Universal Screening Tools
PSC-17 (Pediatric Symptom Checklist-17): Ages 3-17 years
SDQ (Strength and Difficulties Questionnaire): Ages 3-17 years
SDQ (Strength and Difficulties Questionnaire) English I Spanish I Chinese (traditional) I Chinese (simplified)
Substance-use Screening Tools (CRAFT)
Substance-use Screening: CRAFFT screening interview
Trauma Screening Tools
Depression Screening Tools
SMFQ (Short Mood and Feelings Questionnaire): Ages 6-19 years
SMFQ (Short Mood and Feelings Questionnaire) Child-report I Parent-report
EDPS (Edinburgh Postpartum Depression Scale): Mothers
Anxiety Screening Tools
ADHD Screening Tools
Vanderbilt: Ages 6-12 years
SNAP-IV (Swanson, Nolan and Pelham Teacher and Parent Rating Scale): Ages 6-18
ASRS-V1.1 (Adult ADHD Self-Report Scale)
ASRS-V1.1 (Adult ADHD Self-Report Scale): English
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Table of Contents for ADHD
Link to Full PDF
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Vanderbilt (ages 6-12 years)
Parent Vanderbilt, Initial: English | Spanish | Chinese
Teacher Vanderbilt, Initial: English | Spanish
Parent Vanderbilt, follow up: English | Spanish
Teacher Vanderbilt, follow up: English
Vanderbilt Scoring Instructions PDF
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SNAP-IV (Swanson, Nolan and Pelham Teacher and Parent rating scale, ages 6-18 years)
SNAP-VI (90-items): English
SNAP-VI (26-items): English
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ASRS-V1.1 (Adult ADHD Self-Report Scale): English
PCIT
PCIT is an evidence-based treatment (EBT) for preschool aged children with disruptive behavioral problems. It is conducted through “coaching” sessions where a therapist observes through a one-way mirror while the parent and child is observed interacting in the playroom. The therapist will be coaching you live on how to manage your child’s behaviors from outside the one-way mirror observing you and directing the parent through a “bug-in-the-ear” device.
Parent Training in Behavioral Management (PTBM)
Use rewarding stimuli (i.e., positive reinforcement) or removal of an aversive stimuli (i.e., negative reinforcement) to increase desirable behavior.
Adults are trained to identify the behaviors, explain them in simple terms, identify the triggers or setting the behaviors occur in, modify response/punishment, and develop positive strategies to decrease child’s undesirable behaviors.
Modify Triggers (Preventive)
Clear, behavioral specific instructions
Consistent and predictable discipline
Daily structured schedule
Use a timer to help complete tasks
Modify Consequences
Reward system (ie. sticker charts, school-home daily report card)
Praise positive behaviors
Ignore negative attention seeking behaviors
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Psychoeducational assessments
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504 Plan, or Individualized Education Plan (IEP) if indicated.
Online Resources
Parents’ Medication Guide for ADHD (AACAP)
Center for Disease Control: Treatment of ADHD
Helpful topics:
- For Parents of children with ADHD (NICHQ Toolkit ADHD Psychoeducation)
- Educational Rights for Children with ADHD with IEP Sample Letter
- How to Establish Home-School Daily Report Card
- Homework Tips for Parents
- What Can I Do When My Child Has Problems With Sleep
UCSF Collaborative Life Skills Program
- List of Reward ideas
- Turning Homework Problems into Behavioral Goals
- Tips for Designing a Home Challenge
- Home Challenge Samples + Home Challenge Template
- Strategies for Avoiding Negotiations
- Parent Stress Management
Special Education Resources: DREDF (Disability Rights Education and Defense Fund)
Children and Adults with ADHD (CHADD)
ADDitude Magazine
Table of Contents for Anxiety
- Rule out Depression – PHQ-9
- If any obsessions/compulsions – rule out OCD – CY-BOCS
- If any trauma hx, nightmares/flashbacks – rule out PTSD
Psychoeducation
Normalization
Anxiety is a normal part of life. Everyone experiences anxiety sometimes, but it can become a problem if it’s causing you a lot of distress or getting in the way of your functioning. Our brains use the fight, flight, or freeze response to help us stay safe. Have you heard of this before? Basically, it means that when our brains perceive a threat, we often respond by fighting (arguing, irritability), fleeing (avoidance), or freezing (shutting down). While a little anxiety can be helpful, too much can get in the way of things. For instance, a little anxiety might help motivate you to study for your test, but too much anxiety can lead to procrastination (avoidance) which while in the short term may make you feel better, isn’t helpful in the long term.
