Identification of social-emotional problems among young children in foster care.
BACKGROUND
Little is known about how best to implement behavioral screening recommendations in practice, especially for children in foster care, who are at risk for having social-emotional problems. Two validated screening tools are recommended for use with young children: the Ages and Stages Questionnaire: Social Emotional (ASQ-SE) identifies emotional problems, and the Ages and Stages Questionnaire (ASQ) identifies general developmental delays in five domains, including personal-social problems. The current study examined: (1) whether systematic use of a social-emotional screening tool improves the detection rate of social-emotional problems, compared to reliance on clinical judgment; (2) the relative effectiveness of two validated instruments to screen for social-emotional problems; and (3) the patterns of social-emotional problems among children in foster care.


METHODS
We used retrospective chart review of children in foster care ages 6 months to 5.5 years: 192 children before and 159 after screening implementation, to measure detection rates for social-emotional problems among children. The ASQ-SE and the ASQ were used in multivariable logistic regression analyses to examine associations between children with social-emotional problems.


RESULTS
Use of the screening tool identified 24% of the children as having a social-emotional problem, while provider surveillance detected 4%. We identified significantly more children with social-emotional problems using the ASQ-SE than using the ASQ, and agreement between the instruments ranged from 56% to 75%, when data were stratified by age group. Multivariable modeling showed that preschool children were more likely to have a social-emotional problem than toddlers and infants (aOR = 3.4, 95% CI = 1.1-10.8).


CONCLUSIONS
Systematic screening using the ASQ-SE increased the detection rate for social-emotional problems among young children in foster care, compared to provider surveillance and the ASQ. A specific social-emotional screening tool appears to detect children with psychosocial concerns who would not be detected with a broader developmental screening tool.
Jee
Sandra H
SH
Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, NY, USA. sandra_jee@urmc.rochester.edu
Conn
Anne-Marie
AM
Szilagyi
Peter G
PG
Blumkin
Aaron
A
Baldwin
Constance D
CD
Szilagyi
Moira A
MA
D000342:Affective Symptoms / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D004644:Emotions; D005260:Female; D005581:Foster Home Care / Q000523:psychology*; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012919:Social Behavior; D012920:Social Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires