title: Statutory health assessments for pre-school foster children fail to screen accurately for mental health disorders.
abstract: The aim of this study was to determine the diagnostic accuracy of statutory health assessments in identifying existing mental health disorders in pre-school foster children. It was examined whether a foster carer completed screening instrument could enhance accuracy. A representative sample of 43 pre-schoolers under the care of one inner-city local authority underwent comprehensive multidimensional mental health assessments as the reference standard. Statutory health assessments gave false negative results for 65% (95% confidence interval (CI) 44-82%) of children diagnosed with at least one mental health disorder according to the reference standard and 18% (95% CI 3-52%) of children with developmental delay. The Ages & Stages Questionnaire completed by the foster carers failed to identify 65% (95% CI 44-82%) of the children with diagnosed mental health disorders. There was no evidence of selective underreporting by foster carers in relation to specific diagnostic categories. In conclusion, statutory health assessments in their current form may fail to identify the majority of pre-school foster children with mental health disorders. Adding a screening instrument to the assessment process may not be adequate to improve diagnostic accuracy.
authors.affiliation: Child and Family Department, Tavistock and Portman NHS Foundation Trust, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hillen
authors.forename: Leonie
authors.initials: L
authors.lastname: Gafson
mesh_terms: D002675:Child, Preschool; D005260:Female; D005581:Foster Home Care / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening / Q000592:standards*; D001523:Mental Disorders / Q000175:diagnosis*; D011581:Psychological Tests / Q000592:standards; D012680:Sensitivity and Specificity; D012946:Social Welfare
keywords: Out-of-home care; assessment; mental health; pre-school children; sensitivity; specificity