ASQ:SE (Ages and Stages Questionnaires: Social-Emotional)
This is a general screen for the social/emotional status of children 6–60 months of age, although it can be used for children as young as four months. It covers such items as self-regulation, communication, adaptive functioning, and interaction with people.
There are eight color-coded questionnaires for use at 6, 12, 18, 24, 30, 36, 48, and 60 months, eight corresponding scoring sheets, and a User's Guide, which includes instructions on implementing the ASQ:SE, tips on cultural sensitivity, and developmentally appropriate activities for parents.
There are 22 to 36 items in a questionnaire, depending on the child's age. It takes parents 10–15 minutes to complete and 1–3 minutes for staff to score. There is also a child-care provider form to look at behavior in that setting. The content is written at the fifth-to-sixth-grade reading level, and is appropriate for respondents from diverse backgrounds.
Overview of scoring. The response categories are: "Most of the time", "Sometimes", and "Rarely or never". For some items, a "Most of the time" response will be reassuring and for some items it will be a concern. The threshold for identifying at-risk children varies by age. Please consult the manual for scoring instructions.
BITSEA (Brief Infant-Toddler Social & Emotional Assessment)
This is a screen for social-emotional development and competencies for children from 12 to 36 months.
There is one form for all age groups. There is also a child-care provider form to review behavior in that setting.
Parents complete the 42-item form, which can be completed onsite or in the family environment. There are two additional questions that ask parents or caregivers "how worried" they are about the child's behavior, emotions, relationships, and language development. The questionnaire can be completed in 7 to 10 minutes. The content is written at the sixth-grade reading level.
Overview of scoring. The response categories are: "Not true/Rarely", "Somewhat true/Sometimes", and "Very true/Often", and are scored 0, 1, and 2 respectively. The threshold for identifying at-risk children varies by age. Scoring indicates either a possible problem or a possible deficit/delay in competencies. Please consult the manual for further scoring instructions.
CRAFFT (Screen for substance abuse)
This is a screen for adolescent substance abuse. The name, CRAFFT, is an acronym for key components in the questions: Car, Relax, Alone, Forget, Friends, Trouble. This tool is use for youth 14 and up.
There is one form, consisting of six questions about behaviors relating to alcohol and drug use.
The tool is usually self-administered by the youth, but could also be conducted as an interview. It takes less than five minutes to complete and a brief time for staff to score.
Overview of scoring. The response categories are either "Yes" or "No" ."Yes" responses to two or more questions indicate that the youth is at risk. Please consult the CRAFFT website for scoring instructions.
ECSA (Early Childhood Screening Assessment)
The ECSA is a screening tool for early childhood mental health concerns and parental depression for children 18–60 months. The screen also identifies parental concerns.
There is one form for all age groups. The parent version includes items focused on parental depression and parental distress. The child care version is available without caregiver items.
Parents complete the 40-item form, identifying frequency of specific behavioral problems as well as those items about which they have concerns. The last four items include the PHQ-2 validated screen for adult depression as well as two items that reflect parental distress. The measure also includes a question about "how worried" parents are about the child's behavior, emotions, and relationships.
Measure Completion: The content is written at the fifth-grade reading level and can be completed in 5–10 minutes. It is available in English, Spanish, and Romanian.
Please complete all items for most accurate scoring. If more than 2 items (items 1–36) are missing, the score is not interpretable.
Items 1–36: The response categories are: "Rarely/not true", " Sometimes/Sort-of", and "Almost always/very true", and are scored 0, 1, and 2 respectively. A score of 18 or higher on items 1–36 represents a positive screen with a higher risk of meeting criteria for a mental health disorder.
Items 37–38: A score of at least 2 on items 37 and 38 indicates a positive PHQ-2 screen reflecting likelihood of parental depression.
Items 39–40: Items 38 and 39 reflect maternal distress. No cut-off has been identified.
Concern: Parents are also asked to circle a “+” if they are “concerned about a behavior and want help with it”.
Please consult the ECSA manual for scoring instructions.
EPDS (Edinburgh Postnatal Depression Scale)
The EPDS was developed for screening postpartum women in outpatient, home visiting settings, or at the 6 –8 week postpartum examination. It has been utilized among numerous populations including U.S. women and Spanish speaking women in other countries. The EPDS consists of 10 questions. The test can usually be completed in less than 5 minutes.
This tool is free and available online. Available in over 35 languages including Spanish, Portuguese, French, and Khmer. Please select the link below for the screener and scoring instructions.
M-CHAT (Screening for Autism Disorders)
The M-CHAT was developed at the University of Connecticut's Department of Psychology, and is designed to screen children aged 16 to 30 months for an autism spectrum disorder (ASD).
The 23-item, parent-completed form generally takes five to seven minutes to be completed and a brief time for staff to score.
Note: The American Academy of Pediatrics (AAP) now recommends administering the screen at two visits: 18 months and again at 24 months.
Overview of scoring. The response categories are: "Yes" and "No". The threshold for identifying at-risk children is a "No" response to two or more of the critical items (identified in the scoring instructions) OR failure of any three items. Please consult the M-CHAT Web site instructions.
