The Child and Adolescent Functional Assessment Scale (CAFAS): review and current status

Area of Science:

• Child and Adolescent Psychiatry
• Mental Health Services Research
• Psychometrics

Background:

• Functional impairment measures are crucial for children's mental health services, aiding in eligibility, treatment planning, and outcome evaluation for serious emotional disturbance (SED).
• The Child and Adolescent Functional Assessment Scale (CAFAS) is a widely adopted multidimensional tool for assessing functional impairment in youth.
• CAFAS is utilized nationwide for treatment eligibility and outcome documentation in numerous states and projects.

Purpose of the Study:

• To critically examine the technical merits and psychometric properties of the Child and Adolescent Functional Assessment Scale (CAFAS).
• To evaluate the empirical evidence supporting the CAFAS's validity for treatment decisions in pediatric mental health.

Main Methods:

• A close examination of the technical merits of the CAFAS was conducted.
• Review of existing empirical evidence regarding the scale's psychometric properties and validity.

Main Results:

• Empirical evidence supporting the valid use of CAFAS for treatment decisions is currently lacking.
• There is a noted lack of concern among stakeholders regarding the identified psychometric limitations of the CAFAS.

Conclusions:

• The widespread use of CAFAS for critical treatment decisions is not adequately supported by empirical evidence.
• Addressing the identified psychometric limitations of the CAFAS is essential to realize its full potential in children's mental health services.