Strengths and Difficulties Questionnaire Procedure


This procedure sets out the requirement for a Strengths and Difficulties Questionnaire (SDQ) to be complete in relation to all Children Looked After. It contains guidance on who should carry out the SDQ, how it should be recorded and how the information gathered should be used to improve health outcomes for the child / young person.


Health Care Assessments and Plans Procedure


Medium or High SDQ Workflow

1. Introduction

Evidence suggests that any Child Looked After has the risk of being up to five times more likely to have emotional health needs than children who are not in care.

Since April 2008 all local authorities in England have been required to provide information on the emotional and behavioural health of children and young people in their care, and to report back to central government on an annual basis. Data is collected by local authorities through the completion of the Strengths and Difficulties Questionnaire (SDQ) on individual children. A single aggregated score for the cohort is then provided based on the scores for each child (the total difficulties score) and submitted to the Department for Education through the SSDA903 data return each year.

The SDQ is not merely a data collection tool. When used consistently and, when outcomes for each child or young person are analysed, the SDQ is a very useful way in which social workers and others working with Children Looked After can identify their emotional health needs, act upon them accordingly and review progress and improvement of outcomes.

The SDQ should be completed with the care giver for all children who have been Looked After for at least 12 months and were aged between four (4) and sixteen (16) years (inclusive) at the date of their latest Health Needs Assessment.

The SDQ has five sections that cover details of emotional difficulties, conduct problems, hyperactivity or inattention, friendships and peer groups and Pro Social behaviour.

The SDQ has been internationally used and accepted and is considered universally suitable. It is available in alternative languages from the Strengths and Difficulties Questionnaires website.

2. Who should carry out the Strengths and Difficulties Questionnaire and when?

There are three types of SDQ; one undertaken by the social worker and care giver, one undertaken with the young person by a health practitioner (where children are aged 11 and over), and one which can be undertaken by the school.

2.1 SDQ with Carer

The social worker is responsible for ensuring that the SDQ is carried out with the care giver of the child or young person. The care giver may be the Foster Carer or if the child or young person is in residential care, the care giver is usually the child's key worker. For a small number of young people, aged 16, in independent accommodation, the SDQ will be completed by the young person themselves with support from their Personal Advisor.

The social worker must discuss the SDQ with the care giver and carry it out with them. This can be done during a statutory visit to the child or young person. For children and young people over the age of five years, the SDQ must be completed to coincide with the completion of the Health Needs Assessment (HNA).

For children aged four years and above, the HNA is carried out every six months, so a decision should be made at which HNA to carry out the SDQ.  This decision might be made by the Team Support Officer in each team, who will then co-ordinate with the Social Worker to ensure the collection of information in regards to the SDQ scores are recorded accurately on Liquid Logic.

The care giver does not require permission from the child to carry out the SDQ; however, it should be carried out with the child's full knowledge. If the child aged 11 or over objects about the completion of the SDQ, the child's Social Worker should record this. The carer and the social worker should not discuss and complete the SDQ in front of the child or young person.

If a child or young person has a disruption or a significant change in their placement, and the SDQ has been completed around this time, best practice would be to carry out the SDQ again to review whether following a settling down period, there has been an improvement for the child.

2.2 SDQ with Health Practitioner

A second SDQ is undertaken with young people aged 11 and over. This is normally carried out by a health practitioner. On Wirral, for children aged 11 -13 years, the School Nurse is responsible; for those young people aged 13+, the Children Looked after Specialist Nurse is responsible. The relevant nurse carries out the SDQ with the child or young person. If the child or young person refuses to take part, the nurse should record this on the HNA.

The Looked after Nurse ensures that the final SDQ score is entered on the HNA. The completed HNA is sent to the relevant social work Team administrator to upload to the child's Liquid Logic record. The team support officer logs the HNA date on the health tab, notifies the Social Worker of receipt and records if SDQ has been completed or not and the score within a case note.

2.3 SDQ with Education

If a school suspects that a pupil is experiencing mental health difficulties they should not delay in putting support in place. One way in which schools can act on this is to use the SDQ to assist them in taking an overview and making a judgement about whether the pupil is likely to be suffering from a mental health problem, how this might be impacting on their ability and/or readiness to learn and how planning to meet their emotional and mental health well-being can be incorporated into their Personal Education Plan (see Education of Children with a Social Worker, Looked After and Previously Looked After Procedure, Personal Education Plan (PEP)).

Further guidance is available from: Mental health and Behaviour in schools - Departmental advice for School Staff.

3. Contents of the Questionnaire

The SDQ provides a number of statements and a judgement must be made by the person completing the SDQ by ticking one of the three/four boxes. A tick must be placed inside the box. A choice must be made by the person completing the form, (this may be the carer or social worker), for the SDQ with Carer.

4. Recording the Questionnaire

Once the SDQ has been completed with the carer, the social worker must ensure that the SDQ scores are recorded on the child or young person's Liquid Logic record. A 'blank' SDQ form on Liquid Logic should be started by the social worker or the team support officer and the details entered on the form.

The overall score (classified as 0-15, 16-19 and 20-40 – with the highest scores being of most concern) and the Pro Social score (classified as 6-10, 5 and 0-4 – with the lowest scores being of most concern) will be generated on the form once each field has been entered. The Pro Social Score is not included in the calculation of the child's emotional well-being. If the team administrator is inputting the information, they must create a case note on the child's Liquid Logic record to alert the social worker of the score. The terminology for the scores within the SDQ guidance is explained below, with the relative score. However, the terminology used in these procedures is Low, Medium or High.

Total SDQ score Pro Social score
Normal 0-15 Low   Normal 6-10 High
Borderline 16-19 Medium Borderline 5 Medium
Abnormal 20-40 High Abnormal 0-4 Low

5. Outcomes, Analysis and Action – What action the scores indicate

Low scores

Where total SDQ score is Low, this should be recorded on the child's record and no further action is required.

Medium or High scores

Where the total SDQ score is Medium or High and where the Pro Social Score is Low or Medium (the pro-social score is a concern but not in isolation), the social worker should consider how best to meet the emotional needs of the child or young person and take action.

Where the child or young person is aged 11 and over, the social worker should also take into account the score from the SDQ carried out by health and undertaken with the young person, rather than their carer.

Where school carry out a SDQ, they should share the outcome of the questionnaire with the allocated social worker who will then record the score on the child's Liquid Logic record in case notes. The social worker should consider this new information in conjunction with the health SDQ and the questionnaire carried out with the carer.

At minimum, best practice would be to discuss the outcome of the SDQ (where there is not a total SDQ of low score) with the relevant nurse (school or looked after) and with the Designated Teacher at school. Scores from all the latest SDQs completed should be shared with any other agencies / practitioners that are directly involved with the young person. The social worker should lead on ensuring that this activity takes places.

Part of the discussion should focus on the educational attainment of the child or young person and the possible relationship between emotional health needs.

Together school, health and the social worker should aim to identify if a child is displaying challenging behaviour in a particular setting or all settings and seek to identify any simple changes within each setting to support the young person. In addition, any other options should be identified to improve the child's emotional health.

In all cases, the following actions should be taken:

  • Discussion / Supervision with the social work team manager. The social worker should discuss the outcome of the SDQ in supervision with their team manager. The team manager does not need to sign off the SDQ. The Team Manager should decide whether a Child and Family Assessment  is required to explore all aspects of the child's life to understand why they may have poor emotional and mental health, and what might help;
  • A phone call should be made to the CAMHS consultation line, this will offer advice and guidance in the first instance, but will also lead to a completion of a referral for a 'choice appointment' if threshold with CAMHS is met;
  • Inform the Independent Reviewing Officer - the information should be shared with the Independent Reviewing Officer (IRO) who should investigate this with the allocated social worker;
  • Discuss the SDQ in the child looked after - the social worker should ensure that the SDQ is included in the care plan review discussion. The IRO will challenge actions identified and taken, and check that there is analysis informed discussion between those involved, that actions are identified and carried out to help improve the child's mental health;
  • Review the Personal Education Plan (PEP) and seek advice from the Virtual School – the PEP should be reviewed by the social worker and the school. Advice should be sought from the Virtual School as part of this process;
  • Consider whether to contact Educational Psychology for advice.

6. Reviewing the SDQ

If any of the SDQs carried out result in a non-low score – including the carer SDQ, the health-led SDQ and the school-led SDQ, a review of each of the SDQs should be carried out within six months and progress analysed. If it is felt that there has been insufficient improvement for the child or young person, further advice from CAMHS should be sought.

7. Using the SDQ for non-Looked After Children and Young People

Although the SDQ is mainly used for children looked after, there is also the potential to use the tool for children who are not looked after. The same CAMHS consultation line is available to be used in these circumstances as well.