Addressing a Young Child’s Mental Health Needs in Primary Care: The Importance of Social Emotional Screening
Introduction
Early social-emotional development is defined as the emerging ability of young children (ages 0–5) to “form close and secure adult and peer relationships; experience, regulate, and express emotions in socially and culturally appropriate ways; and explore the environment and learn — all in the context of family, community, and culture.”[1] Primary care appointments are an ideal setting to monitor social-emotional symptoms, but close to half of U.S. children with a treatable mental health disorder are not receiving professional treatment.[2]
Mental health challenges in early childhood are prevalent and can be significantly impairing, often serving as predictors of lasting developmental problems. The good news is that early intervention has been shown to dramatically improve outcomes. However, relying on selective screening methods such as informal observation can introduce implicit biases, highlighting the need for more universal and objective approaches.[4]
Screening
The American Academy of Pediatrics (AAP) strongly recommends routine behavioral, social, and emotional screening as a vital part of comprehensive well-child visits. A formal developmental screen should be administered at 9, 18, 30, and 48-month well-child visits, or any time a concern about a child’s social-emotional development arises.[5] Specific screening for autism spectrum disorder is recommended at both the 18-month and 24-month well-child visits.[6] The Ages and Stages Questionnaire: Social Emotional (ASQ-SE-2) is a gold standard screening tool, though there are other options you can find at no cost. Along with a social emotional screener, it is useful to use the Social Determinants – all ages to identify basic needs and caregiving risks.
screening tools
When responding to a positive screen, it is important to know how to interpret the results (risk, not diagnosis). Ask more questions to clarify and confirm safety [3]. Provide psychoeducation to the patient and family and use effective communication strategies, such as the HELP mnemonic, developed by the AAP Task Force on Mental Health. You can also call Illinois DocAssist to have our social workers vet referral resources, so that information is ready for the family’s follow-up appointment. If you would like more information about this topic, please visit our website.
Psychoeducation Shareables
Medication Charts:
- Guidelines for Prescribing Psychotropic Medication to Preschool Age Children (3-5 Years Old)
- Psychotropic Medication Dosing for Preschool Age Children (3-5 years)
Screening Tools:
- Organized by issue/diagnosis and many have specific young child screening tools available: https://illinoisdocassist.uic.edu/provider-resources/screening-tools/
Resources:
- Birth to Five Illinois: Illinois has a goal of becoming the best state in the nation for families raising young children by improving and expanding the delivery of childcare and early learning programs for children from birth until they start Kindergarten. They have networks for young child resources, referrals, and education in each of their regions throughout Illinois. Website:
- Brain Building Moments has science-based tips and tools to inspire families to use everyday moments to build young brains.
- BEACON is a centralized resource for Illinois youth and families seeking services for behavioral health needs. It’s common for young people to struggle with behavioral and/or mental health challenges. Please know you are not alone, and neither is your child. We are here to help. If you would like to learn more about the Transformation Initiative, please visit https://www.dhs.state.il.us/?item=161800.
References
References
1 T. Yates, M.M. Ostrosky, G.A. Cheatham, A. Fettig, L. Shaffer, R.M. Santos Research synthesis on screening and assessing social–emotional competence Retrieved from Center on the Social Emotional Foundations for Early Learning https://ddec1-0-en-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=http%3a%2f%2fcsefel.vanderbilt.edu%2fdocuments%2frs%5fscreening%5fassessment.pdf&umid=c6739c51-c317-4fcd-8ac0-e931cb81a4d6&rct=1751464846&auth=598c2fe0aa994999473c76263e3f51f5fe1c8c0d-c7beca7498e9d0be5f60e4533e873be78034edfe (2008)
2. Whitney DG, Peterson MD. US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children. JAMA Pediatr. 2019;173(4):389–391. doi:10.1001/jamapediatrics.2018.5399
3. Recorded webinar: Gleason, M (2020). Social-Emotional Screening ASHEW Webinar. Eastern Virginia Medical School. Recorded on Sept 25, 2020 https://players.brightcove.net/6056665225001/KSSGZDkp6_default/index.html?videoId=6195694932001
4. Fallucco, E. M., Robertson Blackmore, E., Bejarano, C. M., Wysocki, T., Kozikowski, C. B., & Gleason, M. M. (2017). Feasibility of Screening for Preschool Behavioral and Emotional Problems in Primary Care Using the Early Childhood Screening Assessment. Clinical Pediatrics, 56(1), 37-45.
5. Recommendations for Preventive Pediatric Health Care Bright Futures/American Academy of Pediatrics Copyright © 2023 by the American Academy of Pediatrics, updated April 2023: https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf
6. Assessing Developmental Delays: https://www.healthychildren.org/English/ages-stages/toddler/Pages/Assessing-Developmental-Delays.aspx
7. AAP | Addressing Mental Health Concerns in Pediatrics: a Practical Resource Toolkit for Clinicians, 2nd edition https://www.aap.org/Addressing-Mental-Health-Concerns-in-Pediatrics-A-Practical-Resource-Toolkit-for-Clinicians-2nd-E