Education on Avoidance
Avoidance is one of the key parts of anxiety. When something makes us anxious, we tend to avoid it (flight response) which then temporarily relieves the anxiety. However, most of the things that we worry about we can’t avoid forever, and the more we avoid something the bigger the anxiety gets. Like in the studying procrastination example, the longer you put off studying for a test, the more the anxiety builds. This creates a feedback loop where the more anxious someone is, the more they avoid, and the bigger the anxiety gets.
Exposures are a strategy for stopping this feedback loop. Exposures are the opposite of avoidance; you expose yourself to what’s making you anxious instead of avoiding it. While this increases your anxiety short term, with continued exposures your anxiety goes down. This is due to a process called habituation where your body gets used to things over time. Exposures are approached in a stepwise manner; you start by exposing yourself to something that’s a little anxiety-provoking and practice tolerating that. Once that’s okay, you gradually practice exposures to medium and then very anxiety-provoking things. For instance, if someone is afraid of snakes, they might start by talking about snakes, then looking at pictures, then a video, gradually working up to managing their anxiety while seeing a live snake. If your anxiety is milder, you can practice exposures at home with the support of your family and written resources. If your anxiety is more severe, you can work with a therapist to practice exposures as part of a treatment called Cognitive Behavioral Therapy (CBT).
Relaxation Technique
Strategies to calm down the body’s fight or flight response and reduce anxiety.
Deep breathing
- Belly breathing
- Sit comfortably with hands on belly.
- Breath in slowly through your nose.
- Imagine you are blowing up a balloon that is expanding against your hand.
- Breathe out slowly through your mouth, deflating the balloon.
- Try to make your exhale longer than your inhale.
- 3-4-5 breathing
- Inhale for 3 counts
- Hold for 4 counts.
- Exhale for 5 counts
- Fun ways to practice breath control: pinwheels, blowing bubbles, whistling.
Muscle Relaxation: tensing muscles and then releasing them allows them to relax.
Robot Ragdoll
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First try to be stiff like a robot, keep your muscles tight.
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Then relax all your muscles, try to be floppy like a ragdoll.
Progressive muscle relaxation (PMR)
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Sequentially tense then relax each muscle group.
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Start by curling your toes tight for 5 seconds then release.
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Then tense your calves for 5 seconds then release.
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Gradually move up to the head.
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Analogies, such as shrugging your shoulders like a turtle, can be helpful for younger children.
Imagery
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Think of a place that is calming for you.
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Imagine every detail, including each sense (sights, sounds, smell, taste, feel)
Mantra – A phrase to help calm and refocus.
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Think of a coping thought.
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Practice repeating this phrase when you’re anxious.
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Examples: “This too shall pass”, “I am enough”, “I can control my panic with breathing”
Cognitive Behavioral Therapy (CBT)
CBT is a type of time-limited therapy based on the concept that thoughts, behaviors, and feelings all affect each other and that by changing our thoughts and behaviors, we can change how we feel. It is often the first choice for children and teens with depression, which ranges from 6-20 sessions. It is the psychotherapy with the most evidence for treatment of childhood anxiety disorders. It consists of five main parts:
1. Psychoeducation to both child and parent about anxiety disorders and CBT
2. Somatic management skills training
3. Cognitive restructuring
4. Exposures
5. Relapse prevention plans
First-line recommended medication: SSRI (Fluoxetine, Sertraline)
Indications
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Limited improvement with therapy
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Anxiety interfering with ability to engage in therapy, exposures.
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Severe Anxiety (GAD-7 > 16)
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Comorbid disorder requires treatment.
Continue SSRI for at least 6 months into remission before considering weaning off medication.
