Children’s mental health
Outcome measures


Children’s Mental Health Outcome Measures Reporting System User Manual (PDF)


Outcome measures assess clinical outcomes, such as emotional and behavioral functioning, and non-clinical outcomes, such as cost effectiveness and perception of care. DHS promotes standardized diagnostic assessments and evidence-based practices to ensure accountability in the mental health system to produce the best possible results with existing resources for children and youth. Outcome measures determine success in meeting the mental health needs of children and their families.

In 2009, DHS and Minnesota Council of Health Plans recommended adopting the Child and Adolescent Service Intensity Instrument (CASII) or Early Childhood Service Intensity Instrument (ECSII) in conjunction with the Strengths and Difficulties Questionnaire (SDQ) as the statewide outcome measures for children and youth receiving public and private mental health services.

Strengths and Difficulties Questionnaire (SDQ)

The SDQ is a brief behavioral screening questionnaire for 3- to 16-year-olds to detect their general symptoms and developmental assets. The first section examines emotional symptoms, conduct problems, inattention-hyperactivity, peer problems, and prosocial behavior. The second section assesses the impact of these symptoms on the child and the family or school environment. There is also a follow-up section that asks whether the intervention has reduced problems and helped in other ways. Children, parents and teachers can complete separate versions of the SDQ.

Early Childhood Mental Health grantees are piloting use of the Child Behavior Checklist (CBCL) to assess infants, toddlers and preschool children (ages 1½ - 5). Parents, child care providers, and teachers rate concerns and strengths about the child to screen for possible emotional, behavioral, and social problems.

Child and Adolescent Service Intensity Instrument (CASII)

The CASII is an instrument designed to objectively determine the service needs of children and adolescents (ages 6 through 17). Mental health providers rate children and youth on eight dimensions in terms of their strengths and problems. In addition to these ratings, the CASII provides a composite score and level of care recommendation.

Early Childhood Service Intensity Instrument (ECSII)

The Early Childhood Service Intensity Instrument (ECSII) focuses on the service needs of infants, toddlers and children from ages 0 to 5 years in the context of their families and communities. These young children and their families may need services from a variety of providers and natural supports to meet behavioral, emotional or developmental needs. Based on a developmental and systems perspective, the ECSII recognizes the changing capacities and needs of children over this rapid period of development as well as the range of individual variations among children in normal development. The ECSII considers the relationship of risk and protective factors embedded in the children’s communities and families to children’s temperaments and abilities.

The American Academy of Child and Adolescent Psychiatry developed the CASII and ECSII as tools to objectively determine the service needs of children and adolescents and evaluate their overall functioning across various settings regardless of the diagnosis or system. Both the CASII and ECSII consider child development and the importance of family and community. They apply to a wide variety of treatment environments as well as child and adolescent needs. These tools are similar in origin and format to the Level of Care Utilization System (LOCUS), the instrument for determining the appropriate level of service intensity for adults with mental illness.

Outcome measures reporting system

DHS developed an outcome measurement system in 2009 for children’s mental health services. The system allows for reporting on the Child and Adolescent Service Intensity Instrument (CASII) or Early Childhood Services Intensity Instrument (ECSII) and the Strengths and Difficulties Questionnaire (SDQ). The outcome measures system provides immediate feedback to clinicians by scoring the CASII, ECSII and SDQ.

Mental health providers access the Children’s Mental Health Outcome Measures Reporting System through MN-ITS, the DHS billing system for Minnesota Health Care Programs (MHCP). MHCP-enrolled mental health providers are required to administer and submit outcome assessments for all children receiving publicly funded mental health services every six months, at a minimum.

DHS uses information collected through the Outcome Measures Reporting System for a variety of reporting purposes at the federal, state and local levels, including reporting to key stakeholders on the effectiveness of children’s mental health services in Minnesota.

Related Links

  • DHS Bulletin #17-53-01: DHS Updates Requirement for Standardized Outcome Measures for Children’s Mental Health
  • Outcome Measures Pilot: SDQ and CASII (PDF)
  • Training – Outcome Measures
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