is best
if all raters use the same procedures
for gathering information (e.g., talk to
the same informants, use the same
interview format)
© 2009 Functional Assessment Systems
29
Instructions for Using Exception

“Exception” and “Explanation” appear on every level of
every CAFAS subscale. Use exception when you want to
rate the youth at a level of impairment where no items are
circled, circle the corresponding “EXCEPTION” number, and
explain the reason for your rating in the box labeled
“Explanation.”

Can be used for:
 Behavior not described on the CAFAS.
o Example: Encopresis
 Overriding the severity level associated with a behavioral
description. This should be done cautiously.
o Example: IEP permits return to mainstream classroom,
but delayed until next year because near end of year.
 Provide additional information (to provide context for
understanding the youth’s behavior) after having endorsed an
item in the column.
© 2009 Functional Assessment Systems
30
Instructions for Using
“Could Not Score”
 Appears on every subscale
 If under rare circumstances, there is
insufficient information to rate the
youth on a scale, circle the number
corresponding to “Could Not Score.”
 Always try to get the information so
that you can knowledgeably rate every
subscale
© 2009 Functional Assessment Systems
31
Basis for Judgment
 Use a literal approach in judging behavior
criteria. Attend to the limited and specific
meaning of each item.
 Do not infer that a problem exists on the basis
of another problem, the underlying dynamics,
or the youth’s apparent diagnosis.
 Base your rating on what you have observed or
what has been reported by the youth or other
informants.
 Rate the youth’s functioning independent of
previous diagnoses, prognosis, or presumed
nature of the disorder.
© 2009 Functional Assessment Systems
32
Treatment and Scoring
 Rate the youth’s current functioning without
necessarily scoring as more impaired because
of the services the youth is receiving
 The rating should accurately reflect the public
performance of the individual
 Do not score more severely because of
outpatient psychotherapy or medication
 However, you would give a higher score in the
case where external controls or structure are
thought to be needed to maintain acceptable
behavior (the rules for scoring tell you how to
do this).
© 2009 Functional Assessment Systems
33
CAFAS Does Not
Dictate Treatment
 The goal of the interventions is to
reduce impairment in specific domains.
 The means for reducing impairment is
determined by the professional and the
family.
 The CAFAS Profile does not dictate
treatment approach! For example, you
may choose to work on “underlying”
issues.
© 2009 Functional Assessment Systems
34
Quantitative Scores
 Subscales scores
 Range: 0 to 30
 Total score = Sum of 8 subscales Range: 0 to
240
 Higher score = Higher impairment
 Various outcome indicators to determine
progress
© 2009 Functional Assessment Systems
35
The CASE of
Jamie Foster
Using the CAFAS with families to discuss
the youth’s needs and generate a
treatment plan.
Using the CAFAS with families to assess
progress (e.g. every 3 months).
© 2009 Functional Assessment Systems
36
Tracking Progress During Treatment CAFAS Subscale Scores
30
20
10
Intake
© 2009 Functional Assessment Systems
M
oo
ds
Ha
Su
rm
bs
fu
l
ta
nc
e
Us
e
Th
ink
in
g
Ho
m
e
Co
m
m
un
ity
Be
ha
vi o
r
Sc
ho
ol
/W
or
k
0
3 Months
37
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
School/Work
Role Performance
Home
Role Performance
Community
Role Performance
Behavior Toward
Others
Moods/
Emotions
Self-Harmful
Behavior
1
2
3*
4*
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
41
42
43*
44
45
46
47
48*
49
50
66
67
68*
69*
70
71*
72
88
89*
90*
91
92
116
117
118
119*
120
142*
143*
144*
145*
51
52
53
54*
55
56
73
74
75
76
77*
78*
79
121
122
123
124
125
126
127
146*
147*
148*
57
58
59
60
61
80
81
82
83
28
29
30
31
32
33
34
35
36
37
38
39
40
62
63
64
84
85
86
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
128
129
130
131
132
133
134
135
136
137
138
139
140
65
87
115
141
Substance Use
Thinking
154*
155*
156*
157*
158*
159*
160*
161*
162*
163*
164*
165
166
167
168
169
170
171
182*
183*
184*
185*
186*
149
150
172
173
174
175
193
194
195
196
197
151
152
176
177
178
179
180
198
199
153
181
200
187
188
189
190
191
192
Figure 1. CAFAS Profile comparing intake and 3 months evaluation for Jamie Foster (case example).
Intake scores are solid; 3 months score have dashes. Items with an asterisk denote risk behaviors.
© 2009 Functional Assessment Systems
38
CAFAS Total Score
Tracking Progress During Treatment CAFAS Total Score
120
110
100
90
80
70
60
50
40
30
20
10
0
Intake
© 2009 Functional Assessment Systems
3 Months
39
Parents Taught Us That
Valued Data Becomes Refrigerator Art
Celebrating with the CAFAS chart sustains hope!
© 2009 Functional Assessment Systems
40
Scales Assessing
the Caregiver
 Material Needs
 Family/Social Support
 Separate but identical scales for:
 Primary Family
 Non-custodial family or parent not living in the
home
 Surrogate Family
 NEW! Caregiver Skills Scales
© 2009 Functional Assessment Systems
41
The CAFAS Assessment
Report
Produced by the CAFAS Software
Handout: Jamie Foster Client Report
© 2009 Functional Assessment Systems
42
The Components of the
CAFAS Assessment Report
 Specific CAFAS items endorsed*
 Level of impairment on individual CAFAS
subscales*
 Overall level of dysfunction*
 Youth Risk Behaviors* (see next slide)
 Service Dependency Needs
 Summary of case (optional: clinician can insert)
 Bar graph comparing first and last CAFAS
 List of scores for all previous CAFAS
evaluations
* Documented on CAFAS form
© 2009 Functional Assessment Systems
43
Youth Risk Behaviors
 If any of the following specific CAFAS items are
endorsed, then potential risk to the youth or
others is present.
 Has made a serious suicide attempt or is considered to be
actively suicidal (119, 142-145) or possibly suicidal
(146-148)
 Has been or may be harmful to others or self due to:
o Aggression:
 at School (3,4)
 in the Community (68)
 at Home (43)
 in Behavior in general (89)
o Sexual Behavior (69, 77, 90)
o Fire Setting (71, 78)
 Runaway Behavior (48, 54)
 Psychotic or Organic symptoms in the context of severe
impairment (182-186)
 Severe Substance Use (154-164)
© 2009 Functional Assessment Systems
44
Developing A
Treatment Plan
Handout: Jamie Foster Treatment Plan
© 2009 Functional Assessment Systems
45
Strengths and Goals
 For each subscale, there is an accompanying
list of positive behaviors from which
strengths & goals can be selected. Examples
from School subscale:
 Strengths/Goals
• • Is permitted to attend school
• • Attends more days than not
• • Attends regularly
• • Is able to get assistance from an
adult at school when problems arise
© 2009 Functional Assessment Systems
46
Jamie’s Treatment Plan: School
Item #(s)
Problems
Goals
Description
019
Grade average is lower then “C” and is not due to lack
of ability or any physical disabilities
022
Non-compliant behavior results in teacher or immediate
supervisor bringing attention to problems or
structuring youth’s activities so as to avoid
predictable difficulties, more than other youth
G17
School grades are average or above
S03
Strengths S04
Attends regularly
Likes going to school
Plan
© 2009 Functional Assessment Systems
47
Clinical Interpretations of the
CAFAS Profile
 Assessing outcome as a dynamic
process which is client-centered,
rather than “pre-post” events which
are researcher/administratorcentered.
© 2009 Functional Assessment Systems
48
Examining the Youth’s Profile
1. Does the pattern of scores make sense?
Could the rating be incorrect?
Was sufficient information solicited?
2. What are the most impaired areas of functioning?
3. Are there high risk behaviors?
4. What are the areas of relative strength?
5. If there is unevenness across domains (i.e. ups and
downs in the profile), what is going on?
6. Is there “pervasiveness” (i.e. evenness across
subscales)? (generally a poor prognosis indicator)
© 2009 Functional Assessment Systems
49
Stump the Supervisor
© 2009 Functional Assessment Systems
50
Stump the Supervisor
Assume that you supervise a new
employee who has just done an intake
evaluation for a client. You begin the
supervision by reviewing the CAFAS
Profile. Look at each profile “at a
glance.”
What questions would you ask the supervisee, in order
to make sure that he or she has conducted a good
assessment?
What would be your priorities for the treatment plan
for each client?
© 2009 Functional Assessment Systems
51
© 2009 Functional Assessment Systems
Ho
me
Co
mm
un
ity
Be
ha
vi o
r
Mo
od
s
Ha
rm
ful
Su
bs
tan
ce
Th
ink
in g
Sc
ho
ol /
W
or
k
Case: Peter
30
20
10
0
Intake
52
CAFAS PROFILE: YOUTH’S FUNCTIONING
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
School/Work
1
2
3
4
5
6
7
8
9
10
11





12
13
14
15
16
17
18
19
20
21





22
23
24
25
26
27




28
29
30
31
32
33
34
35
36
37
38
39






40

Youth’s Name
Home
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
Community














