The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services

Abstract

BackgroundFew cost-utility studies of child and adolescent mental health services (CAMHS) use quality adjusted life years (a combination of utility weights and time in health state) as the outcome to enable comparison across disparate programs and modalities. Part of the solution to this problem involves embedding preference-based health-related quality of life (PBHRQOL) utility instruments, which generate utility weights, in clinical practice and research. The Child Health Utility (CHU9D) is a generic PBHRQOL instrument developed specifically for use in young people. The purpose of this study was to assess the suitability of the CHU9D as a routine outcome measure in CAMHS clinical practice.MethodsTwo hundred caregivers of children receiving community mental health services completed the CHU9D alongside a standardised child and adolescent mental health measure (the Strengths and Difficulties Questionnaire – SDQ) during a telephone interview. We investigated face validity, practicality, internal consistency, and convergent validity of the CHU9D. In addition, we compared the utility weights obtained in this group with utility weights from other studies of child and adolescent mental health populations.ResultsParticipants found the CHU9D easy and quick to complete. It demonstrated acceptable internal consistency, and correlated moderately with the SDQ. It was able to discriminate between children in the abnormal range and those in the non-clinical/borderline range as measured by the SDQ. Three CHU9D items without corollaries in the SDQ (sleep, schoolwork, daily routine) were found to be significant predictors of the SDQ total score and may be useful clinical metrics. The mean utility weight of this sample was comparable with clinical subsamples from other CHU9D studies, but was significantly higher than mean utility weights noted in other child and adolescent mental health samples.ConclusionsInitial validation suggests further investigation of the CHU9D as a routine outcome measure in CAMHS is warranted. Further investigation should explore test-retest reliability, sensitivity to change, concordance between caregiver and child-completed forms, and the calibration of the utility weights. Differences between utility weights generated by the CHU9D and other utility instruments in this population should be further examined by administering a range of PBHRQOL instruments concurrently in a mental health group.

Health-related quality of life associated with bullying and aggression: a cross-sectional study in English secondary schools

“…Because the recall period (one day) is so short, the measure may be insensitive to issues that irregularly affect respondents. For example, a recent study investigating the measure's use in children receiving mental health services found that asking about today may have underestimated estimations of dysfunction because today was atypical in some way [28]. As relates to the INCLUSIVE trial, the CHU-9D may minimise estimated differences in HRQol related to bullying victimisation and school antisocial/aggressive behaviour since these behaviours often do not occur on a daily basis.…”

“…Refining the CHU-9D's recall period to "a typical day" as suggested by Furber and Segal may alleviate this issue [28]. The recall period for the PedsQL is longer at one month and potentially this could lead to different findings.…”

Measuring the financial and productivity burden of paediatric hospitalisation on the wider family network

“…Evaluating patient safety and quality interventions in health care have traditionally focused on health system outcomes such as mortality and morbidity. Assessing broader measures of the impact on patients can be challenging in children as patient‐reported quality‐of‐life measures that are used in adult studies are often not validated in younger age groups . Paediatric care is also complicated by the impact of a child's illness on the family as parents are encouraged to actively participate in their child's care when in hospital, and a child's admission involves the whole family as parents juggle jobs and other care commitments .…”

Feasibility of an online intervention (STAK-D) to promote physical activity in children with type 1 diabetes: protocol for a randomised controlled trial

“…The recall period is today/last night. The CHU9D has demonstrated validity in paediatric clinical populations [52]Communication questionnaireA short questionnaire developed specifically for this study will be used to explore children’s perceptions of the communication around physical activity they have with their diabetes team. It contains two items and assesses children’s perceptions of (1) frequency of physical activity discussion (e.g.…”

“…The recall period is today/last night. The CHU9D has demonstrated validity in paediatric clinical populations [52]…”