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Clinic begins social, emotional screening

WILLMAR, Minn. -- Even the littlest patients need attention to their emotional health.

A new initiative at Affiliated Community Medical Centers is incorporating social and emotional screening during the standard 18-month well-child checkup to assess how these youngsters are faring emotionally.

By screening more children more consistently, it's hoped that worrisome issues can be identified sooner so that families can be referred to resources that would best help them.

"It's an underaddressed area," said Dr. Joe Vogel, a pediatrician at ACMC in Willmar and lead physician for the project. "The goal is to find problems sooner and to give support."

With earlier identification, "you can have a big impact in that child's development over time," he said. "If we can help support that family early enough during those early years, that child can grow, mature and be better able to handle situations as they get older, both at home and in the school system."

The initiative started in June as a pilot project in ACMC's pediatrics department in Willmar.

"Then we'll expand it for use in family medicine," said Andrea Carruthers, care improvement coordinator for the regional multispecialty clinic.

ACMC hopes to eventually offer the social and emotional screening to children at all its clinics, making it one of the few clinic systems outside the metro area to do so.

The project is part of a $324,000 two-year grant awarded by the Minnesota Department of Health to the PACT 4 mental health collaborative to increase the local capacity for addressing children's mental health.

"There's always been a need to do what we can to help with early recognition," said Rick Loseth, clinical coordinator at PACT 4, a family service and children's mental health collaborative in west central Minnesota.

Studies consistently show that when children's emotional and social needs are adequately met, outcomes are better, he said.

Reaching the youngest children has been a challenge, though. Kindergarten screening can help catch issues among 4- and 5-year-olds, but there has been a gap for those under age 3.

The initiative at ACMC will enable health providers to reach more of these very young children, Vogel said. "We'll be able to screen everybody and not miss kids. It'll be more comprehensive."

ACMC is using an assessment known as the Ages and Stages Questionnaire -- Social and Emotional, or ASQ-SE. This relatively new tool helps assess children's social and emotional development by evaluating their behavior -- whether a child likes to be hugged, for instance, or has lengthy tantrums or difficulties with eating or sleeping.

The answers don't necessarily point to a psychiatric problem. "It's not about diagnosing or labeling," Vogel said.

Rather, the questionnaire helps parents and the pediatrician identify areas ripe for further discussion, he said. "Is it a problem or isn't it? The first key is to find out if the behavior is normal or abnormal."

Families who would benefit from extra help will be referred to appropriate community resources through Kandiyohi County Public Health, which is serving as the clearinghouse for referrals.

Some families might benefit from learning more parenting skills, or might need family counseling, said Chery Johnson, assistant nursing director at Kandiyohi County Public Health.

"If people have other needs, we could refer them to resources as well," she said. "If there are families that are struggling with their child's behavior or concerned about their child's behavior, it helps to just have a process to be able to say, 'Here's something we can do to help you.'"

It's too soon to know how many youngsters will be identified by the screening as in need of further help, or what types of issues will be uncovered. It's known, however, that certain risk factors -- abuse in the home, mental illness in a parent, neglect or homelessness, for example -- can raise the likelihood that a child will suffer socially and emotionally early in life.

Loseth called the project "a large undertaking."

"In the world of changing systems, this is a big change," he said.

PACT 4 worked with multiple agencies to design the program, he said. "We really tried to make use of everyone that's already in place. We think we have some really great knowledgeable partners. It's a great example of people trying to work together on behalf of little kids."

In the past, services often were fragmented, Carruthers said. "Now it's much more collaborative. More and more, we're bridging. It's all about being that community of support and making sure we have families connected with someone. ... Everybody is pretty excited about this."

Anne Polta is a reporter at the West Central Tribune in Willmar, Minn., which is owned by Forum Communications Co.