Aims Children in Care (CIC) have a higher prevalence of emotional, behavioural and mental health diagnoses. The Department of Health UK guidance requires annual screening assessment of these children using the validated Strengths and Difficulties Questionnaire (SDQ). A score of 17 and above indicates significant concern regarding the presence of mental health morbidity.

Methods Using the local authority social care database, an audit of all children who had their first statutory medical assessment between March 2012 and March 2013 by our trust CIC service was undertaken, to evaluate adherence to these guidelines. We reviewed the medical notes of children with an SDQ score of 17 and above to assess if action was taken and whether referral to local specialist mental health services made a difference to their mental health and wellbeing.

Results We identified 424 children eligible for SDQ assessments. In 179 children (42%), there was no record of an SDQ ever being performed. Out of the remaining 245 children, 145 (34%) had just one SDQ result and 100 (24%) had two SDQ results over a 1 year period from entering social care. 40 of these 100 children had at least one SDQ score of 17 or above.

29 out of 40 patient notes were reviewed. 3 were excluded as they contained no accurate information regarding CIC medicals. Of the remaining 26 children, 69% were male, 81% were 6–15 years old and 38% had at least one psychiatric diagnosis. 12 children were referred to mental health services, 10 were not referred and 4 were already under specialist follow up. Overall, the average change in SDQ score was –3.4. In those referred it was –4.2; not referred –2.5; already under a service –3.25.

Conclusion These results demonstrate:

• Annual assessment of mental health using the SDQ is being inadequately performed or recorded.

• Those receiving referral to specialist mental health services had a greater reduction in SDQ scores, although this is a small study.

Assessing and responding to mental health screening in CIC makes a beneficial difference. Further research and service changes may be required to better support these children.