M-CHAT (Revised with Follow-up)
M-CHAT –R/F™ (Modified Checklist for Autism in Toddlers- Revised with Follow-up) was developed by Diana L. Robins, Ph.D. The revised tool reduces the false positive rate and detects more Autism Spectrum Disorder cases than the original M-CHAT when used during routine pediatric check-ups. The M-CHAT-R/F is valid for children 16–30 months.
PEDS (Parents' Evaluation of Developmental Status)
This is a screen for the behavioral and developmental status of children birth to eight years.
There is one form for use with all ages. It consists of 10 questions about specific concerns. The form can be completed by parents in about five minutes and takes a brief time for staff to score. The form is written at the fourth-to-fifth-grade reading level. It can also be completed online by parents.
Overview of scoring. The response categories are: "No," "Yes," or "A little," to specific concerns. The form also provides space for comments. The Score Form tallies concerns (categorized as predictive or non-predictive) in a grid by age and by developmental area. Since it lists multiple ages, it serves as a longitudinal record, similar to a growth curve. Shading indicates predictive concerns, which allows for easy scoring and interpretation. There is also an Interpretation Form, in the form of a decision tree, which guides the provider regarding next steps, based on identified concerns. Please consult the manual for scoring instructions.
PHQ-9 (Screen for depression) (Patient Health Questionnaire 9: Depression Screener)
This is a screen for depression for young adults 18 years and older. Keep in mind that the MassHealth requirement for behavioral-health screening includes individuals up to 21 years of age.
The tool is a one-page questionnaire. The young adult fills out the form, which takes about five minutes to complete and a brief time for staff to score.
Overview of scoring. The patient answers nine questions as occurring over the last two weeks "Not at all", "Several days", "More than half the days", or "Nearly every day". If sufficient questions are endorsed as occurring often enough, a depressive disorder should be considered. The screener itself also includes advice for the patient on when to talk to the doctor or seek help. Please consult the PHQ- 9 website for scoring instructions.
PSC (Pediatric Symptom Checklist)
This is a general screen for behavioral and emotional problems in children from four to 16 years.
There are two forms of this tool.
PSC - Pediatric Symptom Checklist – The PSC is completed by parents of children four to 16 years old.
PSC-Y - Pediatric Symptom Checklist - Youth Report – The PSC-Y is completed by youths from 11 to 18+ years of age.
Both versions are 35-item questionnaires that can be completed in about five to 10 minutes, and take a brief time for staff to score. MassHealth providers may also select the shorter form which contains 17 items.
Overview of scoring. The response categories are: "Never (0)", "Sometimes (1)", and "Often (2)". For children four and five years of age, a score of 24 (threshold) or more indicates a child at risk; for 6 to 16-year-olds, the threshold score is 28. For the PSC-Y, the threshold score is 30. Please consult the PSC Web site for scoring instructions.
This tool is free and available online. It is available in English, Spanish, and several other languages. Please select the link below to see the languages available.
SDQ (Strengths & Difficulties Questionnaires)
The SDQ is designed for general behavioral health screening of children 3 to 16 years of age, consisting of a one-page form of 25 items. There are three age-group forms (3-4 year olds, 5-10 year olds, and 11-16 year olds) as well as three respondent versions (parent, teacher, and self, for 11-16 year olds).
Responses to 20 of the 25 items generate a "total difficulties" score, based on subscale scores in "emotional symptoms," "conduct problems," "hyperactivity," and "peer problems," which are derived first. In addition, this tool provides a "pro-social behavior" (strengths) subscale score. For the purpose of the CBHI, the primary care provider can base the determination of a patient's need for services on the parent/guardian or self reported "total difficulties" score; however, the subscale scores may be clinically useful as well. Variations of the basic form are also available, and providers may find them of value for a more detailed picture of a patient's behavioral health status.
Overview of Scoring
The SDQ takes the parent/guardian or youth approximately five minutes to complete. Each item is reported as "not true," "somewhat true," and "certainly true." Multiple scoring methods provided fall into two categories: hand-scoring or computer-based. Providers should expect some time will be needed to learn how to score this tool, but it should be fairly easy to score once it is familiar.
SWYC/SWYC-MA (The Survey of Wellbeing of Young Children)
The Survey of Wellbeing of Young Children (SWYC) is a free, parent-report screening instrument for children under five years of age. The SWYC was developed to provide first-level screening for a wide range of developmental-behavioral domains in a single instrument: cognitive, language, motor milestones, social-emotional/behavioral functioning, as well as autism and family risk factors. The entire instrument requires 15 minutes to complete and is easy to score and interpret.
There is an age-specific SWYC form for each age on the pediatric periodicity schedule up to five years of age (2, 4, 6, 9, 12, 15, 18, 24, 30, 36, 48, and 60 months). Each of these 12 forms consists of questions appropriate for children in its designated age range.
The SWYC/MA is a modified version of the SWYC tool that incorporates the Edinburgh Post Natal Depression Scale (EPDS), a validated 10-item questionnaire to identify postpartum depression.
All forms are available for free. Download them from the SWYC website.
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How to Propose a New Behavioral Health Screening Tool
Each spring MassHealth reviews the menu of approved behavioral health screening tools in order to keep current with best practice and research. In addition to scanning the environment to identify new tools to include on the menu, MassHealth will consider outside requests.