Use of the pediatric symptom checklist to screen for psychosocial problemsin pediatric primary care - A national feasibility study

Background: Routine use of a brief psychosocial screening instrument has be en proposed as a means of improving recognition, management, and referral o f children's psychosocial morbidity in primary care. Objective: To assess the feasibility of routine psychosocial screening usin g the Pediatric Symptom Checklist (PSC) in pediatrics by using a brief vers ion of the checklist in a large sample representative of the full range of pediatric practice settings in the United States and Canada. We evaluated l arge-scale screening and the performance of the PSC in detecting psychosoci al problems by (1) determining whether the prevalence of psychosocial dysfu nction identified by the PSC was consistent with findings in previous, smal ler samples; (2) assessing whether the prevalence of positive PSC screening stores varied by population subgroups; and (3) determining whether the PSC was completed by a significant proportion of parents from all subgroups an d settings. Patients and Methods: Twenty-one thousand sixty-five children between the a ges of 4 and 15 years were seen in 2 large primary care networks: the Ambul atory Sentinel Practice Network and the Pediatric Research in Office Settin gs network, involving 395 pediatric and family practice clinicians in et st ates, Puerto Rico, and 4 Canadian provinces. Parents were asked to complete a brief questionnaire that included demographic information, history of me ntal health services, the 35-item PSC, and the number of pediatric visits w ithin the past 6 months. Results: The overall prevalence rates of psychosocial dysfunction as measur ed by the PSC in school-aged and preschool-aged pediatric outpatients (13% and 10%, respectively) were nearly identical to the rates that had been rep orted in several smaller samples (12%-14% among school-aged children and 7% -14% among preschoolers). Consistent with previous findings, children from low-income families were twice as likely to be scored as dysfunctional on t he PSC than were children from higher-income families. Similarly, children from single-parent as opposed to those from 2-parent families and children with a past history of mental health services showed an elevated risk of ps ychosocial impairment. The current study was the first to demonstrate a 50% increase in risk of impairment for male children. The overall rate of comp leted forms was 97%, well within an acceptable range, and at least 94% of t he parents in each sociodemograghic subgroup completed the PSC form. Conclusions: Use of the PSC offers an approach to the recognition of psycho social dysfunction that is sufficiently consistent across groups and locale s to become part of comprehensive pediatric care in virtually all outpatien t settings. In addition to its clinical utility, the consistency and widesp read acceptability of the PSC make it well suited for the next generation o f pediatric mental health services research, which can address whether earl ier recognition of and intervention for psychosocial problems in pediatrics will lead to cost-effective outcomes.