SSRI treatment flow chart
SSRI
SSRI Tipsheet (PDF)
Clinical Pathway for Anxiety
Full PDF: Clinical Pathway for Anxiety
Handouts
Anxiety Resources Family Handout (PDF)
Emotion Coping Skills Resources (PDF)
Anxiety Book Resources (PDF)
Anxiety Disorders: Parents’ Medication Guide (AACAP) English | Spanish
Online Resources
Tools for supporting Emotional Wellbeing in Children and Youth (Link)
AACAP Anxiety Disorders Resource Center (Link)
Anxiety & Depression Association America (Link)
Anxiety Canada (Link)
The National Child Traumatic Stress Network (Link)
Coping Cat Parents (Link)
Anxiety in the Classroom (Link)
Tools for supporting emotional wellbeing in children and youth (Link - The National academies of Sciences Engineering Medicine)
Project Empower (Link - one session online program for parents teaching skills to build bravery and reduce anxiety in children)
Resources for Primary Care Providers
Primary Care Provider Resources for ASD (PDF)
Handouts for Families
Autism Resources for Families (PDF) English I Chinese (traditional) I Chinese (simplified)
Helpful Links
Conservatorship
Autism Speaks Guardianship and Conservatorship
Local community resources
Other academic institutional resources for ASD
Stanford Autism Center
Stanford Adult Neurodevelopment Clinic
UC Davis Health Mind Institute Autism
Download Full PDF
PHQ-9 Adolescent (ages 11-17 years) English | Spanish
SMFQ (Short Mood and Feelings Questionnaire) Child-report I Parent-report | Scoring
EDPS (Edinburgh Postpartum Depression Scale) English | Spanish
Psychoeducation
- Depression in Children and Teens (PDF)
- Managing Depression or Sadness: Tips for Families (AAP) English | Spanish
Psychotherapy
1. CBT is a type of time-limited therapy based on the concept that thoughts, behaviors, and feelings all affect each other and that by changing our thoughts and behaviors, we can change how we feel. It is often the first choice for children and teens with depression, which ranges from 6-20 sessions.
2. Interpersonal Psychotherapy (IPT) is a time-limited (12-16 session) individual psychotherapy for adolescents aged 12 and above with depression. The principal of IPT is that interpersonal problems may cause or exacerbate depressive symptoms and vice versa. It aims to identify life events and interpersonal problem areas that lead to depression and equips teens with interpersonal problem solving and communication skills to interact with challenging situations positively.
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First-line recommended medication: Selective Serotonin Reuptake Inhibitor (Fluoxetine, Escitalopram, Sertraline)
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Indications (can be fold out? If too lengthy)
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Limited improvement with therapy
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Depression interfering with ability to engage in therapy, exposures.
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Severe Depression (PHQ-9 ≥ 15)
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Comorbid disorder requires treatment.
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Continue SSRI for at least 9-12 months into remission before considering weaning off medication.
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SSRI treatment flow chart
SSRI Tipsheet (PDF)
Click here for resource: Suicide and Safety
AAP Endorsements – Guidelines for Adolescent Depression in Primary Care (GLAD-PC)
Handouts
Online Resources
- AACAP Suicide Resource Center
- Suicide Safety: Precautions at home (Link)
- Teen Suicide Prevention – Mayo Clinic (Video)
- Anxiety & Depression Association America
- Families for Depression Awareness
- National Alliance on Mental Illness (NAMI)
- Effective Child Therapy (Evidence-based Mental Health Therapy for children and adolescents)
- The National Child Traumatic Stress Network
- StopBullying.gov
Crisis Resources
- National Suicide Prevention Lifeline 988 Suicide & Crisis Lifeline (Call, Chat, or Text 988)
- Crisis Text Line (Text HOME to 747747)
- The Trevor Project
Download Full PDF
2. If Screening (C-SSRS, ASQ) Positive, then complete Brief Suicide Safety Assessment (BSSA, 10-15 mins)
- Work together with patient: NIMH ASQ Brief Suicide Safety Assessment (BSSA) Worksheet
- For Provider (reference): BSSA Provider Guide
3. Good evidence supporting use of Safety Planning and Lethal Means reduction to reduce suicide attempts and completed suicides.
- Suicide Safety Plan (Stanley-Brown)
- Lethal Means Reduction (PDF)
4. Mental Health Crisis Resources Handout for Family
Mental Health Crisis Resources Handout for Family
AAP Clinical Report: Suicide and Suicide Attempts in Adolescents (Article)
Online Resources
Crisis Resources
- National Suicide Prevention Lifeline 988 Suicide & Crisis Lifeline (Call, Chat, or Text 988)
- Crisis Text Line (Text HOME to 747747)
- The Trevor Project
Online Resources
- American Foundation for Suicide Prevention (AFSP)
- NAMI (National Alliance on Mental Illness)
- StopBullying.gov
- AACAP Suicide Resource Center
- Suicide Safety: Precautions at home (Link)
- Teen Suicide Prevention – Mayo Clinic (Video)
Resources for Primary Care Providers
CAPP Eating Disorder Guide for Providers ( Short PDF I Comprehensive PDF)
Handouts for Families
CAPP Eating Disorder Guide for Caregiver (PDF)
Helpful Links
Articles
Online Resources
- AAP Trauma Toolbox for Primary Care Link
- AACAP Bullying Resource Center Link
- AACAP Trauma and Child Abuse Resource Center Link
- ACES Aware Link
- Child Traum Academy Link
- The National Child Traumatic Stress Network (NCTSN) Link
- International Society for Traumatic Stress Studies (ISTSS) Link
- The Center on the Developing Child – Harvard University Link
- Health Care Toolbox: Pediatric Medical Traumatic Stress Link
Helping Families Understand Trauma and Impact
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Scripts for Helping Families Understand Trauma and Impact |
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Affirmation of Trauma Response |
Symptoms (sleep difficulties, aggression, acting out etc) are the body’s way of protecting itself from threat.
