BACKGROUND: Foster children who have experienced adverse childhood events are at-risk for developing social-emotional problems that may ultimately lead to toxic stress. There is a lack of research on whether administration of a standardized questionnaire aids in the clinical documentation of social-emotional problems of foster children. The Ages and Stages Questionnaire: Social Emotional (ASQ:SE) is recommended by the American Academy of Pediatrics to identify social-emotional problems. The purpose of this DNP scholarly project is two-fold (a) to assess the social-emotional problems of foster children aged 0-5 using the ASQ:SE, and (b) to determine if administration of the ASQ:SE will identify social-emotional problems and improve clinical documentation versus use of provider surveillance only. METHODS: A retrospective chart review of a convenience sample of ten foster children, from birth to 4 years of age, was completed in a multispecialty clinical setting to examine documentation for social-emotional problems. The ASQ:SE was administered with the legal guardians of the same foster children.RESULTS: Both provider surveillance and administration of the ASQ:SE detected social-emotional problems in foster children aged 3 months-4 years. However, use of the standardized ASQ:SE detected more consistent behaviors across adaptive, affect, autonomy, communication, compliance, interaction and self-regulation themes than provider surveillance only. CONCLUSION: The systematic use of the ASQ:SE specifically improved identification of social-emotional problems in foster children up to 4 years of age compared to provider surveillance only and significantly improved clinical documentation, thus decreasing risk of toxic stress.