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Comparing Early-Childhood and School-Aged Systems of Care for Children with Emotional and Behavioral Difficulties: Risk, Symptom Presentation, and Outcomes

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Abstract

Objectives

Most large-scale evaluations of systems of care (SOCs) have focused on school-aged populations, with limited research examining early childhood SOCs. As a result, little is known about how risk profiles, symptom presentation, and outcomes may vary between early childhood and school-aged SOC participants. This descriptive study uses data from two SOCs—an early childhood SOC (EC-SOC) and a school-aged SOC (SA-SOC)—to examine the differences across age groups in how children and families present to SOCs and the extent to which risk factors and symptoms change over six months of enrollment.

Method

Participants were 184 children in the EC-SOC (mage = 3.91) and 142 children in the SA-SOC (mage = 9.36). Families completed measures assessing risk factors and functioning at enrollment and at six-month follow up. Descriptive analyses measured the presence of risk factors and symptoms at enrollment and follow-up. Correlations were computed to determine the associations between symptom measures.

Results

Results identified areas of similarity and difference between families presenting for SOCs at different developmental stages. Younger children experienced greater behavioral problems (Hedge’s g = 0.52, p< 0.001) with more associated caregiver stress (Hedge’s g range = 0.34–0.62, p < 0.01) and strain (Hedge’s g = 0.34, p= 0.005). Trauma was more strongly associated with child and caregiver symptoms among younger children. Greater change in symptom measures was observed for the EC-SOC.

Conclusions

Findings highlight the importance of providing services in early childhood and provide guidance for SOC service provision at different ages.

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Acknowledgements

We acknowledge Virginia Stack, MS, for overseeing the Rhode Island Positive Educational Partnership, Meghan Finley, PhD, for overseeing the evaluation component, and Jo-Ann Garigulo, MPA, for managing the data for the Rhode Island Positive Educational Partnership. We also acknowledge Tim Marshall, MSW, and Elaine Fitzgerald Lewis, DrPH, for their oversight of Building Blocks Early Childhood System of Care, and Amy Griffin, MA, for overseeing the evaluation project. Finally, we thank children, youth, and their families for participating in these projects.

Author Contributions

AS: designed and executed the study, analyzed the data, and wrote the paper. JSK: designed and executed the study and collaborated in the writing and editing of the manuscript. CAC: designed and executed the study and collaborated in the writing and editing of the manuscript.

Funding

The preparation of this paper was supported, in part, by the first author’s National Institutes of Health T32-funded postdoctoral training fellowship (T32DA019426-13). The New London Building Blocks project was supported by a grant from the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration. The Rhode Island Positive Educational Partnership project was supported through a cooperative agreement by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration to the State of Rhode Island Department of Children, Youth, and Families.

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Authors and Affiliations

  1. Yale School of Medicine, New Haven, CT, USA

    Alayna Schreier, Joy S. Kaufman & Cindy A. Crusto

  2. University of Pretoria, Pretoria, South Africa

    Cindy A. Crusto

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  1. Alayna Schreier
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  2. Joy S. Kaufman
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Correspondence to Alayna Schreier.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Yale University Human Research Protection Program and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Schreier, A., Kaufman, J.S. & Crusto, C.A. Comparing Early-Childhood and School-Aged Systems of Care for Children with Emotional and Behavioral Difficulties: Risk, Symptom Presentation, and Outcomes. J Child Fam Stud 28, 2312–2325 (2019). https://doi.org/10.1007/s10826-019-01447-z

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