!Kids and capability
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agk's phlog
28 September 2021 @ 1137
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written on X61 after lunch
at the kitchen table
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I wrote my research paper on a 16-question capability
assessment, OxCAP-MH. It was developed in the UK ten
years ago. A research group in Austria got into it
and published a flurry of studies in the last 3 years.
My first day back to work put me on the child unit of
the psych hospital. When I was on leave, staff short-
age and an adolescent riot led management to close an
adolescent unit. I had patients aged 7 to 17 sleeping
and programming together---a real challenge!
Check-in had been the unit's first group. Kids hated
answering the symptom-focused, pathologizing quest-
ions three times per shift (by us, nurses, and social
workers):
* Wanna kill yourself?
* Wanna kill anybody else?
* Wanna hurt yourself?
* Wanna run away?
* Hearing anything I can't hear?
* Seeing anything I can't see?
* Pain anywhere in your body?
* Do you feel loved? By who?
* What are your triggers?
* What's your coping skill?
A kid says yes, he gets a high risk indicator on his
15-minute observation sheet, chart, and shift report.
HRIs include "SI" (suicidal ideation), "SH" (self-
harm risk), "AVH" (audiovisual hallucinations),
"ELOPE" (elopement risk), etc.
While I was on leave, check-in was abolished. I'd
relied on check-in to get to know each kid each
shift. I don't care about the question set. I just
need the excuse to talk to each kid, listen, and
establish rapport. It helps me plan programming,
manage the millieu, and handle distress.
I took the OxCAP-MH question set, more or less (our
intranet blocks the TLD of the university website
that hosts it), and translated it to kid-friendly
language. I changed the five-item Likert scale to a
three-item scale (YES/Sort of/NO). I ran it by the
charge nurse. She okayed it.
Each kid (and adolescents on the unit) answered my
16-item "OxCAP-MH (Child)" assessment at the start
of my next three shifts.
* I can play (or hang out) with friends.
* I get too worried to sleep.
* I can do stuff I think is fun.
* I like where I live.
* I feel safe at school.
* Somebody will probably discriminate against me.
* Somebody will probably beat me up or hurt me.
* I get to help make decisions that affect me.
* I can say what I think about things.
* I get to play outside (or enjoy nature).
* I like the people I'm around.
* I have love, friends, and support.
* I get to be creative.
* My triggers are...
* My best coping skills are...
* My goal for today is...
The program coordinator liked my improvised check-
in. Now it's used every day. My observations:
* Lots of our kids have sleep disrupted by worry,
don't feel safe at school, and can't say what
they think.
* Play, fun, friends/support, and liking people
cluster.
* Kids' explanations matter.
One can't play with friends/outside, have fun,
etc., because she's tired or sick. Another's
dad won't let him, or mom won't get out of
bed. A third is shy, doesn't have friends, or
is in a new foster family/school.
It will take organized IRB-approved research to say
anything defensible about what kind of mess I made
by cutting the five-item scale down and yanking
three questions, or how to score it and what scores
mean. Still, it's been a fun project so far.