62
63
64






65

66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83





Behavior
Toward
Others
88
89
90
91
92










93
94
95
96
97
98
99
100
101
102









103
104
105
106
107
108
109
110




84
85
86






111
112
113
114






87

115

Moods/
Emotions
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141





















Self-Harmful
Behavior
142
143
144
145
146
147
148
149
150
151
152
153





















Peter
ID#__________
Substance Use
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181





















Thinking
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
For each scale, mark the item number(s) which corresponds to those marked on the CAFAS form and fill in the circle indicating severity level. A profile is yielded by connecting the filled circles.
© 2009 Functional Assessment Systems
53





















© 2009 Functional Assessment Systems
Ho
me
Co
mm
un
ity
Be
ha
vi o
r
Mo
od
s
Ha
rm
ful
Su
bs
tan
ce
Th
ink
in g
Sc
ho
ol /
W
or
k
Case: Lisa
30
20
10
0
Intake
54
CAFAS PROFILE: YOUTH’S FUNCTIONING
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
School/Work
1
2
3
4
5
6
7
8
9
10
11





12
13
14
15
16
17
18
19
20
21





22
23
24
25
26
27




28
29
30
31
32
33
34
35
36
37
38
39






40

Youth’s Name
Home
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
Community














62
63
64






65

66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83





Behavior
Toward
Others
88
89
90
91
92










93
94
95
96
97
98
99
100
101
102









103
104
105
106
107
108
109
110




84
85
86






111
112
113
114






87

115

Moods/
Emotions
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141





















Self-Harmful
Behavior
142
143
144
145
146
147
148
149
150
151
152
153





















Lisa
ID#__________
Substance Use
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181





















Thinking
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
For each scale, mark the item number(s) which corresponds to those marked on the CAFAS form and fill in the circle indicating severity level. A profile is yielded by connecting the filled circles.
© 2009 Functional Assessment Systems
55





















Sc
ho
ol /
W
or
k
Ho
me
Co
mm
un
ity
Be
ha
vi o
r
Mo
od
s
Ha
rm
ful
Su
bs
tan
ce
Th
ink
in g
Case: Barry
30
20
10
0
Intake
© 2009 Functional Assessment Systems
56
CAFAS PROFILE: YOUTH’S FUNCTIONING
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
Role
Performance:
School/Work
1
2
3
4
5
6
7
8
9
10
11





12
13
14
15
16
17
18
19
20
21





22
23
24
25
26
27




28
29
30
31
32
33
34
35
36
37
38
39






40

Youth’s Name
Role
Performance:
Home
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61














62
63
64






65

Role
Performance:
Community
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83





Behavior
Toward Others
88
89
90
91
92










93
94
95
96
97
98
99
100
101
102









103
104
105
106
107
108
109
110




84
85
86






111
112
113
114






87

115

Moods/
Self-Harm:
Moods/
Emotions
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141





















Moods/
Self-Harm:
Self-Harmful
Behavior
142
143
144
145
146
147
148
149
150
151
152
153





















Barry
ID#__________
Substance Use
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181





















Thinking
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
For each scale, mark the item number(s) which corresponds to those marked on the CAFAS form and fill in the circle indicating severity level. A profile is yielded by connecting the filled circles.
© 2009 Functional Assessment Systems
57





















Sc
ho
ol /
W
or
k
Ho
me
Co
mm
un
ity
Be
ha
vi o
r
Mo
od
s
Ha
rm
ful
Su
bs
tan
ce
Th
ink
in g
Case: Jamie
30
20
10
0
Intake
© 2009 Functional Assessment Systems
58
Youth’s Name
CAFAS PROFILE: YOUTH’S FUNCTIONING
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
Role
Performance:
School/Work
1
2
3
4
5
6
7
8
9
10
11





12
13
14
15
16
17
18
19
20
21





22
23
24
25
26
27




28
29
30
31
32
33
34
35
36
37
38
39






40

Role
Performance:
Home
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61














62
63
64






65

Role
Performance:
Community
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83





Behavior
Toward Others
88
89
90
91
92










93
94
95
96
97
98
99
100
101
102









103
104
105
106
107
108
109
110




84
85
86






111
112
113
114






87

115

Moods/
Self-Harm:
Moods/
Emotions
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141





















Moods/
Self-Harm:
Self-Harmful
Behavior
142
143
144
145
146
147
148
149
150
151
152
153





















ID#__________
Jamie
Substance Use
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181





















Thinking
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
For each scale, mark the item number(s) which corresponds to those marked on the CAFAS form and fill in the circle indicating severity level. A profile is yielded by connecting the filled circles.
© 2009 Functional Assessment Systems
59





















Sc
ho
ol /
W
or
k
Ho
me
Co
mm
un
ity
Be
ha
vi o
r
Mo
od
s
Ha
rm
ful
Su
bs
tan
ce
Th
ink
in g
Case:Wanda
30
20
10
0
Intake
© 2009 Functional Assessment Systems
60
CAFAS PROFILE: YOUTH’S FUNCTIONING
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
Role Performance:
School/Work
1
2
3
4
5
6
7
8
9
10
11





12
13
14
15
16
17
18
19
20
21





22
23
24
25
26
27




28
29
30
31
32
33
34
35
36
37
38
39






40

Youth’s Name
Role Performance:
Home
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61














62
63
64






65

Role Performance:
Community
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83





Behavior
Toward Others
88
89
90
91
92










93
94
95
96
97
98
99
100
101
102









103
104
105
106
107
108
109
110




84
85
86






111
112
113
114






87

115

Moods/
Self-Harm:
Moods/
Emotions
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141





















Moods/
Self-Harm:
Self-Harmful
Behavior
142
143
144
145
146
147
148
149
150
151
152
153





















Wanda
ID#__________
Substance Use
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181





















Thinking
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
For each scale, mark the item number(s) which corresponds to those marked on the CAFAS form and fill in the circle indicating severity level. A profile is yielded by connecting the filled circles.
© 2009 Functional Assessment Systems
61





















Sc
ho
ol /
W
or
k
Ho
me
Co
mm
un
ity
Be
ha
vi o
r
Mo
od
s
Ha
rm
ful
Su
bs
tan
ce
Th
ink
in g
Case: Denny
30
20
10
0
Intake
© 2009 Functional Assessment Systems
62
Youth’s Name
CAFAS PROFILE: YOUTH’S FUNCTIONING
Level of
Impairment
SEVERE
30
MODERATE
20
MILD
10
MINIMAL/NO
0
COULD NOT
SCORE
Role
Performance:
School/Work
1
2
3
4
5
6
7
8
9
10
11





12
13
14
15
16
17
18
19
20
21





22
23
24
25
26
27




28
29
30
31
32
33
34
35
36
37
38
39






40

Role
Performance:
Home
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61














62
63
64






65

Role
Performance:
Community
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83





Behavior
Toward Others
88
89
90
91
92










93
94
95
96
97
98
99
100
101
102









103
104
105
106
107
108
109
110




84
85
86






111
112
113
114






87

115

Moods/
Self-Harm:
Moods/
Emotions
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141





















Moods/
Self-Harm:
Self-Harmful
Behavior
142
143
144
145
146
147
148
149
150
151
152
153





















ID#__________
Denny
Substance Use
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181





















Thinking
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
For each scale, mark the item number(s) which corresponds to those marked on the CAFAS form and fill in the circle indicating severity level. A profile is yielded by connecting the filled circles.
© 2009 Functional Assessment Systems
63





















