Using the Dominic Interactive
A multipurpose screener

For clinical work
Children like computer games. They make them feel in charge. Putting children in front of a computer to play a game tends to give them confidence and foster the kind of relationship children are comfortable with. It is themselves they speak to while answering the Dominic Interactive queries.

Internalizing disorders
Even though they know the children well, empirical data suggest that adults tend to perceive the externalizing behaviour problems rather than the anxious or depressive aspects of the child's inner world, and may not be aware of various delinquent activities.

The Dominic Interactive supports a more nuanced assessment of children’s mental health. Among children referred for behavioural difficulties about 50% suffer from internalizing disorders as well. The Dominic Interactive helps uncover often hardly noticeable or hidden internalizing problems.

Caught between the habitually overwhelming outer point of view of adults and the inner world of children, clinicians are more often in agreement with the child.

Defense reactions
The Dominic Interactive may avoid asking questions that trigger a defense reaction.

  • Clicking on any tendency bar on the results page brings the questions back on screen.
  • Clicking on any question brings the picture back to help the child elaborate.
  • Questions can be brought back on screen at anytime, e.g., during later appointments.

Other clinical advantages

  • Professionals often have to read traditional questionnaires to the child and many find them complicated and boring.
  • When children get tired during clinical interviews the Dominic Interactive may rekindle their motivation.
  • The Dominic Interactive may help parents recognize issues mentioned by the professional.


At school
The school environment favours the identification of disruptive behavioural problems. The Dominic Interactive promotes a more balanced perspective on children. A case in point is the high number of children deemed hyperactive in the school environment. The Dominic Interactive often reveals that the child suffers from anxiety disorder.

  • Mental health problems are closely related with academic underachievement, jeopardizing the child's future.
  • While no one wants to be overzealous in seeing emotional and behavioural development as problems one does not want to ignore significant problems. Attempts to avoid the stigma of mental health disorders may hinder appropriate detection. Under-identification or misidentification makes it less likely that such children will be referred for needed mental health services.
  • Screening strengthens the capacity of schools to serve as a key link to a comprehensive system of community-based identification, assessment and treatment services for child mental health.
  • The Dominic Interactive is cost-efficient for at-school screening and to establish school profiles.
  • Because students can easily be assessed, they can quickly be referred to appropriate resources.


Research
Scientific advantages

  • Any interference between the child’s reaction and the final result is blocked out. Data are provided directly by children themselves, minimizing any bias by the interviewer or the social environment.
  • Social desirability bias is diminished. Child-computer interaction induces more spontaneous, less socially desirable responses than child vs. adult-interviewer interaction.
  • No question can be skipped.
  • The instrument allows 6 year-olds to be reliable informants about their own mental health. Standardized data can thus be gathered from children as young as age 6.
  • Data are exported in TXT format and a tabulator facilitates import within statistical packages.

Financial advantages

  • The program is so easy, fast and simple that interviewers need little training.
  • Because it runs quickly, assessment costs are greatly reduced.
  • Group administration in computer labs further reduces costs.
  • Because the child's responses are automatically recorded, coding costs and errors are eliminated.


Public health
Mental health: some statistics

  • According to epidemiological surveys prevalence estimates of mental disorders in children and adolescents hover around 20%.
  • The WHO calculated a “Burden of Disease” for each type of illness (Murray & Lopez, 1996). Health problems directly or indirectly associated with mental health represent more than 50% of the global burden of disease in developed societies, more than cancer and cardiovascular diseases put together.
  • Mental disorders are very stable and more than half of them start before age 14.

Consequently, population-based approaches to youth mental health are hard to sidestep if any improvement is to be achieved.

Screening
Screening is the identification of health issues using fast, low-cost procedures.

When mental health is concerned, the number of symptoms matches the severity of the condition. Therefore symptom screening, like medical triage in wartime, sorts children out based on the severity of their condition.

Services organization

  • This type of information allows services to be based on actual needs, instead of population numbers, political motives or subjective impressions.
  • It also allows prioritizing and resources to be devoted to those most suffering, most at risk or most dangerous to themselves and/or others.
  • Screening also detects the nature of problems, i.e., qualitative information. As a result, focused prevention and treatment programs can be implemented.
  • Because prevalence estimates are so high, group interventions and collective family prevention programs (e.g., development of parental competencies) are more appropriate than costly individual interventions that might target only the neediest.
  • Early intervention, in addition to relieving suffering, is more effective, less time consuming and less costly than later intervention that takes place when a child's behavior can no longer be tolerated.

Screening gives every child equal access to services
Because teachers or parents have difficulty tolerating deviant behaviors, children who are taken care of are often those who are most annoying for adults.

There are many other youths whose mental health problems are never identified because they do not cause much trouble, like children and adolescents carrying internalizing disorders that may foster suicidal behaviour. Suicide is the third most frequent cause of adolescent death in the US, and the second in Quebec.


Training
Many professionals (e.g. teachers, administrators, etc.) attending to children receive only little training in child psychopathology. For these service providers who are in constant interaction with children, child mental health usually remains highly abstract and theoretical. This lack of training has led to reactive, punitive, control/containment interventions that do not work to establish positive behaviours or improve learning.

Because the Dominic Interactive pictorial format graphically shows what child mental health problems look like, the illustrated situations stay vividly in the mind of students and professionals (e.g., nurses, physicians), helping them recognize children’s emotional and behavioural problems.



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