Questionnaire Better Detects Emotional Problems in Foster Care Children

Jim Kling

October 09, 2010

October 9, 2010 (San Francisco, California) — A standardized questionnaire reveals that 24% of foster care children have social–emotional problems compared with 4% identified by provider surveillance. The results were presented here at the American Academy of Pediatrics 2010 National Conference and Exhibition.

Two validated screening tools have been recommended for use in young children. The Ages and Stages Questionnaire–Social Emotional (ASQ-SE) focuses on social–emotional problems, whereas the Ages and Stages Questionnaire (ASQ) includes development issues in 5 domains and includes personal–social problems.

"We know that mental health problems are a big issue for kids in foster care, but we don't have enough resources to refer everybody, so we need to have a systematic screening process for [identifying] the kids who are most at risk so we can get services to them," Sandy Jee, MD, MPH, an assistant professor of pediatrics at the University of Rochester Medical Center in New York, who presented the research, told Medscape Medical News.

The researchers set out to determine whether use of a screening tool improved the detection rate of social–emotional problems in foster care children, and the relative effectiveness of the 2 questionnaires. They conducted a retrospective chart review of detection rates for children between 6 months and 5.5 years of age. Detection rates were determined for both ASQ-SE and ASQ, and the team employed multivariable logistic regression analyses to examine associations between children who had social–emotional problems and those who did not.

In all, 192 children were screened with provider surveillance. Providers identified 4% with social and/or emotional problems. Among 159 children screened with a screening tool, the rate increased to 24%. More children with potential social–emotional problems were identified using the ASQ-SE than the personal–social domain on the ASQ questionnaire. Agreement between the 2 tools ranged from 56% to 74%, depending on age group. Multivariable modeling, which adjusted for demographics and length of time in foster care, revealed that social–emotional problems were most prevalent in pre-school-aged children (adjusted odds ratio, 3.4; 95% confidence interval, 1.1 - 10.8).

The researchers concluded that the ASQ-SE provided superior results for detection of social–emotional problems. "A specific social-emotional screening tool will detect an important subset of children with psychosocial concerns who would not otherwise be detected on a broader developmental screening tool," the authors wrote in their abstract.

"I really think if you want to pick out social and emotional issues, you have to use a specific social and emotional screener," said Dr. Jee.

She pointed out that many foster parents have a high threshold for tolerating behavioral problems, and as a result, vague questions may not elicit a response. "They think really bad behavior is how kids normally act because they've become used to that. We had to use a screening tool with explicit questions about behavior and development, because otherwise they'd [mark the answers] as 'no problem, no problem, no problem.' "

Standardized questionnaires are gaining increased acceptance in the community, added Linda Sagor, MD, MPH, division director of general pediatrics and director of the Foster Children Evaluation Services Clinic at University of Massachusetts Medical School, in Worcester, who moderated the session. "We do a good job of picking up social–emotional issues by talking to the families, but we do a better job by talking to families and using these standardized tools. It really determines a much higher rate of social–emotional issues, and that's really because if we can detect them, then we can provide services for those kids," Dr. Sagor told Medscape Medical News.

Dr. Jee and Dr. Sagor have disclosed no relevant financial relationships.

American Academy of Pediatrics 2010 National Conference and Exhibition: Abstract 11232. Presented October 4, 2010.

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