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The Survey of Well-being of Young Children

Frequently Asked Questions

Contents

  1. There are lots of screening instruments; what is unique about the SWYC?
  2. How do I know what SWYC form to use?
  3. When do I need to adjust a child’s age for prematurity?
  4. How many items are on the SWYC?
  5. How long does the SWYC take to complete?
  6. Is the SWYC validated?
  7. Is the SWYC protected by copyright?
  8. What CPT code should I use for the SWYC?
  9. Can I use only the social-emotional screener, or only the Milestones, or do all 4 sections of the SWYC have to be used together?
  10. Can I make changes to the SWYC for use in my practice?
  11. Is the SWYC available in electronic form or in Electronic Health Records (EHR)?
  12. Is the SWYC approved by MassHealth?
  13. What is the SWYC/MA?
  14. What makes someone qualified to interpret the SWYC?
  15. When I hand parents the SWYC, I tell them that their child’s doctor has asked that they complete the form. Sometimes parents then ask for more information about why they need to do so. What should I say?
  16. What should we do when a child screens positive on the SWYC? We can’t possibly refer every child.
  17. It seems like the SWYC detects a lot of false positives. Why can’t it just tell me which children have a real problem and which children don’t?
  18. I think too many children score positive on screening instruments, so I only really trust positive results that are several points above the states threshold. What is the effect of that decision?
  19. For what ages has the POSI been validated?
  20. Why is the POSI not included on the 15 month and 36 month SWYC forms?
  21. Why is a “high score” positive on some SWYC components but a “low score” is positive on others?
  22. I just reviewed the Milestones forms for two of my patients. One child is 6 months old and the other is 7 months old. Both of their parents completed the 6 Month SWYC form. Both children got a Milestones score of 12, but when I checked my scoring chart I saw that the younger child’s score fell in the “Appears to Meet Age Expectations” range, while the older child’s score fell in the “Needs Review” range. Since they have the same score on the same age-specific SWYC form, I don’t understand why this is.
  23. The last couple questions on each age-specific form’s Milestones questions seem advanced. Most children won’t be able to do those skills yet. Why are the Milestones written like that?
  24. How can I access journal articles about the SWYC?
  25. How can I contact you?


There are lots of screening instruments; what is unique about the SWYC?

The SWYC was created in order to provide a screening instrument that includes questions addressing a broad array of areas of development in preschool children. It was also designed to be free of cost and easily accessed by parents, pediatric primary care providers (PPCPs), home visit providers, preschool teachers, nurses, and other professionals involved in child care and early education. It includes items that assess cognitive, language, motor, and social-emotional development, as well as family risk factors (e.g., parental depression, conflict, substance abuse, and hunger) and behaviors suggestive of autism spectrum disorder (ASD). It is short and easy to score. 

How do I know what SWYC form to use?

There are two ways to pick the right age-specific SWYC form to use.

a.Calculate the child’s age by hand. Then, use the chart below to select the appropriate form or consult the age ranges listed on the forms themselves.



b. Use the Excel-based Form Selector and Milestones calculator. You just need to enter the date of administration and the child’s birthday, and the calculator will tell you which form to use.

When do I need to adjust a child’s age for prematurity?

You only need to adjust for prematurity if the child is under 24 months and was born at least 3 weeks prematurely.

How many items are on the SWYC?

Parents are asked to complete a two-page, age-specific form. Depending on the child’s age, the form includes either three or four components: (1) cognitive, language and motor development; (2) social-emotional development; (3) family risk factors, including parental depression, discord, substance abuse, and hunger; and for children between 15 months and 36 months (4) autism. The length of the SWYC forms varies slightly by age, but there are roughly 40 questions on each age-specific form.

How long does the SWYC take to complete?

Different parents require different amounts of time to complete the SWYC. Most take about 10 minutes.

Is the SWYC validated?

