Transcript Parent Questionnaire - PQ - CT-AIMH

CT Infant Mental Health
Association
CT INFANT MENTAL HEALTH
ASSOCIATION
Screening for Emotional and
Behavioral Challenges
in Young Children
April 30, 2007
Screens for Emotional and
Behavioral Challenges in
Young Children
• BITSEA - Brief Infant-Toddler SocialEmotional Assessment
• Ages and Stages: Social-Emotional
• DECA - Devereux Early Childhood
Assessment
• Parent Questionnaire: Screen for
Environmental Risk
Why Is Screening Important?
• Identify children at the earliest
possible time so that intervention
may be provided
• May be conducted in multiple
environments:
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Pediatric health care
Early care and education
Home visiting programs
Family resource and support centers
• Provides an opportunity to start a
very important conversation with a
parent or caregiver
Ecological Approach
Must look broadly at:
• Child – health and
development
• Relationship between
child and parents, as well
as other important
caregivers
• Challenges in the
environment which
impact the child’s
development
Ecological Approach
COMMUNITY
PARENTAL CHALLENGES
RELATIONSHIPS
CHILD:
HEALTH AND
DEVELOPMENT
Emotional and Behavioral
Problems Do Not Just Go Away!
• Emotional or
behavioral
problems at age 3
years
60% psychiatric
diagnosis by
kindergarten
or 1st grade.
If We Do Not Act Now
• Need for special
education
• Serious emotional
disturbance
• Substance abuse
• Teen pregnancy
• School drop-out
• Violence in home
and community
• Crime and
incarceration
• Unemployment
• Abuse and neglect
• Poverty
Parent Questionnaire:
Screening for Environmental Risk
Darcy Lowell, M.D.
Director, Child FIRST
April 30, 2007
Parent Questionnaire:
Screen for Environmental Risk
• This is a screening measure to begin to
assess risk in the caregiving environment
• Goal: Identify those environments with
challenges which interfere with a parent’s
ability to nurture and support a child’s
development, and intervene to prevent
later morbidity.
Characteristics of the
Parent Questionnaire
• Filled out by parent or caregiver
• Takes approximately 2-3 minutes to
complete
• Available in English and Spanish
• Developed by Child FIRST through grants
from SAMHSA and Robert Wood Johnson
Foundation
• Soon to be validated
Why Is Environmental Risk
Important?
• First three years of life, 80-90% of brain
growth is completed.
• Quality of nurturing environment is an
essential determinant of brain
architecture.
• Stresses and challenges
are mediated through
the caregiver-child
relationship.
Examples
• Children who are not touched or played
with have brains 20-30% smaller on MRI
• 40% of infants of depressed mothers have
decreased brain activity
• Repetition of traumatic or stressful
experiences leads to hard wiring of
neuronal pathways for fear, anxiety, and
hypervigilance
Relationship between Risk and
Serious Emotional Disturbance
• Cumulative level of risk is
directly related to incidence
of emotional disturbance:
< 2 risks associated with a
7% incidence of
behavioral problems
> 8 risks associated with a
40% incidence of
behavioral problems
Experience with the Parent Questionnaire
• Bridgeport PCC:
45% + for risk
• Bridgeport ECC:
35% + for risk
• In Bridgeport:
Of those children who
were high risk, 70%
screened positive for
emotional concerns
Examples of
Environmental Risks
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Parental mental health issues
Substance abuse
Domestic and community violence
Teen and single parenthood
Isolation and lack of social supports
Lack of education and illiteracy
Unemployment
Homelessness, housing instability and
inadequacy
Health and dental issues
Poor quality child care
Lack of basic needs: food, clothing, heat,
furniture
Lack of books and toys
Incarceration
How Can We Increase Parents’
Capacity to Nurture and Support
Their Children’s Development?
• Increase parental knowledge of child
development and the critical importance of
their role.
• Address the challenges in the nurturing
environment which prevents parents from
focusing time and attention on their children.
• Impact the parents’ psychological status
Parent Questionnaire - Scoring
• Questions in risk categories are numbered
from 1 through 12.
• Each numbered group of questions
receives a maximum of 1 point.
• Scoring:
– “Yes” in any sub-question receives 1 point
– Exceptions: # 3 and # 7 are reverse scored:
For #3: “No” in all 3 sub-questions gives 1 point
For # 7: “No” gives 1 point
– Starred * items are automatic positives
Parent Questionnaire:
Scoring Example
1. I am worried about my child’s development…………...YES NO
He/she is not learning as fast as I expected………….. YES NO
Any Yes = 1
2. I am worried about my child’s behavior……………
YES NO
I am worried that my child is not happy …….………… YES NO
Any Yes = 1
3. I am employed or in an education/training program…. YES NO
My child’s other parent is employed or in an
education/training program……………………………... YES NO
I have completed high school or have a GED…………YES NO
4. I feel very worried, stressed or sad a lot of time………..YES NO
Sometimes I feel that life is just too hard to continue….YES NO
3 Nos = 1
*
Any Yes = 1
Parent Questionnaire:
Positive Screen
• 3 or more points
• Yes in any one of the “red flag” questions
is an automatic positive:
* # 4 – depression
* # 8 – domestic violence
* # 10 – substance abuse
• Any clinical concern, regardless of number
of points
Start a Conversation
• Purpose of screening is to be able to start a
conversation with a parent which enables you to
understand the challenges in the child’s
environment.
• Remember, a parent may give a “no” answer
even if a problem exists.
• A parent may attribute a problem he/she has to
the other parent only.
• Questions may be misunderstood or answers
may reflect normal developmental challenges.
Follow-up is essential.
And now meet
Marla and Louis