Accuracy of a Proactive Case Detection Tool for Internalizing and Externalizing Problems Among Children and Adolescents

Purpose
Lack of identification and referral of children and adolescents with mental health problems contributes to the treatment gap in low- and middle-income countries, and especially in humanitarian settings. The Community Case Detection Tool (CCDT) is developed to improve community-based detection and increase help-seeking among children and adolescents in need of mental health care. The CCDT uses brief, easily understood pictorial vignettes that represent common symptoms of childhood internalizing and externalizing problems. The tool is developed for gatekeepers to support proactive detection of children in need of mental health care and to subsequently encourage help-seeking. This study evaluates the accuracy of the CCDT in detecting children and adolescents aged 6–18 years with significant mental health care needs in a conflict-affected setting: the occupied Palestinian territory.

Methods
Teachers and community workers were trained to use the CCDT. Children detected using the tool were invited for a structured clinical interview with a psychologist using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version, as well as the Strengths and Difficulties Questionnaire, to test the accuracy of CCDT-based detection.

Results
Our sample consists of 52 children positively detected as matching with one of the vignettes. Approximately three of four detected children were indicated for psychological treatment based on the clinical interview (positive predictive value = .769), and 64.6% returned ‘borderline’ or ‘abnormal’ total difficulty scores on the Strengths and Difficulties Questionnaire.

Conclusions
The CCDT offers a promising low-cost solution to mitigate underdetection of mental health problems in challenging settings.