A diagnostic tool, which can be used by mental health clinicians to assess children and teenagers, is to be evaluated by experts from the University of Nottingham and Institute of Mental Health, thanks to a £1.5m NIHR grant.
The STADIA study (STAndardised DIagnostic Assessment for children and adolescents with emotional difficulties) will test the clinical and cost effectiveness of a standardised diagnostic assessment tool, as an addition to usual clinical care, on the diagnosis of emotional disorders in children and adolescents who are referred to Child and Adolescent Mental Health Services (CAMHS).
The tool is called the Development and Well-Being Assessment (DAWBA) and consists of a package of interviews/questionnaires designed to support diagnostic practice. It can be completed digitally online by parents and young people aged 11 upwards rather than face to face, soon after the referral has been received by CAMHS – a factor which could help in the process of diagnosis.
Mental health disorders affect around 1 in 8 children and young people, most commonly emotional disorders such as depression and anxiety disorders. The multi-disciplinary nature of CAMHS means that children are seen by practitioners from different professional backgrounds, with variations in the nature and scope of assessments offered – for example, a previous study found that less than a third of referred children who met criteria for depression had this diagnosed clinically.
The STADIA trial will involve around 1,200 children and adolescents between the ages of 5 and 17 presenting with emotional difficulties referred to CAMHS who will be randomly assigned to two groups. One group will receive usual clinical care (including assessment as usual, where applicable) and the other group will additionally complete the DAWBA assessment tool soon after the referral has been received by CAMHS.
Leading the study, Professor Kapil Sayal, said: “Children and young people with emotional difficulties often also have wider difficulties such as self-harm, poor physical health, and problems with schooling, friendships, family relationships and taking part in wider day-to-day activities. These difficulties can have a long-lasting impact into adulthood. For children and their families, receiving the correct diagnosis is vital so that appropriate care and interventions can be offered.
“Currently, the NHS has limited information about whether standard assessment approaches can help these children and their families. By evaluating different approaches to assessment within CAMHS, and sharing the findings, this research will help improve care and inform clinical guidelines. The findings will help the NHS decide how best to ensure value for money in diagnosis approaches for mental health problems among children and teenagers.”
The study will work closely with clinicians and patients across Nottinghamshire Healthcare NHS Foundation Trust’s CAMHS service, as well as with four other NHS Trusts across England, throughout the four year study. The NHS Trusts taking part are in London, Berkshire, Cambridgeshire, the East Midlands and the North West. Team members include a parent co-applicant and the study will have Parent and Young Person Advisory Group Panels.
Professor Hywel Williams, Director of the NIHR Health Technology Assessment (HTA) Programme, which funded the study, said: "This is an important area of research. Mental health problems of children and adolescents often impact into adulthood. We hope this research will help children experiencing emotional difficulties, and their families, by assisting clinicians in making better diagnosis decisions so the appropriate care and treatment can be offered."
Other research collaborators include the University of Nottingham’s Clinical Trials Unit who will coordinate the study, and the NIHR MindTech MedTech Co-operative.
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