The Assessment Checklist for Adolescents Plus (ACA+) Mental Health and Relational Strengths Measure for Adolescents in Statutory Out-Of-Home Care: Content Validity and Factor Structure for a Residential Care Sample

Background The Assessment Checklist for Adolescents Plus (ACA+) is a 30-item caregiver-report mental health and relational strengths measure, containing items that are the converse of maltreatment-related mental health and relational difficulties measured by the Assessment Checklist for Adolescents (ACA) and its short form (ACA-SF). The present study is the first to investigate the ACA+’s content validity and factor structure. Methods ACA+ and ACA-SF scores were obtained for 220 adolescents (50.9% boys), aged 12-18 years, living in residential out-of-home care (OOHC) in the UK. Item validity was estimated from item score distributions (item means and prevalence), and correlations with ACA+ total and ACA-SF scale scores. Factor structure was investigated using principal components factor analysis. Results As anticipated, all item-rest correlations were positive ( r = .20 to .58), while correlations with the ACA-SF total score were all negative. However, items measuring emotion sharing and relational intimacy were positively correlated with several ACA-SF sub-scale scores, suggesting that among some adolescents these items measure maladaptive dysregulated emotion and relational difficulties. To maximise clinical utility, two sets of factor analyses were performed, yielding: a 21-item four-factor solution that can be safely interpreted by children’s agencies; and a 29-item six-factor solution that requires skilled interpretation by mental health clinicians. Factor analyses explained 53.9% and 75.1% of the score variance respectively. Conclusions The present analyses suggest the ACA+ has strong content and factorial validity for assessment of adolescents in residential OOHC. Further research is needed to establish its validity for use with adolescents in foster and kinship care.