title: Identification of social-emotional problems among young children in foster care.
abstract: 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.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, NY, USA. sandra_jee@urmc.rochester.edu
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Jee
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Conn
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
authors.forename: Aaron
authors.initials: A
authors.lastname: Blumkin
authors.forename: Constance D
authors.initials: CD
authors.lastname: Baldwin
authors.forename: Moira A
authors.initials: MA
authors.lastname: Szilagyi
mesh_terms: 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