A cross-service approach to identify mental health problems in 3–5-year-old children using the Strengths and Difficulties Questionnaire

The Child Healthcare Services (CHS) in Sweden offer regular health check-ups and reach almost all 0–5-year-old children. Although one of the objectives of the CHS is to detect mental health problems, evidence-based methods are not used for this purpose at the Child Health Clinics (CHCs). Therefore, an evidence-based instrument to assess children’s emotional and behavioural problems through parent and teacher reports, the Strengths and Difficulties Questionnaire (SDQ), was introduced, as part of the Children and Parents in Focus trial, run between 2013 and 2017 in Uppsala, Sweden. The overall aim of this thesis was to evaluate the introduction of the procedure, including the facilitation strategies provided to support implementation, and to provide inter-rater correlations and norms for the SDQ in this population. Data were collected through individual interviews with nurses, parents and preschool teachers; group interviews with nurses; and a survey performed at the end of the trial to evaluate nurses’ experiences of the SDQ-procedure and the implementation process. In addition, delivery, response rate and population coverage of the questionnaires were calculated. Quantitative data were analysed using descriptive statistics, Pearson correlations and Intraclass Correlation Coefficients (ICC), and qualitative data using Grounded Theory and content analysis. Results showed that nurses found it useful for their assessment to have access to preschool teachers’ SDQ-ratings. Parents were also positive to the procedure but had concerns regarding confidentiality of the responses. Preschool teachers were least positive, fearing labelling of children and negative parental reactions. Significant, albeit poor, agreement (ICC) was found between parent and teacher ratings and good agreement between parents’ ratings. Teachers were found to report lower levels of problems compared to parents. Cut-off values differed for age and were somewhat higher for boys (lower for prosocial), suggesting that boys display more behaviour problems. Nurses perceived facilitation strategies used by the research team useful to support implementation and delivered the procedure, essentially, as intended. However, response rate remained lower than expected, around 50%. The findings suggest that implementing the SDQ to aid CHC-nurses’ assessment of 3-5-year-olds’ mental health is feasible, but requires further effort in regular services to reach all children