Cultural Competence Issues
 It is important to be knowledgeable
about the youth’s/family’s culture.
 Try to understand the cultural context
of the behavior so you do not
misinterpret behavior.
 Seek opinions of persons knowledgeable
about the culture if in doubt.
 EX: The child’s verbalizations of some
religious beliefs may at first appear to be
hallucinations, but further inquiry reveals
that there are no faulty perceptions (“the
devil made me do bad things”).
© 2009 Functional Assessment Systems
64
 Try not to impose your own value judgments
that may be heavily influenced by your age,
sex, social class, or cultural background.
 EX: You should not rate a youth as more impaired
just because she is an unwed mother.
 Rate behaviors appearing in the CAFAS, even
if they are more common in some cultural
contexts (e.g. aggression).
 To add context and balance to understanding
the youth, you can make comments under
Exception or in the summary on the CAFAS
assessment report (e.g. aggressive only when
worried about the mother’s welfare). Be sure
to rate strengths.
 However, still rate the behavior! We want to
intervene on the youth’s behalf.
© 2009 Functional Assessment Systems
65
Why do Reliability Training?
 Reliability means different raters give the
same score when rating the same client.
 In order to detect client change from preto post-treatment, the scores must be
reliable (a “statistical fact”).
 All raters need to use the same rules.
Each of us has “individual error,” although
the type of error differs across individuals.
During training, we want to identify our
scoring errors and correct them.
© 2009 Functional Assessment Systems
66
Scoring Rules for each
Subscale
© 2009 Functional Assessment Systems
67
School/Work
Moods/Emotions
Home
Self-Harmful
Community
Behavior Toward
Others
© 2009 Functional Assessment Systems
Behavior
Substance Use
Thinking
68
CHART DEMONSTRATING IMPAIRMENT
Icon associated
with each subscale
appears here.
This column, containing
levels of impairment, is for
reference purposes only &
has been omitted from
subsequent charts.
Headings (bolded) are used to
help organize items into
concepts when there are multiple
items at an impairment level
30
Level of Impairment CAFAS Item
Severe Impairment
TEXT
20
Moderate Impairment
10
Mild Impairment
Scale scores are colorcoded & appear here.
© 2009 Functional Assessment Systems
CAFAS item descriptions
appear here.
Item
CAFAS item numbers
appear here.
69
SYMBOLS USED IN
PRESENTATIONS
EX
Example
Continuation
Purple Text
Terms defined later in presentation
N/A
Not applicable
/
Or
>
At least or more (equal to or more)
( )
Not explicitly mentioned in CAFAS item but is
in Instructions for Scoring in Manual
© 2009 Functional Assessment Systems
70
SCHOOL/WORK
Role Performance
Grades
Attendance
Behavior
Work
© 2009 Functional Assessment Systems
71
Expectations – School/Work
Grades
Attendance
Behavior
Work
Grade average is “C” or above average, or
Performs up to abilities
Attends school regularly
Not disruptive to group process!! Behaves in
a way that does not interfere with their own
or with others’ ability to learn or work
Can meet expectations without undue
supervision by others
Adheres to work schedules
Follows instructions & orders
Satisfactorily carries out assigned duties
© 2009 Functional Assessment Systems
72
Preamble – School
Question: How do you rate the youth
during the summer?
Answer: Rate the youth’s behavior for the
most recent time period when in school.
© 2009 Functional Assessment Systems
73
Grades
Item
30
Failing most of classes (E or F)
20
Average of “D” or lower
19
Failing at least half of classes
20
Not working up to ability (and caregivers
or others are concerned)
26
10
9
Do not rate if poor academic performance is solely due to:
Mental retardation or other serious, documented learning
problems
Sensory deficits. EX: hearing problems
Physical disability/impairment
Items on the No Impairment level allow you to document these
challenges
© 2009 Functional Assessment Systems
74
Preamble - Attendance
Unexcused absences due to any reason except physical illness,
religious or family holidays
Truancy: deliberately engaging in more pleasurable activities or
avoiding school when youth is capable of attending school
School Refusal: stays home to be with caregiver, could be due to:
Desire to be with parent figure
Fearfulness
Depression, anxiety, post-traumatic stress
Rate regardless of understandable justification:
EX: avoiding scene of trauma (youth was raped at school), kept home
to baby-sit
Remember: You are not blaming – you are saying services are
needed!
If kicked out of school, rate that item as well as the item that indicates
reason for it (e.g., aggressive threat). If behavior is not described by
an item, circle Exemption and write in reason under “Explanation.”
© 2009 Functional Assessment Systems
75
Attendance
30
Item
Refuses to attend (even if for “good” reason)
1
Asked to leave during rating period
1
2
Is expelled
20
Chronic truancy with consequences. EX: detention,
make-up class, loss of course credit, failing courses
or tests, note to parents
6
Chronic absences with consequences
7
Dropped out & no job or vocational training
10
Truant
14
10% = once every 2 weeks
Or, for several consecutive days
15
Absent (10% or several days)
10
N/A
© 2009 Functional Assessment Systems
76
Definitions for
Behavior Problems
Bad behavior in school (or on bus) & during the rating
period
Aggression refers to physical contact:
With another person in some way, either direct physical contact
or with an object [hit, bite, scratch, shove, throw object at the
person]
Which was done deliberately (not an accident)
With the intent to harm the other
Threat of aggressive behavior or “aggressive potential”
implies that:
Youth’s verbal or nonverbal behavior led another person to
believe that harm to another could happen.
A protective intervention was deemed important to prevent the
possibility of any harm (if witnessed).
© 2009 Functional Assessment Systems
77
Definitions for
Behavior Problems
Non-compliant behavior: refers to disobedience or not
following rules. EX: runs in hallways, refuses to raise
hand before speaking, brings forbidden objects to
school
Inappropriate behavior: refers to behavior for which
the school may not have specific rules but would
generally be known to be inappropriate. EX:
deliberately clogging toilets, “flipping off” teacher
Poor attention span & high activity level (i.e.,
hyperactivity):
Refers to behavioral descriptors, not a disorder, in CAFAS
Rate only if school reports as a problem
© 2009 Functional Assessment Systems
78
Behavior Problems
30
Item
Ejected from community school - “not want in the
building” because of behavior in rating period
Multiple suspensions due to behavior in rating
period
2
2
Judged to be threat due to aggressive potential
based on actions or statements
Monitoring or supervision needed
Harmed or made serious threat
3
3
4
5
8
Unable to meet minimum requirements
Still disruptive, even though in specialized
program/class
© 2009 Functional Assessment Systems
79
20
Behavior Problems
Item
Persistent or repeated disruption of group
functioning
Known to school authority figure due to chronicity
12,13
Known to authority figure due to severity of
problems (e.g., principal, disciplinarian)
Special program/classroom implemented
Special program/classroom needed or
recommended. EX: Referral for BD placement;
for ritalin by teacher because disruptive
© 2009 Functional Assessment Systems
12,13
12,13
17
17
80
Behavior Problems
10
Can be managed by classroom teacher
Teacher brings attention to problems.
EX: by verbal reprimands, negative
consequences (i.e., staying in during recess).
Teacher structures to prevent problems.
EX: youth’s desk next to the teacher
Occasionally disobeys rules & more than other
youths
Item
22,23
23,23
24
Problems present but not disruptive
25
© 2009 Functional Assessment Systems
81
Flow Chart for School Behavior
30
Kicked out?
Yes No In alternative school?
Yes No
In special program/classroom &
disruptive?
Yes No
20
Known to authority figure because of severity?
Yes No Known to authority figure because of chronicity?
Yes No
In special program/class?
Yes No
Special program/class
recommended?
Yes No
10
Classroom teacher identified youth as behavior problem?
Yes No
0
© 2009 Functional Assessment Systems
82
Work
30
20
10
Item
Asked to leave job
1
Does not show up at job
2
Harmed or made threat at work
4
Holds no job or not looking for a job, if not
in school/vocational training
10
Missed days or tardy, gets reprimand
16
Receives reprimand or warning for
unsatisfactory performance/behavior
18
Work productivity less than ability
26
© 2009 Functional Assessment Systems
83
Postscript: Rating School
When in a Residential Facility
Question: How do you rate youth in residential
care?
Answer: Do not give an “automatic 30” on the School
or Home scales.
In general,
Use same rules.
Rate public behavior.
Rate behavior during rating period.
Rate most severe behavior during the rating period.
Rate the youth’s behavior during school hours and while in a
group educational setting.
© 2009 Functional Assessment Systems
84
Rating School When in a
Residential Facility
Was the youth placed in the residential facility during the rating period?
No
Yes
Was the youth placed in the residential
facility in part due to “bad” behavior
occurring at school or on job?
See Next Slide
No
Yes
If placed for other
behavior (e.g.
suicidal), rate
behavior in school.
Often have problem
in school as well.
© 2009 Functional Assessment Systems
You can rate item # 001 & continue down
the column for Severe Impairment and
endorse items which reflect the behavior
that resulted in the youth’s placement out
of the school. If none of the items capture
the behavior, endorse the “Exception” item
and write a description of the behavior or
circumstances under “Explanation.”
85
If the Youth Was Not Placed in the
Residential Facility during the Rating Period
Is the youth currently mandated by school to be in an alternative school (i.e., not wanted in the
building) or is the youth expelled?
No
Yes
Score #002 and “Exception.” In Explanation,
note the mandate and perhaps comment on
youth’s likely behavior if mainstreamed.
Is school setting artificially constrained (unlike mainstream classroom)?
