Abstract
A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed. The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis. Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period. The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.
Highlights
Detection of mental health problems in the Swedish Child Health ServicesIn Sweden, Child Healthcare Services (CHS) are responsible for offering a universal programme, including routine health check-ups, without charge, to all parents with children aged 5 and under
This paper aimed to describe a facilitation programme developed to support the introduction of Strengths and Difficulties Questionnaire (SDQ) in clinical practice and evaluate how nurses perceived the facilitation strategies used
Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required
Summary
While a multiple informant approach is considered best practice for the assessment of children’s mental health [2] and preschool teachers have been recognised as important informants in identifying children with mental health problems [3], current assessments at Child Health Clinics (CHCs) rely mainly on parents’ description of their child’s functioning and health. The introduction of a structured tool to assess children’s emotional and behavioural problems through parent and teacher reports could reduce the risk of mental health problems being left undetected. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. The dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed
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