This is a complex question for any screening instrument, and there is seldom (if ever) a simple “yes” or “no” answer. The question is whether one can have confidence that a screening instrument is accurate enough for its intended use. High-quality, up-to-date research, ideally published in peer-reviewed journals, should increase one’s confidence. We also look for independent replication and direct comparisons to existing screening instruments. If a screener has been changed in any way, whether translated into a new language or used in a new setting or with a new population, we look for research demonstrating its accuracy despite the changes.

Research on the SWYC is described in this manual and our publications. As of 2013, three of the SWYC’s four components have been compared statistically to a well-respected screening instrument (ASQ-3 and ASQ-SE), and to parents’ reports of developmental-behavioral diagnoses. One has also been compared to the CBCL, a frequently used parent report of symptoms of behavioral/emotional disorders. The items that comprise the fourth component of the SWYC, called Family Questions, were assembled from previously-validated tests and have not been evaluated in their current form. Detailed descriptions of the methods of study and the statistical techniques used to validate the SWYC are described in our manuscripts. Ongoing research conducted by us and by independent investigators will compare the SWYC to “gold standard” clinical assessments (see section 5B on “Ongoing Research” in our manual)

Is the SWYC protected by copyright?

Yes. Although the SWYC is freely available, it cannot be modified without expressed permission of the authors. If you are interested in translating the SWYC into a new language or administering it in a way for which the downloadable forms are not appropriate, please contact Kate Mattern at: theswyc@gmail.com.

How do I purchase the SWYC?

No purchase is required. All of the age-specific SWYC forms are freely available on this website. You can find them by clicking on "Age-Specific Forms" in the navigation bar.

What CPT code should I use for the SWYC?

Currently the CPT code 96110 is used for billing for all sorts of developmental-behavioral screening. There is also a new code, just approved, 96127, which is designated to be for “behavioral screening.” Some people have asked if the SWYC would qualify for the use of both 96110 and 96127 simultaneously, since it does legitimately screen for both kinds of problems, “developmental” and “behavioral.” To our knowledge no health insurance company has addressed this possibility yet.

Can I use only the social-emotional screener, or only the Milestones, or do all 4 sections of the SWYC have to be used together?

The SWYC is designed to be a comprehensive, first-level screening instrument for routine use in regular well-child care. It combines what is traditionally “developmental” with traditionally “behavioral” screening, and adds screening for autism and for parental depression and other family risk factors. As such, it is designed to be used as a single package, and to be used regularly over the course of health supervision. However, it is also acceptable to use individual parts of the SWYC separately to meet particular needs.

Can I make changes to the SWYC for use in my practice? 

We don’t allow user modifications to the BPSC, PPSC, POSI, or Milestones components of the SWYC. 
 
The SWYC Family Questions were chosen from other previously validated, free measures. In the past, we have cooperated with user requests to modify the Family Questions for use in a local setting by substituting or adding new items from other free measures. Please email us at theswyc@gmail.com if you are considering such a change. When we consider these requests, our standard protocol is to:
  1. Assign responsibility for formatting and obtaining needed copyright permissions to the user. We cannot help format modified SWYC forms, and it is the responsibility of users who want to modify the SWYC forms to ensure that they have the appropriate copyright permissions to use alternate items from other free measures.
  2. Stipulate how the user and his/her institution should refer to this amended form. To avoid confusion, we ask that users undertaking modifications be clear within their local system and in any publications or other materials they create that a modified version of the SWYC is being used. We ask that such users agree to language like “an adaptation of SWYC version 1.05, with alternate items substituted for the first 3 of the Family Questions.
  3. Request feedback after the modification has been pilot-tested. We are open to considering modifications to the standard SWYC Family Questions in the future. We have asked that users who modify the SWYC for local use assist us in these deliberations if possible, by sharing:
  • their perspective on why their proposed modifications are preferable 
  • any data it is feasible to provide after using the new questions for a year, such as the percent who screen positive 
  • any feedback from doctors using the modified form about how useful they find the modified instrument to be in practice

Is the SWYC available in electronic form or in Electronic Health Records (EHR)?

