Directions for Developmental Screening in Child Welfare Services Based On the Ages and Stages Questionnaires

Background and Purpose. Rates of developmental problems, delays, and early social and emotional difficulties are high among young children referred to child welfare services (CWS), yet too few children receive early intervention services (EI). Many agencies now use standardized screening to address this gap, yet little is known about screening results. Existing research focuses on children in foster care, and on screening conducted by physicians or nurses. This study reports statewide data of 0 to 3-year-olds (n=570) referred to CWS and screened using the Ages and Stages Questionnaires (ASQ) and its social-emotional version (ASQ-SE). Objectives are to inform CWS planning and policy around screening strategies. Research questions are: (1) what are concern rates when using the ASQ in CWS; (2) is there evidence to support policies that screen only children with substantiated maltreatment or those living in foster care?; and (3) are concern rates related to which agency—CWS or EI—conducts screening? Methods. Data are from a statewide database in a large mid-atlantic state and include children screened following CWS referral between September 2008 and March 2010. Data include screening results, child demographic, and maltreatment characteristics. Information about which agency conducts screening is from phone survey interviews with CWS representatives in each county. Descriptive, bivariate, and multivariate logistic regression analyses were used. Two separate models predicted children with any developmental and any social-emotional concerns. Independent variables were child demographics, living situation, maltreatment type, neo-natal intensive care unit (NICU) at birth, child subject of the referral, and CW or EI-administered screening. Children's average age was 17 months. Race is 82% White, 11% African American, and 8% other or multiple races. One-third had substantiated maltreatment, 22% were not the subject of CWS referral (but in the household), and most lived with biological parents (79%). Most were screened by CWS (83%). Results. Nearly one-third of children showed either developmental (22%) or social-emotional (18%) concerns warranting EI referral. Multivariate analyses showed that children with a NICU history were significantly more likely to have developmental concerns (OR=2.29; p<.05). Developmental concerns were over 3 times as likely among children screened by EI compared with CWS (OR=4.42; p<.001). Children who were the subject of CWS referral were more likely to have social-emotional (SE) concerns (p<.05). No other variables predicted developmental or SE concerns, including substantiation status. Conclusions and Implications. Concern rates are similar to national data of children investigated, but lower than rates of children in foster care. Findings support other research that screening policies should not be guided by children's substantiation or foster care status. Higher rates of SE concerns predicted by children being the subject of the referral could be related to increased problems due to maltreatment, referrals to CWS because of social-emotional-behavioral problems, or caregiver reporting bias. Findings indicate that when screening is implemented, CWS caseworkers may need more support, mentoring, or training around detecting child developmental problems. Options could include early childhood consultation, or developmental specialist caseworkers. Caregivers may also be more comfortable sharing information about children with EI, compared with CWS.