Crisis Assessment Tool (CAT)
CRISIS ASSESSMENT TOOL (CAT)
The CAT, originally known as the Childhood Severity of Psychiatric Illness (CSPI), is a decision support and communication tool to allow for the rapid and consistent communication of the needs of children experiencing a crisis that threatens their safety or well-being or the safety of the community. It is intended to be completed by the individuals who are directly involved with the youth. The form serves as both a decision support tool and as documentation of the identified needs of the child served along with the decisions made with regard to treatment and placement at the time of the crisis. There are five key characteristics of the CAT that should be considered when completing the ratings.
Five Key Principles of the CAT:
- Items were selected because they are each relevant to service/treatment planning. An item exists because it might lead you down a different pathway in terms of planning actions.
- Each item uses a 4-level rating system. Those levels are designed to translate immediately into action
- Ratings should describe the child, not the child in services. If an intervention is present that is masking a need but must stay in place, this is factored into the rating, and would result in the rating of an ‘actionable’ need (i.e., ‘2’ or ‘3’).
- The ratings are generally ‘agnostic as to etiology.’ In other words, this is a descriptive tool. It is about the ‘what’ not the ‘why.’ Only two items, Adjustment to Trauma and Social Behavior, have any cause-effect judgments.
- A 30-day window is used for ratings in order to make sure assessments stay ‘fresh’ and relevant to the child or youth’s present circumstances. However, the action levels can be used to override the 30-day rating period.
This tool is designed from a communication theory perspective. As such, the indicators are selected to represent the key information needed in order to decide the best intervention strategy for a child during a time of crisis. For each indicator, four levels are anchored in order to translate the indicator into a level of action. For the CAT, these four levels can be generally translated into the following:
Action Levels for Items:
- – no evidence – This level of rating indicates that there is no reason to believe that a particular need exists. It does not state that the need categorically does not exist, it merely indicates that based on current assessment information there is no reason to address this need. For example: Does Johnny smoke marijuana? He says he doesn’t, his mother says he doesn’t, no one else has expressed any concern – does this mean Johnny is not smoking marijuana? NO, but we have no reason to believe that he does and we would certainly not refer him to programming for substance related problems.
- – watchful waiting/prevention/relevant history – This level of rating indicates that you need to keep an eye on this area or think about putting in place some preventive actions to make sure things do not get worse, for example, a child who has been suicidal in the past. We know that the best predictor of future behavior is past behavior, and that such behavior may recur under stress, so we’d want to keep an eye on it from a preventive point of view.
- – action needed – This level of rating implies that something must be done to address the identified need. The need is sufficiently problematic that it is interfering in the child or family’s life in a notable way.
- – immediate/intensive action – This level of rating indicates a need that requires immediate or intensive effort to address. Dangerous or disabling levels of needs are rated with this level. A child who is not attending school at all or an acutely suicidal youth would be rated with a ‘3’ on the relevant need.
In order to enhance the reliability of the CAT, anchor points have been designed to facilitate the translation of levels of each indicator into the four action levels described above. It should be noted that these anchor points represent guidelines. Since it is not feasible to exhaustively define all circumstances that might fit a particular level, the assessor may use some clinical judgment to determine the rating when no clear choice is obvious. This judgment should be guided by a decision on the appropriate level of action required for the specific indicator. A primary goal of this tool is to further communication with both the individual youth and family and for the youth’s system of care. As such, consistency and reliability in the use of this tool is important. Therefore, formal training is required prior to any staff completing this tool based on an actual crisis assessment.
Please note that a 30-day window is used. This window is just to remind the rater that the interest is in describing the child or adolescent’s immediate needs in this regard. The use of the word ‘history’ in many of the ratings of ‘1’ refers to lifetime history. In other words, if a youth attempted suicide five years ago but is not actively suicidal, a rating of ‘1’ would be appropriate. The CAT includes items regarding substance abuse. Youth and family responses to questions about these items may suggest the likelihood of a co-occurring substance use disorder or, may suggest that the youth is presenting signs, symptoms, and behaviors influenced by co-occurring issues. The purpose for these questions is not to establish the presence or specific type of a substance abuse disorder, but to alert clinicians to the impact substance abuse may have on the individual’s crisis.