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3.7.8 Improving the Mental Health of Children in Care - the Strengths and Difficulties Questionnaire


  1. Introduction
  2. Strengths and Difficulties Questionnaire (SDQ)
  3. Operational Procedure
  4. Annual Health Care Assessments
  5. Frequency of Completion
  6. Monitoring Compliance

    Appendix 1: Questionnaire

1. Introduction

The white paper Care Matters: Time for Change highlighted the need to improve the mental health of children and young people in care. It recommended that social workers make use of the Strengths and Difficulties Questionnaire (SDQ) to assess the emotional health of children in care, specifically to ascertain whether there are any emotional and behavioural difficulties that might require additional services.

In order to monitor compliance, from April 2008 all local authorities in England will be required to provide data to the Department for Children Schools and Families on an annual basis commencing March 31st 2009. Data from the completed Strengths and Difficulties Questionnaire (SDQ) will be analysed and a summary figure for each child (the total difficulties score) will be submitted to the Department for Children Schools and Families on an annual basis commencing March 31st 2009. 

This procedure sets out how these requirements will be met in Hillingdon.

2. Strengths and Difficulties Questionnaire (SDQ)

The SDQ is a short behavioural screening questionnaire. It has five sections that cover details of emotional difficulties; conduct problems; hyperactivity or inattention; friendships and peer groups; and also positive behaviour. The SDQ has been internationally validated and is appropriate for all Black and Minority Ethnic Groups.

Social workers should use the 'main carer' questionnaire element of the SDQ, attached at Appendix A. 

Local authorities must return a single 'Total Difficulties Score', ranging from 0 to 40, for each child who was aged between 4 and 16 at the date of their latest assessment and has been in care for at least 12 months on 31st March. Whilst data will only be reported for children between the ages of 4 and 16, the SDQs should be also be completed for all children aged 2-4 who are in receipt of some kind of structured day care provision and for those aged between 16 and 18 who are Looked After and the subject of a Pathway Plan.

Completion of the SDQ is straightforward and there should only be rare exceptions where it cannot be completed and where is it not completed, for example, where

  • The carer refuses to complete and return the questionnaire; 
  • It was not possible to complete the questionnaire due to the severity of the child's disabilities;

3. Operational Procedure

The questionnaire must be completed by the child's main carer, i.e. the person with whom the child has spent most nights during the year. For most children in care this will be either a foster carer or their residential social worker. For those children receiving care on a respite basis only, a birth parent would be the most appropriate person to complete the questionnaire although it is likely that some explanation would be required from the social worker as to why this is needed.

The child's social worker should take responsibility for taking the questionnaire to the placement during one of their statutory visits and ensuring it is completed.

The social worker is then responsible for scoring the questionnaires using the software that will be provided for this purpose. It is the social worker's responsibility to ensure that the score, or alternatively the reason for non completion of the questionnaire, is recorded.

4. Annual Health Care Assessments

When making a request for an annual Health Care Assessment, the Strengths and Difficulties Annexe A, obtained from the SDQ scoring software should be included.

The scores will be used to help decision-making about links with Child and Adolescent Mental Health Services (CAMHS). Referral to specialist mental Health Assessment and treatment should be considered in the context of the existing assessment of the health, social and educational needs of children as part of placing a child in care.

5. Frequency of Completion

SDQs must be completed for every new Looked After episode and repeated annually if the placement has not changed. They can be repeated more frequently if desired and this can be useful for assessing changes as a result of intervention. For reporting purposes, only the most recent score will be used.

6. Monitoring Compliance

As part of their quality assurance role, Independent Reviewing Officers will request details of the Annexe A from the latest SDQ at the second review and at all subsequent Looked After Review meetings they will require either the Annexe A or Annexe B whichever is relevant. The social worker is responsible for providing this information alongside other health information.

Independent Reviewing Officers will take responsibility for monitoring compliance and the Assistant Service Manager will report back monthly to Service Managers, details of children for whom no score is recorded.

Appendix 1: Questionnaire

Click here to view Appendix 1: Questionnaire.