title: Validating office-based screening for psychosocial strengths and difficulties among youths in foster care.
abstract: OBJECTIVE
  To assess the effectiveness of social-emotional screening in the primary care setting for youths in foster care.
  
  
  METHODS
  The setting was a primary care practice for all youth in home-based foster care in 1 county. Subjects were youths, aged 11 to 17 years, and their foster parents; both completed a Strengths and Difficulties Questionnaire at well-child visits. The Strengths and Difficulties Questionnaire is a previously validated 25-item tool that has 5 domains: emotional symptoms; conduct problems; hyperactivity/inattention; peer problems; and prosocial behaviors and an overall total difficulties score. We first compared youth versus parent Strengths and Difficulties Questionnaire scores and then assessed the accuracy of these Strengths and Difficulties Questionnaire scores by comparing them in a subsample of youths (n = 50) with results of home-based structured clinical interviews using the Children's Interview for Psychiatric Syndromes.
  
  
  RESULTS
  Of 138 subjects with both youth and parent reports, 78% had prosocial behaviors (strengths), and 70% had 1 or more social-emotional problems. Parents reported significantly more conduct problems (38% vs 16%; P < .0001) and total difficulties (30% vs 16%; P = .002) than did youth. The Strengths and Difficulties Questionnaire had better agreement with the Children's Interview for Psychiatric Syndromes (n = 50) for any Strengths and Difficulties Questionnaire-identified problem for combined youth and foster-parent reports (93%), compared with youth report alone (54%) or parent report alone (71%).
  
  
  CONCLUSIONS
  Although most youths in foster care have social-emotional problems, most have strengths as well. Youth and foster-parent perspectives on these problems differ. Systematic social-emotional screening in primary care that includes both youth and parent reports can identify youths who may benefit from services.
authors.affiliation: sandra_jee@urmc.rochester.edu
authors.forename: Sandra H
authors.initials: SH
authors.lastname: Jee
authors.forename: Moira
authors.initials: M
authors.lastname: Szilagyi
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Conn
authors.forename: Wendy
authors.initials: W
authors.lastname: Nilsen
authors.forename: Sheree
authors.initials: S
authors.lastname: Toth
authors.forename: Constance D
authors.initials: CD
authors.lastname: Baldwin
authors.forename: Peter G
authors.initials: PG
authors.lastname: Szilagyi
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000367:Age Factors; D002648:Child; D005260:Female; D005581:Foster Home Care / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000592:standards* / Q000639:trends; D009819:Office Visits; D010287:Parent-Child Relations; D010349:Patient Compliance / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D011584:Psychology; D018570:Risk Assessment; D012309:Risk-Taking; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012919:Social Behavior; D012940:Social Problems; D011795:Surveys and Questionnaires