Review of mental health screening instruments for use with young children in child welfare

Background and Purpose. Many child welfare agencies are implementing standardized mental health screening as part of efforts to meet federal Child and Family Service Reviews outcomes and provisions of the 2003 Child Abuse Prevention and Treatment Act to ensure that young children receive early intervention services. Yet, many instruments have not been tested in child welfare, and little has been done to review the suitability of existing instruments for practice in child welfare. Mental health instruments have typically centered on the needs of older children and adolescents. This study focuses exclusively on young children and aims to provide practitioners, policymakers, and researchers with a review of options available to screen young children for mental health concerns. Methods. The study used major social science databases, websites of national organizations, and the Mental Measurements Yearbook to identify instruments designed to screen children ages 10 and younger. Instruments were eliminated from further review that: (1) had protocol or content specific to one setting (e.g. classrooms), (2) had to be administered by a licensed professional, or (3) were designed to screen for risk rather than symptoms, for example, exposure to trauma. Instruments at this point were reviewed further according to their psychometric properties, cost, administration and substantive content. Results. Nearly 80 instruments met the age-range criterion (n=77), one-half of which met the screening-definition criterion (n=40). Sixteen were further eliminated, resulting in a comprehensive review of 19 instruments. Seven instruments showed above-average measurement properties, tap children's strengths as well as concerns, and have evidence of validity with families similar to those involved with child welfare. For very young children, these include the Ages and Stages Questionnaires Socio-Emotional (ASQ-SE), the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), and the Preschool Kindergarten and Behavior Scales (PKBS-2). For school-age children, these include the Pediatric Symptom Checklist (PSC), the Strengths and Difficulties Questionnaire (SDQ), Eyberg Child Behavior Inventory, and the Internalizing Symptoms Scale for Children. Most instruments lack sufficient normative and validity data, are completed by parents, even when children are old enough to self-report, and have administrative features that may be challenging for use in child welfare. Families prefer multi-dimensional tools, but instruments for older children tend to focus on one type of symptom. Strengths-based approaches to screening are few and concentrated among very young children. Conclusions and Implications. Enough evidence exists to suggest the need for a more effective strategy to identify children with mental health concerns in child welfare. Yet, there are few screening instruments for young children that have adequate measurement properties and qualities amenable to families, such as being multi-dimensional and tapping children's strengths and resources. Recommended instruments have accumulated sufficient evidence to suggest that adaptation to child welfare services would be successful. Many questions remain however, particularly around cost, resources, and families' interest in sharing with child welfare workers details of their child's mental health, development, and behavior. Screening needs to be accompanied by service initiatives that focus on parent-child interactions, supportive care for young families, and shared program and service planning.