MENTAL HEALTH Use of a Brief Standardized Screening Instrument in a Primary Care Setting to Enhance Detection of Social-Emotional Problems Among Youth in Foster Care Sandra H. Jee, MD, MPH; Jill S. Halterman, MD, MPH; Moira Szilagyi, MD, PhD; Anne-Marie Conn, MA; Linda Alpert-Gillis, PhD; Peter G. Szilagyi, MD, MPH From the Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY (Drs Jee, Halterman, and P. Szilagyi; Ms Conn); Starlight Pediatrics, Rochester, NY (Drs Jee and M. Szilagyi); and Department of Psychiatry, University of Rochester Medical Center, Rochester, NY (Dr Alpert-Gillis) The authors have no conflicts of interest to disclose. Address correspondence to Sandra H. Jee, MD, MPH, 601 Elmwood Ave, Box 777, Rochester, New York 14642 (e-mail: Sandra_Jee@urmc. rochester.edu). Received for publication August 18, 2010; accepted March 8, 2011. ABSTRACT OBJECTIVE: To determine whether systematic use of a vali- dated social-emotional screening instrument in a primary care setting is feasible and improves detection of social-emotional problems among youth in foster care. METHODS: Before-and-after study design, following a practice intervention to screen all youth in foster care for psychosocial problems using the Strengths and Difficulties Questionnaire (SDQ), a validated instrument with 5 subdomains. After imple- mentation of systematic screening, youth aged 11 to 17 years and their foster parents completed the SDQ at routine health maintenance visits. We assessed feasibility of screening by measuring the completion rates of SDQ by youth and foster parents. We compared the detection of psychosocial problems during a 2-year period before systematic screening to the detec- tion after implementation of systematic screening with the SDQ. We used chart reviews to assess detection at baseline and after implementing systematic screening. RESULTS: Altogether, 92% of 212 youth with routine visits that occurred after initiation of screening had a completed SDQ in the medical record, demonstrating high feasibility of systematic screening. Detection of a potential mental health problem was higher in the screening period than baseline period for the entire population (54% vs 27%, P < .001). More than one-fourth of youth had 2 or more significant social- emotional problem domains on the SDQ. CONCLUSIONS: Systematic screening for potential social- emotional problems among youth in foster care was feasible within a primary care setting and doubled the detection rate of potential psychosocial problems. KEYWORDS: foster care; social-emotional; youth ACADEMIC PEDIATRICS 2011;11:409–413 WHAT’S NEW Systematic screening of youth in foster care for socioe- motional problems is feasible in a primary care setting and markedly improves detection of socioemotional problems in this high-risk population. ALTHOUGH THE AMERICAN Academy of Pediatrics recommends routine mental health surveillance and peri- odic mental health screening of all children, 1 most health providers are not yet integrating systematic social- emotional screening into pediatric practice. 2–6 Youth in foster care represent an at-risk group 7–9 likely to have experienced prior preplacement trauma, abuse, neglect, and separation from family. 10,11 Not surprisingly, prevalence rates for mental health problems for children in foster care are significantly higher than that for the general population and range from 40% to 80%, depending on the sample and method of ascertainment. 12,13 National guidelines recommend that children and youth in foster care receive a full mental health evaluation after entry into foster care 14 ; however, given the shortage of psychiatrists, 15 primary health providers may have difficulty accessing services for all those needing mental health care. Hence, it is vital to establish standardized screening practices in primary care settings using validated instruments to identify and triage children with the greatest mental health needs. The primary care site is a logical location to implement standardized screening. Youth entering foster care should have access to primary care for a health assessment, an opportune time for mental health screening. We evaluated the usefulness of systematic psychosocial screening using the Strengths and Difficulties Questionnaire (SDQ) in a primary care practice serving youth in foster care. Our study had 2 objectives: (1) to assess the feasibility of using youth and foster parent-completed psychosocial screening ACADEMIC PEDIATRICS Volume 11, Number 5 Copyright ª 2011 by Academic Pediatric Association 409 September–October 2011