Developmentally and culturally appropriate screening in primary care: development of the behavioral health checklist

Behavioral Health Screening: Validation of a Strength-Based Approach

OBJECTIVE

To evaluate the validity of the Behavioral Health Checklist (BHCL) strength-based factor scores and the extent to which this factor has a buffering effect on the relationship between behavioral health symptom severity and children's social problems.

METHOD

The parents of 1,392 children aged 4 to 12 completed the BHCL and Child Behavior Checklist (CBCL) during sick and well-child visits to urban and suburban primary care practices affiliated with a large children's hospital.

RESULTS

Findings support a single, strength-based factor on the BHCL, and the structure was largely invariant across race, sex, and socioeconomic status. Increased psychopathology symptoms (internalizing, externalizing, and attention-deficit hyperactivity disorder) and lower levels of strengths predicted increased social problems (p < 0.001). Moreover, the interaction terms were statistically significant in all analyses, suggesting that higher levels of strengths may buffer the deleterious impact of psychopathology symptoms on social problems. Post hoc analyses indicated that the buffering influence of strengths on the relationship between psychopathology symptoms and social problems was clinically meaningful except in the older sample for the relationship between externalizing and social problems.

CONCLUSION

The findings support the validity of a strength-based factor of the BHCL and indicate that this factor has a buffering effect on the association between the degree of child mental health symptoms and level of social impairment. This factor, in combination with the problem-focused factors of the BHCL, provides a balanced approach to screening children's mental health functioning.

Validation of the Behavioral Health Checklist in Diverse Pediatric Primary Care Settings

OBJECTIVE

Examine the validity and clinical utility of the Behavioral Health Checklist (BHCL), a screening tool with 2 forms (4-7, 8-12 years) developed for use with children of diverse backgrounds.

METHOD

At pediatric primary care appointments, the parents of 1274 children completed a demographic form, the BHCL, and the Child Behavior Checklist (CBCL). Concurrent validity was examined by conducting correlations between the BHCL and the diagnostic scales of the CBCL. Diagnostic prediction was examined by conducting logistic regression analyses and plotting receiver operating characteristics (ROC) curves. Clinical utility was investigated by examining sensitivity, specificity, and kappa corrections for total predictive power.

RESULTS

The pattern of correlations with the CBCL provided evidence of convergent and discriminant validity for both versions of the BHCL. ROC curve plots provided clear evidence of predictive validity (area under curve values ranged from .84 to .96 across factors and both age-determined versions). Cut-points achieving sensitivity and specificity values of at least .70 were identified for each BHCL factor for each version.

CONCLUSION

The BHCL was demonstrated to have strong construct and predictive validity. The predictive validity of each version was demonstrated across genders, socioeconomic status, and racial groups (black or African American and white). The BHCL has promise as a developmentally and culturally effective behavioral health screener for use in pediatric primary care practices.