Validating Office-Based Screening for Psychosocial Strengths and Difficulties Among Youths in Foster Care

Sandra H. Jee · Moira Ann Szilagyi · Anne‐Marie Conn · Wendy Nilsen · Sheree L. Toth · Constance D. Baldwin +1 more

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Child Welfare and Adoption Child and Adolescent Psychosocial and Emotional Development Child and Adolescent Health

Abstract

OBJECTIVES: 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.

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References

1998Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults 1999The Extended Version of the Strengths and Difficulties Questionnaire as a Guide to Child Psychiatric Caseness and Consequent Burden 1999Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: Is Small Beautiful?2003The Strengths and Difficulties Questionnaire (SDQ)2005The Strengths and Difficulties Questionnaire: U.S. Normative Data and Psychometric Properties 2004Prevalence of Psychiatric Disorders Among Older Youths in the Foster Care System 2004Australian Data and Psychometric Properties of the Strengths and Difficulties Questionnaire 2000Children's Interview for Psychiatric Syndromes (ChIPS)

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2020A Systematic Review of Some Reliability and Validity Issues regarding the Strengths and Difficulties Questionnaire Focusing on Its Use in Out-of-Home Care 2013A Multi-state Study on Mental Health Evaluation for Children Entering Foster Care 2019Use of the Strengths and Difficulties Questionnaire to identify treatment needs in looked-after children referred to CAMHS 2018Identifying Psychosocial Problems Among Children and Youth in the Child Welfare System Using the PSC-17: Exploring Convergent and Discriminant Validity with Multiple Informants

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