No
Evaluate
youth as
you
normally
would
Yes
Is the youth’s behavior impaired (compared to other youth in
mainstream classroom)?
No
Yes
Endorse items that apply. EX: If severe, #005, 008.
If moderate: #012, 013, 017
If the youth is well-behaved in the residential setting, evaluate the youth’s ability to cope in
a less restrictive setting so you can determine the appropriate rating. EX: Attend school off
the residential unit (e.g. in a classroom for youths with behavioral disorders in a local
public school). EX: Establish on-site special group school experience to test coping skills.
© 2009 Functional Assessment Systems
86
HOME
Role Performance
Safety: Person & Property
Compliance: Rules,
Routines, Chores
Non-Runaway Behavior
© 2009 Functional Assessment Systems
87
Expectations - Home
Safety: Person Behaves in a safe manner
& Property
Non-threatening, non-intimidating
Respectful of property in home (i.e.,
home, belongings of other household
members, yard, etc.)
Compliance: Follows household rules
Rules,
Follows expectations. EX: bedtime,
Routines,
curfew, completes chores
Chores
Non-Runaway Trustworthy regarding no runaway
Behavior
behavior
© 2009 Functional Assessment Systems
88
Preamble – Home
Rate the youth’s severest behavior during hours usually
spent in the home (i.e., 3:30 pm to 7:30 am or so)
during the rating period.
Rate behavior in any home or residential setting.
EX: If a youth’s behavior was very impaired while on home
visit (i.e. knocked a hole in the wall of the family’s
apartment) and very good in the residential unit, the youth’s
rating on the Home scale would reflect the destructive
episode at home if it occurred in the rating period.
“Household members” refer to other persons who share
the home or residential setting.
© 2009 Functional Assessment Systems
89
Safety in the Home: Person & Property
30
Item
Not in the home due to (bad) behavior that
occurred in the home in the rating period
41
Deliberate & serious threats of physical harm
Repeated acts of intimidation
43
Constant monitoring to ensure safety
Severe & deliberate property damage.
EX: Throws bat through china cabinet door
(rate property damage to any residences or
residential settings youth lives in)
© 2009 Functional Assessment Systems
44
46
49
90
Safety in the Home: Person & Property
20
10
Item
Repeated irresponsible behavior... potentially
dangerous, but safety of household members
not jeopardized. EX: use stove, not close
gate, leave house door open, bad practical
jokes on siblings
53
Deliberate damage to home, belongings or
yard. EX: Peels wallpaper out of bedroom
closet
55
N/A
© 2009 Functional Assessment Systems
91
Preamble - Compliance
Do not rate non-compliant behavior if parental
requests are abusive or illegal. EX: to steal, do
sex acts
Good Compliance: doing what you are asked to
do, when you are asked to do it, & with a
“decent” attitude
© 2009 Functional Assessment Systems
92
Notes on Terms Related to
Frequency
These descriptors are only relevant when referring to common,
undesirable behavioral problems (that are not rare, particularly
offensive or dangerous behaviors).
Persistent (often scored as a “20”)
“Typical” behavior is bad/unsatisfactory
Chronically
50% of the time or more
Could not “count” on good behavior in special circumstances
Frequently (often scored as “10”)
Less chronic than persistent
More often than other youths
Problem for others or notable inconvenience (but not dangerous or
very disruptive)
Occasionally (often scored as “0”)
© 2009 Functional Assessment Systems
93
Compliance: Rules, Routines, Chores
30
20
Item
Extensive management by others needed to be
maintained in the home
42
Behavior & activities beyond caregiver’s influence
almost all of the time
Supervision of youth required..interferes with
caregiver’s work/roles
45
Persistent failure to comply with rules/routines
EX: bedtime, curfew
Active defiance much of the time
If in residential facility, fails to comply unless close
monitoring
Frequent profanity, cursing at household members
51
© 2009 Functional Assessment Systems
47
51
51
52
94
Compliance: Rules, Routines, Chores
10
Item
Frequently fails to comply
57
Has to be “watched” or prodded to get compliance
Frequently “balks” or resists, but will comply if
caregiver insists
Frequently intentionally annoying. EX: taunting
siblings, purposeful dawdling
58
© 2009 Functional Assessment Systems
59
60
95
Runaway Behavior
30
20
Runaway from home overnight more than
once; whereabouts unknown
Item
48
Runaway once for extended time;
whereabouts unknown
48
Runaway overnight but likely whereabouts
54
known. EX: at a friend’s house
10
N/A
© 2009 Functional Assessment Systems
96
Postscript: Rating Home
When in Residential Facility
Use general scoring guidelines previously presented for this
in the School section.
Compare youth to behavior expected in a “regular” family
setting (in which rules, routines, and curfew are expected to
be followed, and non-threatening, non-intimidating, and
respectful behavior toward others is expected; close
monitoring or constant supervision is not present)
Typically, youths are not “angels” even when they have
improved. (They may seem like “angels” because they are
not as impaired as when they entered the program or as
impaired as other youth in the facility.)
© 2009 Functional Assessment Systems
97
Postscript: Rating “Home”
when in residential facility
Endorse any items that reflect the youth’s severest
functioning during the rating period in any setting during
“home” hours (e.g. 3 pm to 9 am).
Items on the home scale which mention out of home
placement:
At the Severe Level
Item #041: Not in the home due to (“bad”) behavior that
occurred in the home during the rating period.
At the Moderate Level
Item #051: (OR, if youth is not in the home, youth fails to
comply with reasonable rules and expectations unless close
monitoring/ supervision is maintained).
98
© 2009 Functional Assessment Systems
Postscript: Rating “Home” when
in residential facility
Maintaining youth in a residential facility, when he has no impairment in home, is
typically a “systems,” not a measurement issue.
EX: Youth has improved but the environment to which the youth will be discharged is
considered inadequate.
EX: Youth has apparently improved but the residential facility does not have a viable
mechanism for “stepping down” to less restrictive supervision (i.e., “to test” whether the
youth’s improved functioning can be maintained if the level of supervision or structure of
the facility were less).
Suggestions:
If the youth is well-behaved in the residential setting, evaluate the youth’s ability to cope in a
less restrictive setting. EX: Increase privileges and field trips off the unit, home visits, or
visits with a respite family
Establish objective criteria for the youth to make a home visit
Assess at admissions/intake any circumstances which may preclude either:
“testing” the youth’s ability to function in a less restrictive setting or
stepping down the youth to a less restrictive setting when he/she demonstrates an ability
to function well in a highly restrictive setting
At program entry, document circumstances, which may preclude trying less restrictive
setting so that referring/funding entity can begin to work on these issues
immediately.
© 2009 Functional Assessment Systems
99
COMMUNITY
Role Performance
Obeys Laws
Respects Property
Refrains from Particularly
Offensive Acts
© 2009 Functional Assessment Systems
100
Obeys Laws
Respects
Property
Expectations –
Community/Delinquency
Obeys laws, &, if on probation, conditions
of probation
Respects property of others or public
Property
Refrains from Refrains from:
Particularly
Physical aggression
Offensive
Sexual misconduct/mistrust
Acts
Fire-setting (anywhere – even in the home)
© 2009 Functional Assessment Systems
101
&
for Community
Do not endorse if:
Youth’s sole involvement was as a victim
Act was accidental
Youth was just playing or “kidding around” (no
intent to harm)
Youth was truly acting in self-defense (ignore
unconvincing claims)
© 2009 Functional Assessment Systems
102
&
for Community
Do endorse if:
Youth gets into legal trouble
There is good-faith reason to believe youth engages in
delinquent behavior, based on reports by youth, caregiver
or other adult informants
EX: Caregiver convinced that youth is shoplifting based on goods in
the youth’s room that were not purchased & no believable
explanation is given.
EX: Caregiver reports that the youth’s friends were “caught” for an
offense. The youth appears to have been involved but not
“caught.”
Uncomfortable with “good-faith” rule?
Endorse item & “Exception,” citing unconfirmed suspicion
under “Explanation.”
© 2009 Functional Assessment Systems
103
Preamble – Community
Question: Is legal involvement required? If
not, why not?
Answer: No. Rationale:
Most acts are covert & undetected
Charges are often not pressed for a variety of reasons
Youth’s association with delinquent youths puts the
youth at great risk for delinquency
Treatment will be different for youths who are at-risk
for delinquent behavior. EX: parental monitoring
Treatment of co-occurring problems (e.g.,
depression) typically does not reduce delinquency
© 2009 Functional Assessment Systems
104
Obeys Laws
30
20
10
Confined for serious violation
Convicted of serious violation
Substantial evidence of serious violation
(Violation of probation conditions – flagrant
disregard for the law)
Serious (but milder) delinquent behavior
Repeated delinquent behavior (>1 time)
On probation/court supervision (offense < 3 mo)
Probation/court supervision (offense > 3 mo)
At risk of confinement for frequent or serious
violations (warn consequences “next time”)
Minor legal violations
Single incidents of milder delinquent behavior
© 2009 Functional Assessment Systems
Item
66
67
67
67
73
73
74
75
76
80
81
105
Definitions for Obeys Laws
Serious violation
Stealing involving confrontation with victim
Robbery
Purse Snatching
Dealing/carrying drugs
Rape
Drive-by shooting
Violation of probation condition
Auto theft
Mugging
Fraud
Break-ins
Murder
Prostitution
(Milder) Delinquent behavior
Stealing without confronting a victim
Shoplifting
Vandalism
Defacing property
Taking a car for a joy ride (without permission, short time period & plan to
