Comparing early-childhood and school-aged systems of care for children with emotional and behavioral difficulties: risk, symptom presentation, and outcomes

OBJECTIVES : Most large-scale evaluations of systems of care (SOCs) have focused on school-aged populations, with limited research examining early childhood SOCs. As a result, little is known about how risk profiles, symptom presentation, and outcomes may vary between early childhood and school-aged SOC participants. This descriptive study uses data from two SOCs—an early childhood SOC (EC-SOC) and a school-aged SOC (SA-SOC)—to examine the differences across age groups in how children and families present to SOCs and the extent to which risk factors and symptoms change over six months of enrollment. METHOD : Participants were 184 children in the EC-SOC (mage = 3.91) and 142 children in the SA-SOC (mage = 9.36). Families completed measures assessing risk factors and functioning at enrollment and at six-month follow up. Descriptive analyses measured the presence of risk factors and symptoms at enrollment and follow-up. Correlations were computed to determine the associations between symptom measures. RESULTS : Results identified areas of similarity and difference between families presenting for SOCs at different developmental stages. Younger children experienced greater behavioral problems (Hedge’s g = 0.52, p< 0.001) with more associated caregiver stress (Hedge’s g range = 0.34–0.62, p < 0.01) and strain (Hedge’s g = 0.34, p= 0.005). Trauma was more strongly associated with child and caregiver symptoms among younger children. Greater change in symptom measures was observed for the EC-SOC. CONCLUSIONS : Findings highlight the importance of providing services in early childhood and provide guidance for SOC service provision at different ages.The preparation of this paper was supported, in part, by the first author’s National Institutes of Health T32-funded postdoctoral training fellowship (T32DA019426-13). The New London Building Blocks project was supported by a grant from the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. The Rhode Island Positive Educational Partnership project was supported through a cooperative agreement by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration to the State of Rhode Island Department of Children, Youth, and Families.https://link.springer.com/journal/108262020-08-05hj2020Psycholog