Comparing early-childhood and school-aged systems of care for children with emotional and behavioral difficulties: risk, symptom presentation, and outcomes

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.