return)
Minor legal violations
Minor legal violations
Unruly conduct such that complaint was made
Harassing neighbor
© 2009 Functional Assessment Systems
Trespassing onto neighbor’s
property
106
Respects Property
Item
30
Deliberate & severe damage outside home
(include household, if reported to police)
70
20
Serious or repeated defacing property
73
Serious or repeated vandalism
73
Trespass onto neighbor’s property
80
Single incident of defacing property
81
Single incident of vandalism
81
10
© 2009 Functional Assessment Systems
107
&
for Fighting &
Sexual “Misconduct”
To ensure that only more serious offenses are scored
at the SEVERE level of the Community scale,
legal involvement (e.g., police were told) or
deliberate diversion to mental health or social
service is required (as can happen for affluent)
Rationale: Research on discrimination
© 2009 Functional Assessment Systems
108
Physical Aggression
30
Involvement with legal system or diversion
to mental health/social service due to
physically assaultive behavior or
threatening with a weapon (include
toward household members, if reported to
police)
20
N/A
10
N/A
© 2009 Functional Assessment Systems
Item
68
Aggression refers to physical contact with
another person in some way, either direct
physical contact or with an object (i.e.,
hit, bite, scratch, shove, throw object at
the person).
Which was done deliberately (not an
accident)
With the intent to harm the other
A protective intervention was deemed
important (if observed)
109
Definitions for Sexual
Misconduct
Sexual assault or abuse refers to having attempted to, or
actually accomplished, a sexual act:
By making sexual contact with another person (i.e., interact with another
person by touching sexual parts of the body or by placing the penis,
fingers or another object into the orifice of the other, such as vagina,
anus or mouth), AND
By coercion (i.e., through physical force, intimidation or verbal threats
or by persuasion by an older youth in which the older youth exploits
the naiveté of the younger youth)
Inappropriate sexual behavior refers to sexual behavior which
violates social norms & is displayed publicly or is directed
toward another person. EX: exposing oneself in front of
others).
Do not score if the youth was solely a victim.
110
© 2009 Functional Assessment Systems
Sexual Misconduct/Mistrust
Item
30
Involvement with legal system or diversion
to mental health/social service due to
sexually assaultive behavior or
inappropriate sexual behavior
69
20
Sexually inappropriate such that adults
have concern about welfare of other
children who may be around the youth
unsupervised
77
10
N/A
© 2009 Functional Assessment Systems
111
&
for Fire-setting
Scored on Community even if it happens at
Home – Rationale: behavior has potentially
serious implications for community.
Before being scored under “Community” for
playing with fire, child needs to have been
“educated” about danger of fire (e.g., after
playing with matches, etc.)
© 2009 Functional Assessment Systems
112
Fire-setting Behavior
Item
30
Deliberate fire-setting with malicious intent
71
20
Repeatedly (>1) & intentionally plays with
fire such that damage to property or
person could result
78
10
Plays with fire (& child is aware of the
dangers)
82
© 2009 Functional Assessment Systems
113
BEHAVIOR
TOWARD OTHERS
Free of Unusually
Offensive Behaviors
Interactions Free of Negative,
Troublesome Behaviors
Judgment
© 2009 Functional Assessment Systems
114
Expectations – Behavior
Toward Others
Free of
Unusually
Offensive
Behaviors
Interactions
Free of
Negative,
Troublesome
Behaviors
Judgment
Behaves in a safe manner around others.
Able to interact with people & animals
without making them feel uncomfortable.
Has age-appropriate skills for interacting
with others
Judgment does not jeopardize the welfare of
others or unreasonably inconvenience them
© 2009 Functional Assessment Systems
115
&
for Behavior
Towards Others
Reflects on youth’s patterns of behavior in social or
interpersonal interactions
Do rate behavior toward
Peers (other youths)
Caregivers
Other adults or persons in the community
Siblings if behavior is emotionally abusive or dangerous (do
not rate typical sibling arguing)
Animals if cruel to animals (sport hunting is not defined as
animal cruelty)
Question: Why include behavior toward caregivers?
Answer: If youth has to be placed in foster care,
probably the best predictor of behavior, at least initially.
© 2009 Functional Assessment Systems
116
&
for Behavior
Towards Others
Question: Do I rate behavior that may have been
already scored on the School, Home or
Community subscales?
Answer: This can happen, specifically for particularly
offensive, “strong” behaviors, such as physical or
sexually aggressive or highly inappropriate behavior.
Rationale: Concern by others generalizes to settings
other than where the behavior originally took place. If
a youth is sexually assaultive at school, others are
concerned about youth’s behavior in other settings.
© 2009 Functional Assessment Systems
117
Unusually Offensive Behaviors
30
Item
Bizarre behavior
Consistently bizarre or extremely odd. EX: growls, barks &
gnashes teeth at other students or schizoaffective type
interactions, such as others avoid because of unpredictable
accusations
88
Aggressive behavior
So disruptive or dangerous that harm to others is likely (i.e.,
hurts or tries to hurt others, such as hitting, biting, throwing
things at others, using or threatening to use a weapon or
dangerous object)
89
Sexual behavior
Attempted or accomplished sexual assault or abuse of another
person (i.e., used force, verbal threats, or, toward younger
youths, intimidation or persuasion)
90
Cruelty/meanness
Deliberately & severely cruel to animals
© 2009 Functional Assessment Systems
91
118
Unusually Offensive Behaviors
20
10
Item
Aggressive behavior
Behavior frequently & typically inappropriate & causes
problems for self or others. EX: “fighting”
Sexual behavior
Inappropriate sexual behavior in the presence of others or
directed toward others. EX: 10-year-old calls out to
passersby that she will do a specific sex act for a candy
bar.
Cruelty/meanness
Frequently mean to other people or animals
93
94
98
N/A
© 2009 Functional Assessment Systems
119
Negative, Troublesome Behaviors
30
N/A
20
Defiant
Behavior frequently & typically inappropriate & causes
problems for self or others. EX: belligerence, promiscuity
Hostile
Characterized by hostile interactions/intentions (hostile =
like an enemy)
Item
93
95
Spiteful: purposefully annoying
Vindictive: feels revengeful, wants to get even with another for a
perceived wrong. EX: deliberately & persistently annoying to others,
intentionally damaging personal belongings of others
Anger
Frequent display of anger toward others; angry outbursts
© 2009 Functional Assessment Systems
97
120
Negative, Troublesome Behaviors
20
10
Picks on/Uses others
Predominantly relates to others in an exploitive or
manipulative manner. EX: uses/cons others
Involved in gang-like activities in which others are harassed,
bullied, intimidated, etc.
Persistent problems/difficulties in relating to peers due to
antagonizing behaviors. EX: threatens, shoves
Youth is difficult
Unusually quarrelsome, argumentative or annoying to others
Upset (e.g., temper tantrum) if cannot have or do something
immediately, if frustrated, or if criticized.
Quick-tempered, easily annoyed by others & responds more
strongly than other children
© 2009 Functional Assessment Systems
Item
99
100
101
103
105
106
121
Negative, Troublesome Behaviors
10
Problems specifically with peers
Tends to be ignored or rejected: does not engage in typical
peer recreational activities as a result. EX: bullied
Irritates peers: difficulties in peer interactions or in making
friends due to negative behavior. EX: teasing, ridiculing,
picking on others
Predominantly younger friends: immature behavior leads to
poor relations with same-age peers or to having friends
who are predominantly younger
© 2009 Functional Assessment Systems
Item
107
108
109
122
Poor Judgment
Item
30
N/A
20
Poor judgment or impulsive behavior results in
dangerous or risky activities that could lead to injury
or getting into trouble more than other youths (from
the same cultural group). EX: dangerous practical
“jokes” (e.g., joking with power tools in shop class)
showing off” to the point of being dangerous (e.g.,
throwing firecrackers onto a picnic blanket),
encouraging another youth to engage in risk-taking
(e.g., spin self in a clothes dryer)
96
10
Poor judgment or impulsive behavior is inappropriate,
given his/her age, & results in inconvenience to
others. EX: hiding brother’s lunchbox
104
© 2009 Functional Assessment Systems
INTENT OF ITEMS: To rate
Poor Judgment that can
negatively impact on others!
123
126
MOODS/EMOTIONS
Depression
Anxiety
Mood-Related Reactions to
Abuse or Other Trauma
Non-Bizarre Emotional
Reactions
© 2009 Functional Assessment Systems
124
Expectations – Moods/Emotions
Depression
Depression, sadness, moodiness or irritability
may be experienced but are managed so as to
prevent extended negative impact
Anxiety
Anxiety, worries, fears, tenseness or panic
feelings may be experienced but are
managed so as to prevent extended negative
impact
Mood-Related
Youth displays a full range of emotions that
Reactions to Abuse
correspond in expression & intensity to
or Other Trauma
experienced situations.
Avoidance does not interfere with life tasks
Non-Bizarre
Emotional
Reactions
© 2009 Functional Assessment Systems
Others do not experience youth as having
bizarre moods
125
&
for Moods/Emotions
Do not endorse for anger or hostility
Anger is reflected in behaviors rated on other
subscales
Reserve this scale for “internalizing” problems
Alerts clinician to need for specific treatments
© 2009 Functional Assessment Systems
126
Preamble – Depression
Moods are assessed by areas disrupted. Should be a
change in:
Sleep – trouble falling asleep or staying asleep, early awakening,
sleeping too much
Eating – decreased appetite, significant weight loss or gain (5% in
one month)
Energy level (primarily fatigue)
Difficulty concentrating
Normal activities – diminished interest or pleasure in
activities
Change could have occurred prior to rating time period.
