Development, preliminary validation and reliability of the colourful 'My Feelings Form' self-report for young children.

BACKGROUND: Patient-reported outcome measures place the patient at the centre of his/her care. There are calls to introduce child-reported outcome measures to mental health services. We aimed to (a) develop an age-appropriate patient-reported outcome measure for children's mental health, and (b) validate this in a primary school and Child and Adolescent Mental Health Service (CAMHS). METHODS: A list of items to measure children's mental health was proposed (Draft 1) and revised to 14 items following focus group and user consultation (Draft 2). A colourful, cartoon and emoji version was created in consultation with children (Draft 3); a professional cartoon artist created the final 'My Feelings Form' (MFF), with usability feedback (Draft 4). The MFF was tested by 317 children aged 4-13 years from one mixed-gender primary school at two time points in 1 day, and 25 children aged 4-13 years from CAMHS. Results were analysed using test-retest reliability and exploratory factor analysis; a receiver operator characteristic curve was constructed. RESULTS: The CAMHS group scored significantly higher than the school group for the mean total score (23.5 ± 11.3 vs. 16.1 ± 6.2) and for 10 items. Test-retest reliability was acceptable (correlation = 0.74, p < .001). Exploratory factor analysis using 10 informative items identified two factors - emotional factor (Cronbach's alpha = 0.74) and function factor (Cronbach's alpha = 0.59). The revised 10-item form has a Cronbach's alpha of 0.77; a cut-off of 12 has a sensitivity of 80% and specificity of 60%, indicating that it correctly identified 80% of those who were attending CAMHS and gave 60% of the schoolchildren a negative result. CONCLUSIONS: The colourful MFF was co-produced with children, and preliminary data suggest that it is a useful patient-reported outcome measure for children's mental health.

The quality of published paediatric audits and their standards.

OBJECTIVE: Audit is a recognised tool for evaluating the performance and improving the quality of health services. In Ireland and the UK, clear resources are available outlining audit elements. This study was undertaken to evaluate paediatric audits published from 2007 to 2020 to determine the adherence level to the definition of audit and to assess the quality of audit standards. DESIGN: PUBMED, MEDLINE and CINAHL databases were searched to identify relevant articles published in the English language. Each was reviewed to assess whether the following criteria were met: (1) a paediatric healthcare topic was described, (2) practice was reviewed, (3) the standard was specified, (4) an intervention was made and data collection was repeated to assess improvement. The quality of the standard for each true audit was graded utilising the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: Of 1230 published paediatric healthcare articles reviewed, 144 (11.4%) fulfilled the full criteria of an audit. Sixty-three (43.8%) true audits used the highest quality of evidence (level 1a and 1b), predominantly international or national guidelines. Fifty-six (38.9%) audits used the lowest quality of evidence (level 5), predominantly expert opinion. CONCLUSIONS: There is a mismatch between the common usage of the term audit, and the definition, despite its incorporation into training curricula and institutional support. Many articles published as audits do not adhere to the definition of audit. There are variable levels of evidence supporting the standards utilised in published true audits.