ARTICLES
The Service Assessment for Children and Adolescents (SACA): Adult and Child Reports

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ABSTRACT

Objective

To describe differences in parent-child responses to the Service Assessment for Children and Adolescents (SACA).

Method

Studies were done at UCLA and Washington University based on service-using and community subjects drawn from community households or public school student lists, respectively. Results are presented for 145 adult-youth pairs in which the youth was 11 or older.

Results

The SACA adult-youth correspondence for lifetime use of any services, inpatient services, outpatient services, and school services ranged from fair to excellent (κ = 0.43-0.86, with most at 0.61 or greater). Similarly, the SACA showed a good to excellent correspondence for services that had been used in the preceding year (κ = 0.45-0.77, with most greater than 0.50). The parent-youth correspondence for use of specific service settings in the above generic categories ranged from poor to excellent (κ = 0.25-0.83, with half at 0.50 or greater).

Conclusions

The SACA has better adult-youth correspondence than any service use questionnaire with published data, indicating that both adult and youth reports are not needed for all research on mental health services. This is especially encouraging news for researchers working with high-risk youth populations, in which a parent figure is often not available.

Section snippets

Symptom Agreement

A number of studies have examined parent-child agreement concerning behavior problems or symptoms. Meta-analyses of 119 studies revealed that correlations between children and parents were among the lowest of cross-informant correlations and varied with child's age, type of symptoms, and clinical status (Sawyer et al., 1993). It is interesting that, unlike the higher agreement between parents and older children on service use (Leaf et al., 1996), parent-child correlations concerning behavioral

Design

The SACA Reliability and Accuracy studies were conducted at 2 sites: Washington University in St. Louis (WU) and the University of California at Los Angeles (UCLA). Internal review boards at each university reviewed and approved the procedures for obtaining parent consent and youth assent prior to the interview.

For the UCLA study, Ventura County Mental Health provided recruiters with a list of addresses of households with children aged 4 to 17 who had used services within the previous year,

Any Service Use

Information on service use in each of 25 specific settings listed in the youth version was aggregated to produce figures for any service use in 2 time spans: lifetime and in the past year. Parents and children showed good agreement on whether or not any services had been used in the youth's lifetime, 85% for a κ of 0.57 (Table 2). An examination of use of the 3 major venues for services (residential, outpatient, and school) elucidated differences in agreement. Agreement was better for any

DISCUSSION

The analysis of adult and child reports of mental health services in the SACA shows that the SACA is a promising instrument for services research. The agreement between parents and children is higher than that reported for the only other service use instrument with such data for children (Leaf et al., 1996). Furthermore, it is as high or higher than that reported for either diagnostic status or behavior symptom checklists. The MECA reported that their highest κ for generic categories of service

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    Copyright © 2000 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.