EX: Parents report that son “hasn’t been himself”
since his grandfather died last year.
© 2009 Functional Assessment Systems
127
Definitions for Depression
Anhedonia: marked diminished interest or
pleasure in typical activities
Irritability: easily annoyed
Suicide intent: has genuine desire to die
Suicide lethality: the likelihood that the means of
attempting suicide will result in death
© 2009 Functional Assessment Systems
128
Preamble – Depression
Question: Is sadness required?
Answer: NO. Irritability or anhedonia can substitute for
sadness.
If irritability or anhedonia is substituted for
depression, disturbance in two areas is needed
(from previous slide).
Rationale: More signs of depression are needed
because irritability can accompany other
problems. For example, delinquents can be
irritable if their actions are blocked.
© 2009 Functional Assessment Systems
129
Depression, Sadness
30
Item
Depressed with academic incapacitation = absent
> 1 day/week on average
Depression with academic incapacitation = not
doing (any) schoolwork. EX: “stares” at
schoolwork
Depression with social incapacitation = isolates
self from friends. EX: no longer wants to play,
talk on phone or visit with friends
118
Depression with suicidal intent (regardless of
lethality)
119
© 2009 Functional Assessment Systems
118
118
130
Depression, Sadness
20
Depression is persistent (i.e., half the time) with
difficulty in 1 or more:
Item
122
Sleep problems
Eating problems
Difficulties concentrating
Energy level
Normal activities = anhedonia
Irritability or anhedonia with 2 or more:
122
Sleep problems
Eating problems
Difficulties concentrating
Energy level
Normal activities = anhedonia (if irritability only)
© 2009 Functional Assessment Systems
131
Depression, Sadness
10
Item
Often sad, with related symptoms.
EX: nightmares, stomachaches
Disproportionate irritability (no apparent reason)
128
Very self-critical, low self-esteem, feelings of
worthlessness
Sad or hurt if criticized
Sad, depressed or anhedonic in one setting for few
days at a time
130
© 2009 Functional Assessment Systems
129
132
133
132
Preamble – Anxiety
Anxiety typically seen in children
Generalized anxiety/overanxious
Separation anxiety/school refusal
“The List” for anxiety
Sleep problems
Tiredness
Difficulty concentrating
Irritability
Muscle tension (resulting in fatigue)
Feeling on edge, hypervigilant, exaggerated startled
response (“dark alley” effect) (not same as hyperactive)
133
136
© 2009 Functional Assessment Systems
Anxiety, Fear, Worry, Panic, Tenseness
30
20
Item
Fears, worries, anxieties with academic
incapacitation = absent > 1 day/week on
average
Fears, worries, anxieties with marked social
withdrawal. EX: will not leave home to visit
friends
117
Worries persistent & excessive, with 1 or more:
123
117
Sleep problems
Tiredness
Difficulty concentrating
Irritability
Muscle tension
Feeling on edge
© 2009 Functional Assessment Systems
134
20
10
Anxiety, Fear, Worry, Panic, Tenseness
Item
Fears, worries or anxieties result in expressed
distraught when away from home or parent
figures
Worries or anxieties result in special
accommodations (requests). EX: sleeping near
parents; calling home from school
124
Often anxious, fearful, with related symptom. EX:
nightmares, stomachache
Disproportionate fears or worries
Easily distressed if makes mistakes
Anxious if criticized
Anxious in one setting for a few days at a time
128
© 2009 Functional Assessment Systems
125
129
131
132
133
135
Flow Chart for Depression/Anxiety
30
Academic or social incapacitation?
Yes No
20
Depression or anxiety with “vegetative” disturbance (“The
List”) or expressed distraught (if separation anxiety)?
Yes No
10
Is the youth having more than a “bad day,” as evidenced by
the emotional states being:
Disproportionate
Easily evoked
Remain present for several days (but not longer)
Accompanied by symptoms (such as stomachaches, nightmares)
Yes No
0
© 2009 Functional Assessment Systems
136
Mood-Related Reactions to
Abuse or Other Trauma
Item
30
(Extensive avoidance, secondary to traumatic
reactions, resulting in avoiding school or social
settings)
20
Emotional blunting = no or few signs of emotional
expression; emotional expression is markedly flat
(Rate only if exposed to traumatic event &
caregiver reports)
126
10
Notable emotional restriction = has difficulty
expressing strong emotions such as fear, hate, love
(Rate only if exposed to traumatic event &
caregiver reports)
134
© 2009 Functional Assessment Systems
(117)
137
Bizarre Emotional Reactions
30
Viewed as odd or strange because emotional
responses are incongruous (unreasonable,
excessive) most of the time
Item
116
EX: laughs oddly when discussing sad issues (as may
be seen in psychosis, schizotypal, pervasive
developmental disorder)
EX 2: has no “mood” that others can relate to (is seen
in autism)
20
Marked changes in moods that are generally intense
& abrupt (should be abnormal variability)
121
Intended to capture relatively extreme affective
instability related to anxiety & depression – not anger)
EX: parents describe daughter as “laughing one minute
& crying the next”
10
N/A
© 2009 Functional Assessment Systems
138
SELF-HARMFUL
BEHAVIOR
No Self-Harmful Behavior
© 2009 Functional Assessment Systems
139
Expectations – Self-Harmful
No SelfHarmful
Behavior
Youth is free from desires & attempts to
hurt him/herself
Youth can cope without resorting to selfharmful behavior or verbalization
© 2009 Functional Assessment Systems
140
&
for Self-Harmful
May or may not be related to diagnosis of depression
Do not rate acts
Done while kidding around
That were genuinely accidental
Done because youth likes thrill-seeking or risk-taking
activities EX: ride motorcycle without helmet
Done because youth likes engaging in non-conventional
behaviors. EX: tattoos
© 2009 Functional Assessment Systems
141
&
for Self-Harmful
Do rate on this scale if behaviors are in the context of:
Depression
Hopelessness
Wanting to hurt oneself
Wanting to die
Genuine ambivalence about living
Impulsive suicidal behavior that could be lethal
Do rate if behavior is extremely dangerous & psychiatric
hospitalization for it is typical. EX:
Head-banging as sometimes seen in autism or with organicity
Psychotic confusion
Severe anorexia
Dangerous behavior as seen in organicity (e.g., not realize
danger due to effects of trauma, neurological disorder)
© 2009 Functional Assessment Systems
142
Preamble – Self-Harmful
Behavior
Suicide intent: genuine desire to die
Suicide lethality: refers to likelihood that the means
of attempting suicide will result in death
Judging suicidal risk involves clinical judgment in
real-life. Conservative approach would result in
rating severe if cannot confirm non-intentionality.
“Cutting” behavior can be rated at moderate level if
treatment plan has established that acute
hospitalization is not advised (sometimes
associated with borderline personality disorder)
© 2009 Functional Assessment Systems
143
Self-Harmful Behavior
30
Non-accidental self-destructive behavior – potential for
or did self-injury
Item
142
EX: Suicide attempt with intent to die
EX: Self-starvation – severe anorexia
EX: Persistent head-banging
Seemingly non-intentional self-destructive behavior –
potential for or did self-injury & youth aware of the
danger (for younger or inarticulate youth making
suicidal attempts; may use unsophisticated/
incompetent methods)
143
EX: Opens car door in moving vehicle
EX: Runs out in the path of a car if street smart
Has a clear plan to hurt self
144
Has a genuine desire to die (suicidal intent, regardless
of whether an attempt was made & regardless of
lethality of method)
144
© 2009 Functional Assessment Systems
144
Self-Harmful Behavior
20
Non-accidental self-harm, mutilation or injury which is
non-life-threatening & non-trival
Item
146
EX: suicidal gestures without intent to die
EX: “cutting” behavior seen in borderline personality
10
Talks about harming self, killing self or wanting to die
147
Thinks about harming self, killing self or wanting to
die
147
Repeated non-accidental behavior suggesting selfharm, yet behavior very unlikely to cause any serious
injury
149
EX: repeatedly pinching self
EX: scratching skin with a dull object
© 2009 Functional Assessment Systems
145
SUBSTANCE USE
No Negative Effects or
Risk-Taking
Frequency/Amount
of Usage
© 2009 Functional Assessment Systems
146
Expectations – Substance Use
No Negative
Effects or
Risk-Taking
Does not engage in substance use that is
maladaptive, inappropriate &/or
disruptive to normal functioning
Frequency/
Amount of
Usage
No usage or only occasional use with no
negative consequences (i.e., no
intoxication or getting high)
© 2009 Functional Assessment Systems
147
&
for Substance Use
Do not rate:
Sanctioned religious or cultural use (e.g., it’s okay for an alter boy to have
wine at communion – but it’s not okay for him to sneak drinks of
communion wine after church)
Tobacco use on this scale (rationale: not a mind-altering drug in the same
way other substances are). You can rate it on other scales (i.e., School,
Home, Community, etc.)
Do rate use of:
Alcohol
Street drugs
Inhalants (gasoline, glue, paint thinners, spray paints)
Misuse of prescription drugs
Misuse of over-the-counter drugs
© 2009 Functional Assessment Systems
148
Preamble – Substance Use
Drug use is illegal & typically covert.
Rate suspected use or if friends change to users.
If you feel uncomfortable doing this, endorse item &
write “suspected because…” under “Exception.”
Rationale: Treatment is different if co-occurring
substance use is present.
Scale is arranged such that youths who are 12 years
or younger have lower thresholds to qualify as
impaired [see --------- line].
© 2009 Functional Assessment Systems
149
Definitions for Substance Use
Intoxication: signs shortly after alcohol use:
slurred speech, lack of coordination, unsteady
gait, impairment in attention or memory,
impaired judgment, inappropriate mood lability
High: assume all non-alcoholic drug usage results
in getting high [unless believable circumstances]
© 2009 Functional Assessment Systems
150
Negative Effects & Risk-Taking
30
Dominates life
Item
154
Lifestyle centers on acquisition & use
EX: preoccupied with thoughts or urges to use substances
EX: arranges schedule around making contacts
