Social-Emotional (behavioral health) Screening in Toddlers and Preschoolers

toddler outside


The term that used to be used was early childhood mental health. The new term is social-emotional development.   Early identification and intervention for toddlers and preschoolers with social-emotional risk factors or problems is crucial for improving short-term and long-term developmental and mental health outcomes. The earlier social-emotional issues are recognized and addressed, the better the outcome and the lower the overall cost will be.

What happens when social-emotional development goes awry?  There are both short-term and long-term consequences:

  • Short term: Limitations in the ability to learn and may face exclusion in the learning environment
  • Long term: Increased risk for mental illness, delinquency, poor achievement in school, and poor physical health in adulthood

Who’s at risk? Young children living in low-income neighborhoods are nearly twice as likely to experience childhood behavioral problems and mental health problems as adults, compared to children living in moderate-income or affluent neighborhoods, because of the “toxicity” of the stress of poverty on the developing brain and body of children in low-income families and the difficulty accessing mental health services.

Screening with a standardized tool in early childhood has the potential to identify the majority of children who will later exhibit significant emotional/behavioral problems in early elementary school. By waiting until more obvious or serious problems emerge (particularly in the school environment), we will have missed a crucial period for intervention – problems will have become more severe and more costly.  The medical home is the one place where parents and children are seen on a regular basis from early in life that has the appropriate relationship between family and professionals to identify high risk for, or early signs of, behavioral/mental health issues early enough to successfully intervene or prevent them.  Studies show that parents are reluctant to mention social-emotional problems to the primary care provider unless they are specifically asked.   Screening is not a diagnostic test; it gets parents and providers talking about behavioral problems that they would not have been addressing otherwise.

The ASQ –SE is a monitoring questionnaire filled out by parents that is user friendly and compliments the ASQ Developmental screening questionnaire.  It is the most frequently used social-emotional screening questionnaire in primary care settings.  It identifies behavioral issues and parental concerns, brings them to the attention of primary care providers, and gets parents and providers discussing these issues at a stage when intervention is the most effective.  For more information and to download the ASQ-SE, click here.

The Survey of Wellbeing of Young Children (SWYC) was developed at Tufts Medical Center and assesses developmental milestones, social/emotional development, and family risk factors.  It is a relatively new tool so it has not been studied and utilized extensively. Sensitivity and specificity in early studies are in the range of 88 to 90% when compared with other validated tests.  It is free and is gaining acceptance among primary care pediatricians.  It reduces the need for multiple questionnaires, since it assesses development and behavior, and in the future (after the tool has been studied) has significant promise.

The Parents Evaluation of Developmental Status (PEDS) elicits parents’ concerns about children’s language, motor, self-help, early academic skills, behavior and social-emotional/mental health.  It has been studied and used with a diverse sample of families and is free. Sensitivity and specificity are in the range of 75-80%.  It is difficult to score and the responses are open-ended so that it is difficult to know when to refer. It is free.  It is the preferred tool among Massachusetts pediatricians.

The intervention for a positive screen is for the primary care provider to look at the questions receiving a “yes” and ask more questions to get more information and understand more about the problem.  Then the provider will determine how to address the issue: initiate counseling in the medical home or refer to a behavioral health provider.  In most instances the problems can be addressed in the medical home or sometimes with referrals to specialists other than behavioral health specialists.

Billing and coding: At the present time, social-emotional screening is not reimbursed by Medicaid or other payers.

CCHAP Can Help You:

  • Select methods to improve efficiency of providing social-emotional screening.
  • Help you set up a Quality Improvement process to ensure all children are receiving screening.
  • help you implement the ASQ-SE screening tool in your practice.

Contact us to learn more about CCHAP’s services.