Early detection of psychosocial problems in children aged 5 to 6 years by preventive child healthcare: has it improved?

Abstract

To assess whether the quality of identification of psychosocial problems by preventive child healthcare professionals (CHPs) in children aged 5-6 years has improved after a series of nationwide interventions. We analyzed data about 8440 children aged 5-6 years who were assessed during routine well-child visits by CHPs (response rates, 85%-90%). Of these children, 4339 were assessed before the interventions. Parents completed the Child Behavior Checklist (CBCL) and CHPs reported on psychosocial problems that they identified in children. The agreement between identification of psychosocial problems by CHPs and parent-reported problems on the CBCL were assessed before and after the nationwide interventions. CHPs identified psychosocial problems in 22%-28% of all children. Identification of psychosocial problems by CHPs was much more likely in children with an elevated CBCL total problems score than in others (OR: 4.65, 95% CI: 3.28-6.58). The quality of identification by CHPs did not improve after the interventions, the OR for improvement was 0.81 (95% CI: 0.57-1.15). The quality of problem identification by CHPs has not improved. CHPs still miss many cases with parent-reported problems on the CBCL. Additional efforts are needed to improve early identification of psychosocial problems.