Methods: Researchers partnered with twenty-five community mental health centers throughout one Midwestern state. From a list of scheduled intake appointments, researchers randomly selected assessments to observe. Community mental health center clinicians conducted the Waiver eligibility appointment as normal but with researchers observing. Throughout the appointment, researchers took structured notes, specifically regarding how the CAFAS was being delivered to families. The structured notes examined four specific domains: (1) was the child present; (2) were all CAFAS domains discussed; (3) were family/caregiver strengths and resources discussed; and (4) was the interview structured. In total, there were approximately 100 case observations.
Results: Through the observation of eligibility appointments, researchers found extreme variability in how clinicians from mental health centers across the state administer the CAFAS to children and families seeking SED Waiver eligibility. The primary variance centered on clinicians not maintaining interview structure. Clinicians often asked both the caregiver and the child questions, frequently using a mix of information to determine final scoring on the CAFAS. The time of reference for examining the child’s behavior also demonstrated variance. Some clinicians made it clear to caregivers that behavior was only being examined for a certain period time while others did not. Finally, no clinician utilized the caregiver resources portion of the CAFAS, and no clinician asked families about their strengths that could be utilized to address some behavior concerns.
Conclusions & Implications: Despite completing the same standard training for the CAFAS, administration of this assessment varied greatly across clinicians and agencies in this state. Variability in assessment procedures for services for youth with more impaired functioning may differentially impact who has access to the specialized services. Future research needs to explore what drives these differences and how they impact the services received.