Although it is the child healthcare system's task to monitor
children's health, behavior and development, it is preschool teachers
that possess much of the information needed to make a comprehensive
assessment of the child. Their knowledge is not systematically utilized
within child healthcare since there is no established channel for
information sharing between the healthcare and preschool systems.
It is beneficial to systematize the exchange of information between
parents, preschool and child care centers (CHCs) to increase the focus
on young children with mental health problems. This is shown in a
recently conducted study from Uppsala University, published in the
journal PLOS One
‘A method to enhance communication between parents, preschool and child healthcare, regarding children's mental health has been described in a new study.’
"All three groups in our study - nurses, preschool teachers and
parents - thought that the systematic approach works well and that the
routine with questionnaires provides more knowledge about the children
for both preschool and child healthcare services. However, the use of
standardized questionnaires is a controversial issue among preschool
teachers," says Elizabeth Fält, PhD student and district nurse, who
carried out the study.
The ongoing study "Children and Parents in Focus" was launched in
Uppsala, Sweden, in 2013. The study evaluated a method to enhance
communication between parents, preschool and child healthcare, regarding
children's mental health.
When the parents of all three-, four-, and five-year-olds in Uppsala receive
the invitation letter for the child's annual visit to the child health
center, they also receive an additional form with 25 questions. This
form, the Strengths and Difficulties Questionnaire (SDQ), is widely used
internationally and contains questions about the child's behavior,
emotions, and social relationships.
The parents receive three SDQ forms. If the family agrees to
participate in the study, the parents each complete a separate form and
take the third questionnaire to their child's preschool for the teachers
to complete. The completed forms are then returned to the CHC nurse and
reviewed during the child's regular visits to the CHC.
All stakeholders were in favor of the new procedure, though all stakeholders also noted some problems.
* CHC nurses think the forms are important for their assessment and
constitute a good basis for a more complete evaluation of the child.
CHC nurses acknowledge that they gain knowledge of the child that they
would probably have missed without the form. They also feel that it is
valuable to get information from both parents and preschool teachers,
since they see the child in different environments that make different
demands. Unfortunately, CHC nurses finds that socially vulnerable
families, and families with a child where problems are suspected,
refrain from completing the forms more often than other families.
* Preschool teachers want to identify and help children with
difficulties and most preschool teachers think that the transfer of
information using the SDQ can be a good tool for that. But the
interviews also showed that the use of structured forms to assess
children's social and emotional development is a controversial issue
among preschool teachers.
"They argue that the use of structured
(normative) forms is regarded as outdated in preschool and that such
tools are contradictory to preschool's policy documents. They fear the
children might be labelled and thus affected negatively in the future if
they are assessed with standardized forms. Nevertheless, preschools
have a responsibility to offer all children adequate support in their
development and to collaborate with parents, so there is a conflict
there," says Elizabeth Fält.
The preschool teachers also feel worried about parents' reactions to
the preschool assessment. At the same time, they acknowledge that the
information transfer benefits the preschool, as the new routine can
contribute by giving the preschool a more detailed picture of each child
and can result in good collegial discussions.
- Parents look forward to learning about part of the
preschool's assessment at the child healthcare center visit. They think
that the forms get them to reflect on their child's situation and
behavior, which they perceive as positive. They also think that the
questionnaire can lead to valuable discussions with the other parent, as
the points initiate discussions they would not otherwise have.
Nevertheless, parents have some concerns about how personal information
is handled and used; like the preschool teachers, they are afraid that
the information they provide through SDQ might have negative
consequences for the child in the long run.