Sandra J. Bishop

Screening for Psychosocial Dysfunction in Inner-City Children: Further Validation of the Pediatric Symptom Checklist

A sample of 123 6- to 12-year-old outpatients at an inner-city pediatric clinic was screened for psychosocial dysfunction using the Pediatric Symptom Checklist (PSC), a brief parent-completed questionnaire. The prevalence of positive screening scores on the PSC was 22%, significantly higher than the rate found in lower middle to upper middle-class samples. Comparing PSC case classifications with comprehensive assessments made by clinicians, overall agreement was 92% (kappa = 0.82; sensitivity = 88%; specificity = 100%); a comparison with several other measures provided additional support for the validity of the PSC. The PSCs reliability over time was also acceptable. These findings provide preliminary evidence that the PSC is as valid and reliable for screening children from economically disadvantaged and minority backgrounds as it is for middle and upper middle-class populations.

Screening for Psychosocial Dysfunction In Pediatric Practice A Naturalistic Study of the Pediatric Symptom Checklist

This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase (P<.01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricians identify and better serve children experiencing psychosocial difficulties. The study also suggests that further work is needed to understand the barriers to ongoing implementation.

Screening for Psychosocial Dysfunction in Pediatric Dermatology Practice

The Pediatric Symptom Checklist, a brief psychosocial screening questionnaire, was used in a multi-center study of pediatric dermatology clinics (n=377). Overall rates of positive screening indicated that approximately 13% of patients screened positive, a rate similar to findings in primary care pediatric settings. Examining the sample in greater detail demonstrated that children whose dermatologic disorder is perceived to have a greater impact on their appearance are at higher risk for psychosocial dysfunction.

Screening 4- and 5-year-old children for psychosocial dysfunction: A preliminary study with the Pediatric Symptom Checklist

The validity and reliability of the Pediatric Symptom Checklist (PSC), a parent-completed psychosocial screening questionnaire, was examined in a sample of 115 four-to five-year-old pediatric outpatients. The current study assessed agreement between the PSC and the Child Behavior Checklist. These results in the preschool sample were compared with results obtained in a sample of 6− to 12-year-old patients in the same practices. Levels of agreement between the PSC and the Child Behavior Checklist were found to be acceptable and approximately equal to those obtained with older children. Rates of reliability were also equivalent. Results provide preliminary support for the validity of the PSC for screening 4− and 5-year-old children. J Dev Behav Pediatr 15:191–197, 1994. Index terms: Pediatric Symptom Checklist, psychosocial screening, preschool children.

What happens after the care and protection petition?: Reabuse in a court sample☆

Of 206 cases of serious child mistreatment brought before a metropolitan juvenile court on Care and Protection Petitions (C & P), 63 (31%) were dismissed (returning the child to the parent(s]. During a 2-year follow-up period, 18 (29%) of these dismissed cases had substantiated reports of further mistreatment, and 10 (16%) subsequently returned to court on another C & P. Families that had previously been to court for a C & P, and those in which the parent was diagnosed psychotic or character disordered, were significantly more likely to return to court. In addition, we were surprised to find that 8 (6%) of the 130 children ordered permanently removed from parental custody also returned to court. This study documents the continuing mistreatment of children, even after the states most serious interventions. The study also highlights the necessity of incorporating clinical research in the form of ongoing follow-up of individual cases into the court process, and suggests that it may be possible to identify cases with a very high probability of reinjury and return to court.

Protecting seriously mistreated children: Time delays in a court sample

The study examined the progress through the child protective system of a sample of 206 severely abused and/or neglected children brought before the Boston Juvenile Court (BJC) on Care and Protection (C & P) petitions. Overall, children were in the system an average of 5 years from the filing of the first official report of mistreatment to the resolution of their cases. The families had been known to the state child protective service agency for an average of more than 2.5 years before the current court involvement. Once arraigned in juvenile court on the C & P, the average case took almost 1.5 years to reach a disposition. After disposition, children permanently removed from parental custody required, on average, an additional year and a half in Probate Court to reach a permanent placement. Of the more than twenty variables examined, including severity of mistreatment, protective service history, and parental mental illness, no meaningful pattern emerged which could predict delays. Our findings characterize the delays experienced by many abused and neglected children, and highlight the necessity of closer monitoring of the progress of cases through the protective and court systems.

Psychosocial Screening in Pediatric Practice: A Survey of Interested Physicians:

This study followed up on 201 pediatricians and family practitioners who had requested information about the Pediatric Symptom Checklist (PSC), a parent-completed questionnaire which screens for psychosocial dysfunction in school-aged children. The physicians were sent a postcard survey asking whether they had used the PSC in their practices. Of the 157 (78%) who responded to the postcard survey, 36 (23%) reported that they had used the PSC. On a follow-up questionnaire, all of these physicians rated the PSC as useful, and nearly 80% reported that it led to increased case-finding and/or referrals. Ninety-six percent stated that they will continue to use the PSC; more than half of them routinely or frequently. The findings indicate a widespread interest in psychosocial screening, and suggest that additional educational efforts may be necessary to support the acceptance of the PSC in pediatric practice.

The Youngest Victims of Child Maltreatment: What Happens to Infants in a Court Sample?

Current data show that infants represent an increasing proportion of cases of child maltreatment. To learn more about how infants fare in the current system and to provide baseline data against which to compare outcomes following recent legislative reforms, this study examined a subsample of infants in a sample of 200 care and protection cases brought before the Boston Juvenile Court in 1994. Child, parent, and case characteristics of infants 0 to 3 months of age (n = 46) were compared with characteristics of older children in the sample. All cases were followed prospectively for 4 years, and data were abstracted from court records. Results revealed that the infants were primarily children of substance abusers who had extensive prior histories of child protective service system involvement. Although the majority of the infants were eventually permanently removed from parental custody and adopted, many experienced time delays and multiple placements before achieving permanent homes.