EX: cravings for substances
EX: uses in the morning
Dependent on continuing use to maintain functioning
(i.e., likely to experience withdrawal symptoms such as
feeling sick, headaches, nausea, vomiting, shaking)
(Usage suggests drinking is out of control, has no
“social” function)
Has blackouts
Drinks alone
Cannot stop drinking once start (drinks for drunkenness)
© 2009 Functional Assessment Systems
155
162
162
162
151
Negative Effects & Risk-Taking
30
Serious negative consequences related to usage
School: failing or expelled
School: failing classes
Work: fired or losing job
Crimes: doing illegal activity while under influence of
substance (or DWI or legal trouble for substance use)
Health-related: Injured
Health-related: In accident
Physical health problems (includes any inhalant use)
Victimized. EX: raped
Potential serious consequences to offspring
Is pregnant or is a parent & is a drug user
Is pregnant or is a parent & gets drunk or routinely uses
alcohol
© 2009 Functional Assessment Systems
Item
156
156
157
159
159
159
159
*159
160
161
152
30
20
Negative Effects & Risk-Taking
Item
Any use of “hard” drugs, such as crack, cocaine, PCP,
opioids/narcotics (e.g., heroine, oxycodone, or other
misused prescription narcotics), during rating period
qualify for “30” score
Pattern of use likely impairs functioning
Uses in such a way as to interfere with functioning in spite of
potential serious consequences
*EXC
Traffic violations
School
Absences
Tardy (misses some classes)
Uses on school days
Misses out on school or social activities
Work
Absences
Tardy
Uses on work days
(Uses evening before; uses before work)
*Could be scored as “Exception”
© 2009 Functional Assessment Systems
165
165
165
165
165
165
165
165
165
165
165
153
Negative Effects & Risk-Taking
20
(More “generic” troubles which appear to have increased
when usage started or increased)
Getting into trouble is related to usage
166
EX: Argues
EX: Fights with family or friends
EX: Trouble with teachers
EX: Trouble with police
EX: Breaks rules
166
166
166
166
166
EX: Misses curfew
166
Potential victimization
Behavior potentially endangering self or others is related to
usage (e.g., vulnerable to injury or date rape)
Friendships
Friendships change to mostly substance users
10
Item
167
168
N/A
© 2009 Functional Assessment Systems
154
Frequency/Amount of Use
30
20
10
Item
Frequently intoxicated or high > 2 times/week
158
For 12 years or younger, uses regularly (once a week or
more)
163
High or intoxicated once or twice a week (if assume all
non-alcohol drugs result in being high, then includes
marijuana use 1/wk)
169
For 12 years or younger, occasional use without
intoxication & without becoming obviously high
170
Regular usage (e.g., once a week) but without intoxication
or being obviously high
173
Infrequent excess & only without serious consequences
172
For 12 years or younger, has used substances more than
once
174
© 2009 Functional Assessment Systems
155
THINKING
Communications
Perceptions
Cognitions
Orientation & Memory
© 2009 Functional Assessment Systems
156
Expectations - Thinking
Communications Communications are logical & coherent
Perceptions
Perceptions (i.e., what you see, hear,
feel, smell, taste) are based in reality
Cognitions
Cognitions (thinking) are based in
reality
Orientation &
Memory
Level of awareness & memory are not
grossly impaired for age
© 2009 Functional Assessment Systems
157
Preamble – Thinking
Infer thinking from communications
Intent is to identify youths with relatively severe
thinking problems which:
Interfere with functioning, and
Are thought to “predict” poor functioning as an adult
These youths require special treatment, often
psychiatric consultation
For each severity level in this scale, the youth must
meet criteria for degree of impairment & for type
of behavior
© 2009 Functional Assessment Systems
158
Thinking: Impairment Requirements
(Necessary but not sufficient)
30
All three required:
Cannot attend a normal school classroom
Does not have normal friendships, and
Cannot interact adequately in the community [EX: not able to
buy candy bar] due to any of the following:
20
Frequent difficulty in communication or behavior, OR
Specialized setting or supervision needed
10
Occasional difficulty in communications, in behavior, or
In interactions with others due to any of the following:
© 2009 Functional Assessment Systems
159
Preamble – Thinking
Why types of disorders may be associated
with the behaviors rated on the subscale?
Which functions may be impaired?
Disorder
(Always refer to youth’s behavior, not diagnosis)
Autism
Communication & use of language, orientation
Schizophrenia
Communication (incoherent, disorganized),
Perceptions (hallucinations),
Cognitive (delusions)
Orientation
Brief Psychotic
Disorder
Communication, Perceptions, Cognitions
© 2009 Functional Assessment Systems
160
Disorder
Which functions may be impaired?
Schizophreniform
Communication, Perceptions, Cognitions
Schizoaffective
Perceptions (hallucinations), Cognitions (delusions)
Schizotypical
Communication (vague, circumstantial),
Perceptions (e.g,. bodily illusions)
Cognitions (e.g., suspiciousness, odd beliefs, odd
preoccupations or fantasies)
Manic Episode
Communication (i.e., flight of ideas)
Mood – congruent delusions or hallucinations (e.g.,
inflated worth, power, knowledge or special
relationship to famous person)
Anorexia
Cognitions: Body dysmorphic – person sees self as
overweight even when he or she are not; an
exaggeration of sense of self
161
Preoccupied with thoughts of food
© 2009 Functional Assessment Systems
Disorder
Which functions may be impaired?
ObsessiveCognitions (obsessions, compulsions)
Compulsive Disorder
Post-Traumatic
Stress Disorder
Cognitions (e.g., recurrent & intrusive distressing
recollections)
Perceptions (hallucinations, dissociative flashback)
Psychotic Disorder
Due to Medical
Condition
Perceptions, Cognitions (due to neurological, endocrine,
metabolic disorders, etc.)
Dementia Due to
Serious Medical
Condition
Memory impairment (e.g., due to head trauma)
© 2009 Functional Assessment Systems
162
Definitions for Unusual
Communications
Echolalia: repeating words of others in a meaningless fashion
Flight of Ideas: a nearly continuous flow of accelerated speech
with changes from topic to topic
Incoherence: lack of logical or meaningful connection between
words, phrases, sentences
excessive use of incomplete sentences
excessive irrelevancies or abrupt changes in subject matter
idiosyncratic word usage
Loosening of associations: characterized by ideas that shift
from one subject to another. An idea is unrelated or only
obliquely related to the first, without the speaker showing any
awareness that the topics are unconnected.
Source: DSM-IV
© 2009 Functional Assessment Systems
163
Odd Communications
30
Item
Communications which are impossible or
extremely difficult to understand due to
incoherent thought or language (loosening of
associations, flight of ideas)
Speech or nonverbal behavior is extremely odd &
is non-communicative (echolalia, idiosyncratic
language).
182
20
Communications do not “flow,” are irrelevant, or
disorganized (i.e., more than other children of
the same age).
187
10
Eccentric or odd speech (e.g., impoverished,
digressive, vague)
193
© 2009 Functional Assessment Systems
183
164
Definitions for Faulty
Sensory Perceptions
Hallucinations: sensory perceptions that occur without external
stimulation of the relevant sensory organ
Experience of hearing or seeing things which are not there
“Non-pathological” hallucinations = unlikely to have bad
“course” in future. Includes unusual sensory experiences such
as seeing things before falling asleep or upon awakening from
sleep
Do not rate if hallucinations are:
Clearly the acute physiological effects of substance ingestion
Due to physical illness
Related to religious or cultural beliefs (e.g. common belief of
family is to be “looked after” by deceased relatives)
During sleep (i.e., dreaming)
© 2009 Functional Assessment Systems
165
Definitions for Thinking Problems:
Faulty Sensory Perceptions
Other problems related to faulty perceptions
Depersonalization: an alteration in the perception or experience
of oneself so that one feels as if one is an outside observer of
oneself (e.g., feels like one is in a dream)
Derealization: an alteration in the perception or experience of
the external world so that it seems strange or unusual (e.g.,
people seem mechanical)
Dissociation: disruption in the usually integrated functions of
consciousness, memory, identity or perception of
environment.
Source: DSM-IV
© 2009 Functional Assessment Systems
166
Faulty Sensory Perceptions
Item
30
Strange or bizarre behavior due to frequent &/or
disruptive hallucinations; can’t distinguish
fantasy from reality
184
20
Intermittent hallucinations that interfere with
normal functioning
189
10
Unusual perceptual experiences that are not
pathological hallucinations. EX: sees wolves
before going to sleep but knows are not real
196
© 2009 Functional Assessment Systems
167
Definitions for Faulty Cognitions
Do not endorse unless cognitions are “out of touch”
with reality – bizarre, strange or very odd
Delusions: false personal beliefs based on incorrect
conclusions about external reality.
Firmly held in spite of what almost everyone else believes &
in spite of what appears to be obvious proof to the
contrary.
The belief is not one ordinarily accepted by other members
of the youth’s culture or subculture (e.g., it is not an article
of religious faith).
Source: DSM-IV
© 2009 Functional Assessment Systems
168
Definitions for Faulty Cognitions
Obsessions: recurrent & persistent ideas, thoughts, impulses or
images that are:
Experienced, at least initially, as intrusive & senseless. EX: having
repeated impulses to kill a loved one; a religious person having
recurrent blasphemous thoughts
The person attempts to ignore or suppress such thoughts or impulses or
to neutralize them with some other thought or action.
The person recognizes that the obsessions are the product of his or her
own mind
Cause marked distress, are time-consuming (take more than an hour a
day)
Compulsions: repetitive behaviors (e.g., hand washing) or
mental acts (e.g., repeating words) that person feels driven to
perform in response to an obsession.
