Guidelines for Use in Ontario

Who to Rate

CAFAS should be rated on all children ages 6 years through 17 years who receive mental health services. In practice, some organisations rate youth who are older than 17 (17-21), younger than 6 years, some rate younger than 5 years old.
You must know enough about the client/family to rate CAFAS reliably.

Exceptions:

Children receiving services for which no detailed screening or assessment occurs (e.g. prevention, outreach, parenting education groups, support groups).
Children receiving services that are delivered in 1 to 3 sessions (e.g., crisis, early intervention, single-session intervention). If the client moves from crisis/prevention to longer-term active service, rate CAFAS as per guidelines.
Children seen at your organization primarily to redirect appropriately to another agency.
Children receiving service for problems other than a psychological, emotional, behavioural or substance abuse problem e.g., developmental impairment. Each organization should decide whether to rate CAFAS for clients with comorbid developmental impairment and mental health problems.

Note: There are Guidelines (Hodges, 1996) for rating CAFAS with Special Populations, including youths with developmental disorders, youths in residential settings for substance use problems, youths with eating disorders, youths with inappropriate sexual behaviours, youths who are themselves parents, youths in short-term psychiatric hospital settings, youths in long-term residential placements, youths in step-down programs, and youths who have little or no contact with their biological caregivers or family of origin.

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Entry CAFAS

When to Rate:

Complete a CAFAS when enough information has been gathered on the client to be able to complete each scale.
Rate as close to the beginning of "active treatment as possible, typically within the first 2-3 meetings or weeks of service.
If the client has a T1 completed but drops out, leave the T1 in place and not do a T14 unless they did some treatment. Close the episode after a specified time period (It is easy to "reinstate" the clients if they return)

Period You are Rating

Rate the child's most severe behaviour in the month preceding the date of entry into active service. For example, if child began treatment on October 1, rate the child according to his/her behaviour since September 1.

Note: In some organizations, clients will occasionally come directly into day treatment or residential settings without previous documentation or clinician knowledge of the client and family. If a CAFAS has been completed previously by another agency, then a copy of that CAFAS report should be obtained with the file. Then, an Entry CAFAS for your agency should be completed as soon as sufficient knowledge of the client has been obtained to validly complete the scales.

Occasionally, clients will transfer from a service for which a CAFAS is not done (e.g., prevention, crisis) into active treatment within the same organization. An Entry CAFAS should be completed at the time of transfer (when enough information permits a rating). In addition, clients may transfer from less intensive forms of active treatment (e.g. outpatient) into day or residential treatment within the same organization. A CAFAS rating should be done to capture the change of intensity of service, assuming that at least 2 months have transpired since the end of the last time period rated

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Exit CAFAS

When to Rate:

Rate within one month of the last face-to-face or telephone contact with the family.
If you provide aftercare for residential or day treatment clients, a further rating at the exit from aftercare is discretionary.
For residential and day treatment clients, rate at the exit from residential or day treatment setting.
If the clients drop out before before treatment has started and a T1 has been completed keep the T1, close the episode, however do not complete a T14 (you may receive a notification from the software that the T14 is not completed but it is okay to ignore it).

Period You are Rating

Rate the child's most severe behaviour in the month immediately prior to the last active treatment contact.
Rate annually if the child/youth is in treatment for more than one year, then again at the end of "active treatment".

Note: Since the CAFAS rates "the most severe behaviour" in the month rated, all ratings must be at least one month apart. It is our expectation that most exit CAFAS ratings will take place a minimum of 2 months after the Entry CAFAS rating, given the pace at which client change can usually be expected to take place in a manner that can be measured. Also, in cases where clients "drop out", or otherwise leave service precipitously, it is important to remember that the client's behaviour must be known well enough to be able to validly score the CAFAS scales. In these cases, clinical judgment will need to be used regarding when the CAFAS can be completed and when it cannot.