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The Child Healthcare Services (CHS) in Sweden offer regular health check-ups and reach almost all 0-5-year-old children. Parents of all children aged 3 to 5 are invited for a free check-up around their child birthday. 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 (CHC). Therefore, we assumed that introduction of a new instrument (the Strengths and Difficulties Questionnaire - SDQ) to assess children's emotional and behavioural problems through parent and teacher reports, would not only help to test the hypotheses in our population-based trail (Children and Parents in Focus), but it would also address CHC's needs to detect children's mental health problems. Three months into the study, we realised that a lower than expected number of SDQs were returned by parents and teachers. We started exploring the problem through individual interviews with nurses, parents and preschool teachers. 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. We used a range of facilitation strategies such as educational meetings, outreach visits and newsletter to support nurses in implementation of the new procedure. To address parental concerns, we removed some of the questions and redesigned the questionnaires. This resulted to an overall increase of 10-15% in the response rate. The findings suggest that implementing the SDQ at CHCs to assess the mental health of 3-5-year-olds is feasible, but reaching all children remains a challenge that requires more attention.

Introduction of a new method for measuring young children’s mental health at child health clinics