Source: DSM-IV
© 2009 Functional Assessment Systems
169
Definitions for Thinking Problems:
Faulty Cognitions
Suspicions: a distortion of reality, unfounded given the youth’s
current circumstances, or the youth shows a consistent bias of
being suspicious that negatively affect relationships.
Magical Thinking: the belief that thoughts, words or actions
can cause or prevent an outcome in some way that defies the
normal laws of cause & effect.
Source: DSM-IV
© 2009 Functional Assessment Systems
170
Faulty Cognitions
Item
30
Strange or bizarre behavior (talk) due to frequent
and/or disruptive delusions
20
Frequent distortion of thinking (obsessions,
188
suspicions). EX: schizotypical suspiciousness,
bizarre fantasies
Preoccupying cognitions or fantasies with bizarre,
191
odd or gross themes. EX: spends majority of
time isolated & writing stories or drawing
pictures of aliens killing teachers
Thought distortions (e.g., obsessions, suspicions)
194
Expression of odd beliefs or, if older than eight
195
years old, magical thinking. EX: 10-year-old
believes he killed his aunt because he’d said that
171
he wished she would die.
10
© 2009 Functional Assessment Systems
184
Orientation & Memory Loss
Item
30
Pattern of short-term memory loss/disorientation
to time or place most of the time (e.g., not
knowing where you are & the date)
185
20
Frequent, marked confusion or evidence of short
term memory loss
190
10
N/A
© 2009 Functional Assessment Systems
172
Caregiver Resources Scales
Caregiver Material Needs
Caregiver Family/Social
Support
© 2009 Functional Assessment Systems
173
Preamble – Caregiver Scales
Rater specifies informant and relation to child
Often there are multiple caregivers
Reflects on caregiver resources & caregiving
environment
Not necessarily a reflection of “good” or “bad”
parenting
Often factors are beyond the caregiver’s
immediate control, or the youth’s needs are
simply too great for the environment currently
available
© 2009 Functional Assessment Systems
174
Caregiver Scales:
Three Versions
Primary Family – the parent(s) who are rearing the
youth or with whom the youth lives most of the time
(e.g., biological parent, adoptive parent, grandmother).
Where the youth was before treatment and where the youth will
return. If more than one parent in the home, rate greater level of
impairment.
Non-custodial Caregiver – parent(s) who has a
psychological impact on the youth yet is non-custodial
or is not living in the same home as the youth
Surrogate Caregiver – person(s) substituting as
parent(s), such as foster parent(s)
© 2009 Functional Assessment Systems
175
Preamble – Caregiver Scales
CAFAS user group needs to decide:
Caregivers on which data will be collected
How to “track caregivers when caregivers are scored
over time (e.g. quarterly). There are two approaches:
Score the same person on the same scale over time. Example: if
the mother is rated under “Primary Family” at intake, she is
rated on that scale three months later, no matter what he
current role may be.
Score according to function. Example: mother may be scored as
“Primary Family” at intake, and rated on “Non-custodial
Caregiver” scale if her role relative to the youth has changed.
Preferable option.
© 2009 Functional Assessment Systems
176
CAREGIVER
MATERIAL NEEDS
© 2009 Functional Assessment Systems
177
Expectations – Material Needs
Material
Needs
Caregiver provides food, shelter, clothing,
medical care, and shelter for child such
that the youth’s functioning and
development of skills are not impeded
© 2009 Functional Assessment Systems
178
Preamble - Caregiver
Material Needs
Lack of material needs must negatively impact
youth’s functioning to be rated.
Even in low income bracket, parent may be able
to use community and family resources to meet
basic needs of child.
Needs may not be met because of problems other
than poverty (e.g., parent buys alcohol rather
than food).
Safety issues related to sexual or physical abuse
are not rated here.
© 2009 Functional Assessment Systems
179
Caregiver Material Needs
Item
30
Youth’s needs are not being met such that severe
risk to health or welfare of youth is likely
201
20
Frequent negative impact on youth’s functioning
OR a major disruption in the youth’s functioning
203
10
Occasional negative impact on the youth’s
functioning
205
Basic material needs include:
• Food (i.e. balanced diet)
• Housing (i.e. a home that is free from major safety
hazards, provides adequate privacy)
• Clothing (i.e. appropriate for the weather)
• Medical attention (i.e. immunizations, care when
sick)
• Safety (i.e. live in a neighborhood that is reasonably
safe; street violence and drug dealing are not
immediately present or common
© 2009 Functional Assessment Systems
180
Caregiver Family/Social
Support Scale
© 2009 Functional Assessment Systems
181
Preamble – Caregiver
Family/Social Support
Impairment in caregiver’s ability to provide a safe,
secure, and healthy home environment in which the
youth’s developmental needs can be met
Developmental needs: youth’s need to receive guidance
and support in various areas:
Social
Emotional (nurturance)
Academic
Life skills
Regulation of impulses (appropriate limits,
supervision, understanding and managing feelings)182
© 2009 Functional Assessment Systems
Expectations – Caregiver Family/
Social Support Scale
Level of Resources
Available
Caregivers can satisfactorily meet the special needs of the
Parental Judgment
and Functioning
Caregiver exercises good parental judgment so that he/she
can provide a safe, secure, and healthy home
environment in which the youth’s developmental needs
can be met
Non-Abusive
Environment
Caregiver protects the youth from abuse, or, if abuse
occurs, provides the physical and emotional support the
youth needs
Supervised Home
Caregiver provides a home and adequate supervision of the
youth’s activities (whether in or outside of the home)
Conflict
Management
Family environment is free of domestic violence, hostility,
or pervasive conflict
child without jeopardizing other family members
© 2009 Functional Assessment Systems
183
30
20
10
Level of Resources Available
Item
Sociofamilial setting is potentially dangerous
to the youth due to lack of family resources
required to meet the youth’s needs/demands
EX: Caring for a child with autism, other
pervasive developmental disorder, or
psychosis, with limited resources
Youth’s developmental needs cannot be
adequately met
211
Family not able to provide adequate warmth,
security, or sensitivity
© 2009 Functional Assessment Systems
222
230
184
Parental Judgment and Functioning
30
Item
Gross impairment in parental judgment or
functioning. EX: psychosis, substance abuse,
severe personality disorder, mental retardation
212
Caregiver is openly involved in unlawful
behavior or contributes to or approves of youth
being potentially involved in unlawful
behavior
220
20
Marked impairment in parental judgment or
functioning. EX: emotional instability,
psychiatric illness, substance use, physical
illness
223
10
NA
© 2009 Functional Assessment Systems
185
Non-Abusive Environment
30
Item
During the rating period, youth is subjected to sexual abuse in
the home by a caregiver.
214
During the rating period, youth is subjected to physical abuse or
neglect in the home by a caregiver.
Youth currently removed from the home due to sexual abuse,
physical abuse, or neglect. (Initiation of removal may have
been prior to current rating period.)
215
Failure of caregivers to provide an environment safe from
possible abuse for a youth previously abused or traumatized.
EX: Parent allows a friend, who has a history of sexual
offending, to babysit child; allows abuser near the child when
contraindicted.
Parents’ rights terminated
218
20
Failure of caregiver to provide emotional support to youth who
has been traumatized or abused. EX: Openly calls daughter a
slut after she reveals sexual abuse by a neighbor.
10
N/A
© 2009 Functional Assessment Systems
217
Exception
227
186
Supervised Home
30
Item
Caregiver does not want youth to return to the
home.
213
Caregiver “kicks” youth out of the home,
without trying to make other living
arrangements.
216
20
Marked lack of parental supervision of
consistency in care. EX: Frequently does not
know the whereabouts of youth, does not
know the youth’s friends
226
10
Not able to provide adequate supervision,
firmness, or consistency in care over time
233
© 2009 Functional Assessment Systems
187
Conflict Management
30
20
10
Item
Frankly hostile, rejecting of youth
213
Severe or frequent domestic violence
219
Domestic violence or serious threat of domestic
violence
228
Conflict is pervasive (across areas) and continual
(chronic). EX: hostility, tension, scapegoating
224
Family members are insensitive, angry, and/or
resentful to the youth
225
Frequent family arguments and/or
misunderstandings resulting in bad feelings
231
Family relations are characterized by poor problem
solving, poor communication, or emotional
insensitivity
232
© 2009 Functional Assessment Systems
188
The Reliability
Rate behavior in vignettes; not the “clinical summary” in
your head.
Start with severe level of impairment. Do not “jump” to
a true item which is the incorrect answer because it is
not the most severe, true item about the youth.
Rate every scale based on entire vignette, not just a
“subsection” of the vignette.
Rate the behavior if anyone reports it, and it is believable
Read carefully. Try to avoid “fatigue errors.”
© 2009 Functional Assessment Systems
189
The TEST Instructions
Time period to rate is the last three months. If there is
no comment about time, assume behavior is current.
Reliability based on subscale scores (30, 20, 10, 0) in left
margin
Must write in a justification (not wording from CAFAS
item).
Do not rate caregiver (unless you have time).
No group work allowed.
Try to talk only when outside the “testing” room
© 2009 Functional Assessment Systems
190
After Each Vignette!
Questions or errors?
For each subscale there is a “key.” If it “makes sense”
proceed to next vignette.
If not, see presenter:
She may say “OK” – don’t worry, when means you
have right “rule.”
Or, she will try to explain the rule. Use presenter as
personal tutor.
© 2009 Functional Assessment Systems
191
Download

behavior - Mental Health Georgia