The SWYC is available through Patient Tools and CHADIS.  Please contact us if you are interested in building the SWYC into your electronic system by emailing us at theswyc@gmail.com.

Is there an alternative to hand-scoring the forms?

Yes, there is! When the SWYC is administered electronically, the scoring is done automatically. The SWYC may eventually become available as a standard offering from electronic medical record (EMR) providers. In the meantime, some practices have incorporated the SWYC into their local EMR systems on their own. If you are interested in building the SWYC into your local EMR system, you are free to do so. We suggest you check out the user interface examples in our manual for inspiration. If you don’t have an EMR, try our Excel-based calculator available that takes a lot of the work out of the Milestones scoring. You just enter the child’s raw Milestones score, and it tells you whether that score indicates a need for review or appears to meet age expectations. 

Is the SWYC approved by MassHealth?

Yes! The SWYC is approved by MassHealth for compliance with the Children's Behavioral Health Initiative screening guidelines.

What is the SWYC/MA?

Massachusetts has created a revised version of the SWYC screening tool in order to address postpartum depression as a critical issue in the development and well-being of infants and young children. In this SWYC/MA version, the Edinburgh Postnatal Depression Scale questions were added to the 2, 4 and 6 month forms. All other parts of the SWYC/MA at these three ages are identical to the generic SWYC. The remaining age-based forms remain unchanged. The SWYC/MA forms can be found on the Massachusetts Child Psychiatry Access Project (MCPAP) website.

Who should complete the SWYC?

The SWYC can be completed by any caregiver, including parents and grandparents, who have enough knowledge about the child to be able to answer the SWYC questions reliably.

What makes someone qualified to interpret the SWYC?

By “qualified,” we mean someone who:
  • has the skills and experience to understand what a positive screen does and does not mean
  • possesses the ability to explain results to parents in a way that enhances trust and benefits the child 
  • maintains patient confidentiality
Whether or not someone is qualified is not necessarily based on specific degrees or training. Ultimately, the criteria that determine whether or not someone is qualified to interpret SWYC scores are up to your team.

When I hand parents the SWYC, I tell them that their child’s doctor has asked that they complete the form. Sometimes parents then ask for more information about why they need to do so. What should I say?

We would suggest saying something like: “This questionnaire is a tool that helps your child’s pediatrician monitor (child’s name)’s development and behavior. Don’t worry if he or she is not doing all of the things this questionnaire asks about –most children can’t do every skill described. The questions are just a way for your doctor to get a sense of what things you should talk about in more detail.”

What should we do when a child screens positive on the SWYC? We can’t possibly refer every child.

When a child screens positive on the SWYC, this indicates that a conversation with the parent is needed. Often, a conversation is all the intervention that is required. A positive score on the SWYC indicates concern, not diagnosis. Some children who screen positive on the SWYC will, upon further conversation with the parent, actually turn out to be doing just fine. Some will be struggling with behaviors or skills that the parent could use some guidance on managing. For others, you may want to wait and see if particular behaviors have improved by their next visit. Children who score positive on the SWYC will sometimes require a referral, but not most. You should use your clinical judgment to determine when this is the best next step.

It seems like the SWYC detects a lot of false positives. Why can’t it just tell me which children have a real problem and which children don’t?

A screening instrument can’t give a diagnosis – it can only indicate risk. So, when we were creating the SWYC, we had to decide how to set our scoring thresholds. If we made it relatively hard to score positive, that would mean that the only children who score positive would have very concerning scores and almost certainly have a real problem. However, it would also mean that the SWYC would miss lots of children with less extreme scores who also really did have a problem that needed addressing.If we made it relatively easy to score positive, the SWYC would probably not miss many children with real issues. However, this would also mean that it would detect more false positives – children who score positive, but are really doing fine.

As a first-level screener, we decided to prioritize missing as few children as possible with real cause for concern. This does mean that the SWYC will pick up some false positives, but it also means that children with real issues are less likely to be missed.

I think too many children score positive on screening instruments, so I only really trust positive results that are several points above the states threshold. What is the effect of that decision?