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Pathophysiology of Trauma Response |
Our bodies and brains are wired to fight, run, or hide with threat. NOT to learn or remember facts about the event.
These responses are meant to be strong, but short in bursts.
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Help Caregiver recognize feelings of trauma
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Caregiver or older children can reflect on a time they felt threatened or anxious (car accident, fight) and remember how their bodies felt (heart racing, muscles tensing etc)
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Help Caregiver extrapolate own experience to toxic stress
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Think about what it is like if a “bear” is in the house. This can cause fight, run, or hide response but it doesn’t go away, but continues for a long period.
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Brain Response
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When a baby is learning to walk, they practice repeatedly until they can walk without thinking because the brain links become strong.
Response to trauma is similar. Once the brain link is strong, a small trigger can result in a strong response.
Parts of the brain that respond to trauma grow larger with strong connections, while parts of the brain for learning grow smaller.
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Adapted from AAP Helping Foster and Adoptive Families Cope with Trauma
Anticipatory Guidance
Anticipatory Guidance
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Trauma Specific Anticipatory Guidance |
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What you will see |
How Family can Respond |
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Misread facial expressions, non-verbal cues as a threat, or respond strongly to anything perceived as a threat
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Do not take child’s behaviors personally.
Help child understand your tone of voice, facial expression and reassure them. |
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Redirect before behaviors escalate
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Avoid yelling or raising voice Lower tone and intensity of voice Use simple, direct words Give directions without attaching strong emotions
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Difficulty expressing how they feel
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Tell the child it is ok to feel the way how they are feeling and show emotion
Give the child words to label their emotions.
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Poor self-regulation skills
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Practice breathing techniques, relaxation skills when child gets upset. Praise the child for expressing feelings and calming down.
Guide the child at first, then prompt the child to use his skills when he gets upset again.
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Challenging behaviors with the caregiver
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Give messages that the child is safe, wanted, capable, and worthwhile.
Also, offer support by reminding them you are there for them.
Praise even neutral behaviors
Be aware of your own emotional responses to the child’s behaviors.
Correct when necessary, in a calm, unemotional tone.
Repeat, repeat, repeat.
Do not take these behaviors personally.
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Adapted from AAP Helping Foster and Adoptive Families Cope with Trauma
Family Resources for Trauma and Stress
Handouts
Grief and Loss
- DOUGY Center Link
- Sesame Workshop Grief | Traumatic Experiences
- National Alliance for Children’s Grief (NACG) Link
- Lory’s Place Children | Teens | Suicide Loss
- The Compassionate Friends (For families grieving the loss of a child) Link
- Coalition to Help Grieving Students Link
Traumatic Experiences
- AAP Trauma Resources for Families Link
- Piplo Productions Link
- CDC: Coping with Stress after a Traumatic Event Link
- National Child Trauma Stress Network (NCTSN): Families and Caregivers Resources English | Spanish
- NIMH: Helping Children and Adolescents Cope with Traumatic Events Link
- ACES Aware English | Spanish
- Child Traum Academy Link
Bullying and Protecting Kids Online
Crisis Resources
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To support provider well-being, CAPP has developed Project SUPPORT: an online, self-guided Single Session Consultation in partnership with Dr. Schleider's Lab for Scalable Mental Health based on their well-established Single Session materials (https://www.schleiderlab.org/). To complete this brief web-based activity for managing burnout and thinking about your work in new ways, please visit: https://ucsf.co1.qualtrics.com/jfe/form/SV_9S1PP7saB490iYC
To learn more about utilizing the Single Session Consultation approach with your patients, please see our Skills-based ECHO page, which houses a recorded training video, slidedeck, provider scripts and patient action plans.