Early detection of parenting and developmental problems in young children: Non-randomized comparison of visits to the well-baby clinic with or without a validated interview

Validation of the Dutch Infant Crying and Parent Well-Being Screening Tool in Parents of Infants Less than 12 Months of Age

OBJECTIVE

To evaluate reliability and validity of the Dutch version of the Infant Crying and Parent Well-Being (ICPW) tool in identifying parents struggling with infant crying in the first year of life.

STUDY DESIGN

The original ICPW tool was translated into Dutch following established guidelines. The internal consistency and criterion validity of the Dutch ICPW tool were evaluated using a cross-sectional design. The translated ICPW tool and validated questionnaires on parental depression, stress, anxiety, and parenting balance were presented to parents of infants under 12 months during child health care visits and online.

RESULTS

The survey was completed by 488 parents, 400 mothers and 88 fathers. Of these, 172 participated after a child health care visit and 316 via online platforms. The Dutch ICPW showed satisfactory internal consistency (α = 0.69) and excellent criterion validity with parental mental health measures (r = 0.53-0.85). ICPW scores demonstrated positive correlations with parental depression, stress, and anxiety levels, and a negative correlation with parenting balance. Both mothers and fathers with a positive ICPW screen (≥3) reported significantly higher levels of parental mental health issues compared with those with a negative screen (P < .001). The ICPW was positive in 32% of the parents (n = 155), with consistent total scores regardless of the infant's increasing age (r = -0.024, P = .59). The ICPW tool exhibited a strong negative predictive value (93%) for diagnosing postpartum depression.

CONCLUSIONS

The Dutch ICPW tool is a reliable and valid screening instrument for identifying parents struggling with infant crying.

Children's perspectives on health and wellbeing: A concept mapping study

PURPOSE

Children's needs and perspectives regarding health and wellbeing are rarely considered in public health care services. To improve preventive youth health care, the aim of this study was to gain knowledge about children's perspectives on health and wellbeing.

DESIGN AND METHODS

In a concept mapping study, Dutch children, 9-12 years old in primary schools (N = 82), generated ideas regarding health or wellbeing and sorted and rated these ideas on importance. Multidimensional scaling and hierarchical clustering were done in program R. Qualitative analyses determined the final concept maps. Subsequently, we conducted four focus groups about these maps with nurses and physicians.

RESULTS

For the concept "health", children (n = 33) generated 309 statements in 7 themes: 1) healthy living environment, 2) food and drinks, 3) important for a healthy life, 4) leisure time and relaxation, 5) physical diseases and cure, 6) necessities to be healthy, 7) love and affection. For the concept "wellbeing", children (n = 49) generated 435 statements in 9 themes: 1) negative influence on feelings, 2) feeling connected with friends and family, 3) unpleasant feelings, 4) positivity and enjoyable activities, 5) bad experiences and things, 6) problems with friends and family, 7) social media and gaming, 8) puberty and sexuality, 9) tasty food and drinks. Professionals (N = 16) had a more risk-oriented perspective on health and wellbeing than children.

CONCLUSIONS

Children have a wide variety of perceptions of what is important for their health and wellbeing.

PRACTICE IMPLICATIONS

Children's perceptions could inform preventive youth health care services to better adapt to children's needs.

Early detection of risk for maltreatment within Dutch preventive child health care: A proxy-based evaluation of the long-term predictive validity of the SPARK method

BACKGROUND

For effective prevention of child maltreatment, it is crucial that risk factors for child maltreatment are identified as early as possible. In the Dutch preventive child healthcare, the SPARK-method is used for this purpose.

OBJECTIVE

The current study investigated the predictive validity of the SPARK-method for predicting child protection activities, as a proxy for child maltreatment, and whether the estimation can be improved with an actuarial module.

PARTICIPANTS AND SETTING

Participants included a community sample of 1582 children of approximately 18-months-old for whom the SPARK was administered during well-child visits at home (51 %) or at the well-baby clinic (49 %).

METHODS

SPARK measurements were linked to data on child protection orders and residential youth care over a 10-year follow-up period. The predictive validity was evaluated using Area Under the receiver operating characteristic Curve (AUC) values.

RESULTS

Results showed good predictive validity for the SPARK clinical risk assessment (AUC = 0.723; large effect). The actuarial module led to a significant improvement in predictive validity (AUC = 0.802; large effect), z = 2.05, p = .04.

CONCLUSION

These results show that the SPARK is suitable for estimating the risk of child protection activities and that the actuarial module is a valuable addition. The SPARK can be used to support professionals in preventive child healthcare with their decision on appropriate follow-up actions.

An innovative postnatal risk assessment and corresponding care pathways in Preventive Child Healthcare

Aims

This study aims to evaluate the effectiveness of an innovative postnatal risk assessment (the postnatal Rotterdam Reproductive Risk Reduction checklist: R4U) and corresponding care pathways in Preventive Child Healthcare (PCHC), along with PCHC professional satisfaction.

Design

Four PCHC organizations located in three municipalities with a higher adverse perinatal outcome than the national average were selected for participation. The study concerns a historically controlled study design.

Methods

The study enrolled participants from September 2016 until December 2017. The historical cohort existed of children born in previous years from 2008 until 2016. The outcome measure was defined as catch‐up growth: more than 0.67 standard deviation score weight for height increase in the first 6 months of life. PCHC professional opinion was assessed with a digital survey.

Results

After the inclusion period, 1,953 children were included in the intervention cohort and 7,436 children in the historical cohort. Catch‐up growth was significantly less common in the intervention cohort; 14.9% versus 19.5% in the historical cohort (p < 0.001). A regression sensitivity analysis, using matching, showed an odds ratio of 0.957 (95% CI 0.938–0.976) for the intervention cohort. In the survey, 74 PCHC physicians and nurses participated; most of them were neutral concerning the benefits of the postnatal R4U.

Conclusion

This study shows that the implementation of a novel postnatal risk assessment including in PCHC is feasible and effective. Final efforts to ensure a widespread implementation should be taken.

Impact

PCHC offers a unique opportunity to recognize and address risk factors for growth and development in children and to implement care pathways. Effective and widely implemented risk assessments in antenatal and PCHC are scarce. To our knowledge, this kind of evidence‐based postnatal risk assessment has not been implemented in PCHC before and seizes the opportunity to prevent catch‐up growth and its long‐term effects.

Assessing Concerns and Care Needs of Expectant Parents: Development and Feasibility of a Structured Interview

Many adverse situations for parenting and healthy child development can be detected before a child's birth. The aim of this project was to develop and test an instrument to use in prenatal home visits, to improve the identification of adverse situations and care needs during pregnancy. The preSPARK is based on a valid and reliable broad-scope structured interview called SPARK (Structured Problem Analysis of Raising Kids). The preSPARK focuses on 12 topics ranging from aspects of the period before pregnancy to future parents' expectations. The preSPARK was tested in daily practice for feasibility and discriminative capacity. User experience was assessed from the perspective of the professional. In total, 64 home visits using the preSPARK were carried out by 21 nurses. About 24% of the expectant parents needed intensive help or immediate action on one or more topics. The risk assessment showed 29% of the participants were at high risk, 40% at increased risk, and 31% at low risk for future parenting and child developmental problems. The nurses indicated that the preSPARK provides a good structure for home visits and gives insight in interrelated factors. The preSPARK is feasible in daily practice and clarifies risks and care needs of expectant parents.