The effect is the same as if you had raised the threshold. Positive results will be more likely to be correct (higher Positive Predictive Value), but you will miss more children who might benefit from treatment (lower sensitivity). Be aware of the tradeoff in this approach.

For what ages has the POSI been validated?

We recommend the POSI for children from 16 months to 36 months. It is included on the 18 month, 24 month, and 30 month SWYC forms.

Why is the POSI not included on the 15 month and 36 month SWYC forms?

There is a SWYC form for every age on the periodicity schedule. As depicted in the Table, the age ranges for these SWYC forms do not correspond perfectly with the age range of the POSI. Thus:
  • The 18 month, 24 month, and 30 month SWYC forms include the POSI. The POSI is valid across the entire age range of these forms.
  • The 15 month and 36 month SWYC forms do not include the POSI. The POSI is valid for part of the age range of these forms, but not for the entire age range.
Although the POSI may be valid for children at 15 months, at this time there is insufficient evidence to recommend the form for children of this age.

Clinicians who wish to use the POSI for children older or younger than the suggested age range are free to do so, but we recommend additional caution when interpreting results.


Why is a “high score” positive on some SWYC components but a “low score” is positive on others?

The Milestones measure developmental achievements. The more achievements that are reported the better. As such, a high score on the Milestones is good, and therefore not indicative of risk. All other SWYC components measure negative attributes (i.e., symptoms). As such, a high score on these components would mean more symptoms, which would indicate risk.

How do I use the Milestones longitudinally?

Keep a Milestones scoring chart in a patient’s file. At each visit, circle your patient’s score on the same chart as used in previous visits. This will allow you to track your patient’s development over time.

I just reviewed the Milestones forms for two of my patients. One child is 6 months old and the other is 7 months old. Both of their parents completed the 6 Month SWYC form. Both children got a Milestones score of 12, but when I checked my scoring chart I saw that the younger child’s score fell in the “Appears to Meet Age Expectations” range, while the older child’s score fell in the “Needs Review” range. Since they have the same score on the same age-specific SWYC form, I don’t understand why this is.

Each SWYC form covers an age range. The 6 month form is for children who are 6, 7, and 8 months old. Children who are at the younger end of the age range for a particular form will tend to score lower than children that are older in the same age range. The scoring algorithm adjusts for this tendency. So despite the fact that the 6-month Milestones was completed for both of your patients, a score of 12 for a 6 month old child falls under the “Appears to Meet Age Expectations” range, whereas a score of 12 for a 7 month old child falls under the “Needs Review” range.

The last couple questions on each age-specific form’s Milestones questions seem advanced. Most children won’t be able to do those skills yet. Why are the Milestones written like that?

There are 10 Milestones items on each age-specific SWYC form. The first few items on each form are “easier” skills that most children will be doing. As the list goes on, the skills become more challenging. Most children will not be able to do all ten skills listed at any particular age.

We designed the forms in this way to provide continuity between the age-specific forms (so that the “harder” items at 12 months, for instance, become the “easier” items at 15 months) and to provide parents with some idea of what skills they may see their children doing next.

How can I access journal articles about the SWYC?

On the horizontal navigation bar at the top of this page, hover over "More" and then select “Publications, Invited Talks, and Presentations.” There, you will find instructions on how to download free PDFs of the articles.

How can I contact you?

Email us at theswyc@gmail.com. We'd love to hear from you!

The SWYC and the information on this site are not designed to and do not provide medical advice, professional diagnosis, or treatment. The information and any reference materials posted here by Tufts Medical Center, Inc. are intended solely for the information of the reader. Such information is NOT intended to replace consultation with a qualified medical professional. The SWYC is copyright © 2010 Tufts Medical Center.


Final SWYC logo.


Translations

The SWYC has been translated into Spanish, Burmese, Nepali, and Portuguese.

Learn more about the process and download the translated versions >


Need more information?

Check out the manual! Or, see our list of publications, talks, and presentations and our FAQ page.