Quality standard

Quality statement 2: Comprehensive assessment

Quality statement 2: Comprehensive assessment

Quality statement

Children and young people with a suspected conduct disorder and any significant complicating factors have a comprehensive assessment, including an assessment of the child or young person's parents or carers.

Rationale

A number of factors can contribute to a child or young person developing a conduct disorder and continuing to have problems. It is important to consider all these factors when looking at possible causes and appropriate interventions. Where significant complicating factors are identified as part of initial assessment, a comprehensive assessment should be conducted. This should take into account the home environment which can be a significant risk factor, as well as one of the best places to target an intervention through working with parents or carers. Therefore, conducting a comprehensive assessment with the child or young person and an assessment of their parents or carers is important to inform any appropriate interventions and support plans.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that children and young people with a suspected conduct disorder and any significant complicating factors have a comprehensive assessment, including an assessment of their parents or carers.

Data source: Local data collection.

Process

a) The proportion of children and young people with a suspected conduct disorder and any significant complicating factors who have a comprehensive assessment.

Numerator – the number of children and young people in the denominator who have a comprehensive assessment.

Denominator – the number of children and young people with a suspected conduct disorder and any significant complicating factors.

b) The proportion of parents or carers of children and young people with a suspected conduct disorder and any significant complicating factors who have a comprehensive assessment.

Numerator – the number of parents or carers in the denominator who have a comprehensive assessment.

Denominator – the number of parents or carers of children and young people with a suspected conduct disorder and any significant complicating factors.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that staff are trained and competent to carry out comprehensive assessments for children and young people with a suspected conduct disorder and significant complicating factors, and also to carry out and assessment of their parents or carers.

Health and social care practitioners ensure that they complete a comprehensive assessment for children and young people with a suspected conduct disorder and any significant complicating factors, and also carry out an assessment of their parents or carers.

Commissioners ensure that they commission services that have staff trained and competent to carry out comprehensive assessments for children and young people with a suspected conduct disorder and any significant complicating factors, and also to carry out an assessment of their parents or carers.

Children and young people who are suspected to have a conduct disorder and who have other conditions (for example, problems with learning, communication or substance misuse, mental health problems, or conditions such as epilepsy and autism) have an assessment that looks at all the different parts of their life that can affect their behaviour, including their home and school environment and their parents.

Definitions of terms used in this quality statement

Comprehensive assessment of the child or young person

The standard components of a comprehensive assessment of conduct disorders should include, but is not restricted to, asking about and assessing the following:

  • core conduct disorders symptoms, including:

    • patterns of negativistic, hostile or defiant behaviour in children aged under 11 years

    • aggression to people and animals, destruction of property, deceitfulness or theft and serious violations of rules in children aged over 11 years

  • current functioning at home, at school or college and with peers

  • parenting style

  • history of any past or current mental or physical health problems

  • the presence or risk of physical, sexual and emotional abuse in line with local protocols for the assessment and management of these problems.

The assessment should take into account and address possible coexisting conditions such as:

  • learning difficulties or disabilities

  • neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD) and autism

  • neurological disorders, including epilepsy and motor impairments

  • other mental health problems (for example, depression, post-traumatic stress disorder and bipolar disorder)

  • substance misuse

  • communication disorders (for example, speech and language problems).

When diagnosing coexisting conditions, it may be appropriate to use formal assessment instruments, such as the Strengths and Difficulties Questionnaire, for all children or young people to aid the diagnosis. [Adapted from NICE's guideline on antisocial behaviour and conduct disorders in children and young people, recommendations 1.3.10 to 1.3.12, 1.3.14 and expert consensus]

Comprehensive assessment of the child or young person's parents or carers

A comprehensive assessment of the child or young person's parents or carers should cover:

  • positive and negative aspects of parenting, in particular any use of coercive discipline

  • the parent–child relationship

  • positive and negative adult relationships within the child or young person's family, including domestic violence

  • parental wellbeing, encompassing mental health, parental learning disability, substance misuse (including whether alcohol or drugs were used during pregnancy) and criminal behaviour.

This assessment should also include some assessment of parenting/care history, including identification of care in the child or young person's past, such as the number of placements within or outside the family. [Adapted from NICE's guideline on antisocial behaviour and conduct disorders in children and young people, recommendation 1.3.15 and expert consensus]

Significant complicating factors

Significant complicating factors assessed as part of the initial assessment of children and young people with a possible conduct disorder include:

  • a coexisting mental health problem (for example, depression, post-traumatic stress disorder)

  • a neurodevelopmental condition (in particular ADHD and autism)

  • a learning disability or difficulty

  • substance misuse in young people.

[NICE's guideline on antisocial behaviour and conduct disorders in children and young people, recommendation 1.3.5]

Suspected conduct disorder

Children and young people are considered to have a suspected conduct disorder if their parents or carers, health or social care professionals, school or college, or peer group, raise concerns about persistent antisocial behaviour. [Adapted from NICE's guideline on antisocial behaviour and conduct disorders in children and young people, recommendation 1.3.2]

Equality and diversity considerations

Practitioners should support access to services and the uptake of interventions by children and young people, and their parents and carers, by being flexible in relation to settings and offering a range of support services. Recommendations 1.7.7 and 1.7.8 in NICE's guideline on antisocial behaviour and conduct disorders in children and young people provide examples of settings and support services.

The workforce across agencies should, as far as possible, reflect the local community. Practitioners should have training to ensure that they have a good understanding of the culture of families with whom they are working. Interpreters should be provided if no practitioner is available who speaks a language in which the family members can converse fluently. Consideration should be given to the specific needs of:

  • girls and young women with conduct disorders

  • looked-after and adopted children and young people.