Child Mental Health Assessment: Reflections on the Complexities and Possibilities

As a student completing my clinical child psychology studies, I would become frustrated at times with what seemed like an endless emphasis on the details of assessment and formulation. I wanted to spend more time talking about interventions and therapy – actually helping people! It is only with hindsight that I fully appreciate the strength and importance of this extensive training in assessment. Our assessment formulation is our understanding of the child’s presenting difficulties in the context of an understanding of the child, their family, and their cultural and community influences. This is not only necessary to guide all therapy work; it can be therapeutic in itself. Through this process of assessment and formulation, we are weaving the parents’ understanding of their child with the context and developing a shared understanding with the child and family. The family’s understanding of the presenting difficulties and how to best manage these becomes richer, which breeds empowerment and hope.

Assessment of a child’s emotional and behavioural difficulties is a complex task. In addition to knowledge of mental health, it requires a systemic and a developmental perspective. Systemic because children are embedded within a family system, and for older children, a school system, as well as broader systems such as treatment services, communities and cultural influences. Developmental because child assessment requires an understanding of typical childhood development as well as the individual child’s developmental stage. We need to hear the perspectives the child, the parents or caregivers, and often the preschool or school staff. These perspectives often differ, and are often expressed in different ways. For example, adults may be able to express their views using language during an interview, while children may communicate through behaviour or play, and may require concrete activities and scaffolding to express their views.

Practically, this complexity means that child assessment requires several components. Family sessions, child-focused sessions, parent interviews, questionnaire measures, and preschool or school observations can all be helpful. Family sessions can be particularly helpful early on, as they provide the opportunity to observe family dynamics as well as engage all family members in the therapy process. Family sessions, like child-focused sessions, need to involve more than just talking. To engage children, we need to include hands-on, creative, or playful activities. Even activities as simple as playing with Playdoh or drawing family pictures can help children to relax, engage, and communicate their thoughts. Asking the family to join in the activity can provide further opportunity for observation and reflection – and may help the parents to relax too! If you would like more ideas about playful activities to use with children and families, you might like to read our book, ‘Creative Ways to Help Children Manage BIG Feelings’

It can feel like there is a lot of information to collect to complete a thorough child assessment. Certainly, we have a lot of headings on our Child and Family Assessment Template! However, keep in mind that assessment and formulation are dynamic and ongoing. We are often adding to or adjusting our formulations as we move through the therapy process with children and families. When providing supervision to other psychologists about clients they are finding particularly tricky, we often return to their formulation and assist them to re-consider this in order to move forward in providing effective therapy. Assessment should be ongoing, with our understanding of the child and family deepening over time. At the same time therapy begins with our first interactions with the family and our initial assessment sessions should provide understanding and hopefulness, mobilising the family to begin the process of change.

I’ve suggested that incorporating developmental and systemic perspectives adds to the complexity of child assessment. However, these aspects also contribute to my passion for working with children and my sense of optimism for positive change in the children and families I see. The fact that children are embedded within a system means that we have multiple means for creating change for them. We can work with the children, parents, other family members, educators, and any combination of these, providing many possibilities for change within the child’s system. The fact that children are still developing means that there is always hope for change. It also means there is more scope for both assessment and therapy to be creative, playful, and fun.

If you would like a copy of our Child and Family Assessment Template, you can download one for free at our free resources page. It covers all the areas we suggest you consider when assessing a child with emotional or behavioural difficulties, and is in printable form with space to jot your notes.

Dr Suzanne Barrett
Clinical Psychologist
Creative Child Therapy Workshops.

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