The Assessment Checklist for Children — ACC: A behavioral rating scale for children in foster, kinship and residential care

Population and clinical surveys of the mental health of children in foster, kinship and residential care have failed to account for a range of problems manifested by such children, largely because measurement has been restricted to standard parent-report checklists. These under-researched problems include attachment-related difficulties, anxiety and dissociative responses to trauma, age-inappropriate sexual behavior and self-harm. The Assessment Checklist for Children (ACC) was developed to measure such problems in a prospective epidemiological study of children in long-term care. The ACC is a 120-item carer-report psychiatric rating instrument, measuring behaviors, emotional states, traits, and manners of relating to others, as manifested by children in care. Content was developed systematically, with a view to measuring all clinically significant problems experienced by children in alternate care that are not adequately measured by standard parent-report checklists. Ten clinical and two low self-esteem scales were empirically derived via factor analysis, and labeled: Sexual behavior; pseudomature interpersonal behavior; non-reciprocal interpersonal behavior; indiscriminate interpersonal behavior; insecure interpersonal behavior; anxious–distrustful; abnormal pain response; food maintenance; self-injury; suicide discourse; negative self-image; and low confidence. Initial data indicate that the instrument has good content, construct and criterion-related validity.