Validity and reliability of a structured interview for early detection and risk assessment of parenting and developmental problems in young children: a cross-sectional study

Novel instrument to guide nurse-led consultations with parents of three-year-olds in school health services in Flanders: A feasibility study of SPARK36

BACKGROUND

In the framework of new legislation on School Health Services (SHS) in Flanders (Belgium), nurses lead a preventive consultation with every three-year-old child and its parent(s), with the aim of assessing risks in child development and potential parenting problems. This study assesses the feasibility of the "Structured Problem Analysis of Raising kids aged 36 months" (SPARK36), a broad-scope structured interview to facilitate such consultations.

DESIGN AND METHODS

A feasibility study was conducted with SHS nurses across Flanders, to determine need for this instrument, acceptability and practical feasibility of SPARK36 with both parents and professionals. Nurses were trained to use the instrument. Mixed methods (i.e., questionnaires for both parents and nurses, and a focus group interview with nurses) were used to evaluate the feasibility of using SPARK36.

RESULTS

Parents were satisfied (97.0%) with what was discussed during the consultation and with the consultation's structure (98.8%). After the training, all 20 nurses felt strengthened in performing the consultation and in making a risk assessment. The interview was feasible in 20-30 min. During 561 interviews nurses gave parenting support in 88.2% of cases.

CONCLUSIONS

SPARK36 is acceptable, practically feasible for parents and nurses, and it meets needs of both parties. The instrument supports nurses during their consultation. More research is needed to evaluate the instrument and to prepare its implementation in daily practice.

PRACTICE IMPLICATIONS

SPARK36 is a promising instrument for nurse-led consultations in the SHS setting.

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.

Reducing growth and developmental problems in children: Development of an innovative postnatal risk assessment

Introduction

Globally, awareness of the relevance of both medical and non-medical risk factors influencing growth and development of children has been increasing. The aim of our study was to develop an innovative postnatal risk assessment to be used by the Preventive Child Healthcare (PCHC) to identify at an early stage children at risk for growth (catch-up growth, overweight and obesity) and developmental problems (such as motor, cognitive, psychosocial and language/ speech problems).

Methods

We used the first four steps of the Intervention Mapping process. Step 1: Review of the literature and focus group discussions. Step 2: Identification of program objectives on how to develop and implement a risk assessment in PCHC daily practice. Step 3: Application of the ASE model to initiate behavioral change in the target group. Step 4: Development of the postnatal R4U and a program plan for the implementation in PCHC organizations.

Results

Subsequently in 2015, the 41 item postnatal R4U (the postnatal Rotterdam Reproduction Risk Reduction checklist) was developed according to steps one until four of the Intervention Mapping process and was implemented in four PCHC organizations.

Conclusions

It was feasible to design and implement a postnatal risk assessment identifying both medical and non-medical risks for growth and developmental problems, using the Intervention Mapping process.

Validity of a family-centered approach for assessing infants' social-emotional wellbeing and their developmental context: a prospective cohort study

Background

Family-centered care seems promising in preventive pediatrics, but evidence is lacking as to whether this type of care is also valid as a means to identify risks to infants’ social-emotional development. We aimed to examine the validity of such a family-centered approach.

Methods

We conducted a prospective cohort study. During routine well-child visits (2–15 months), Preventive Child Healthcare (PCH) professionals used a family-centered approach, assessing domains as parents’ competence, role of the partner, social support, barriers within the care-giving context, and child’s wellbeing for 2976 children as protective, indistinct or a risk. If, based on the overall assessment (the families were labeled as “cases”, N = 87), an intervention was considered necessary, parents filled in validated questionnaires covering the aforementioned domains. These questionnaires served as gold standards. For each case, two controls, matched by child-age and gender, also filled in questionnaires (N = 172). We compared PCH professionals’ assessments with the parent-reported gold standards. Moreover, we evaluated which domain mostly contributed to the overall assessment.

Results

Spearman’s rank correlation coefficients between PCH professionals’ assessments and gold standards were overall reasonable (Spearman’s rho 0.17–0.39) except for the domain barriers within the care-giving context. Scores on gold standards were significantly higher when PCH assessments were rated as “at risk” (overall and per domain).We found reasonable to excellent agreement regarding the absence of risk factors (negative agreement rate: 0.40–0.98), but lower agreement regarding the presence of risk factors (positive agreement rate: 0.00–0.67). An “at risk” assessment for the domain Barriers or life events within the care-giving context contributed most to being overall at risk, i.e. a case, odds ratio 100.1, 95%-confidence interval: 22.6 - infinity.

Conclusion

Findings partially support the convergent validity of a family-centered approach in well-child care to assess infants’ social-emotional wellbeing and their developmental context. Agreement was reasonable to excellent regarding protective factors, but lower regarding risk factors.

Trial registration

Netherlands Trialregister, NTR2681. Date of registration: 05–01-2011, URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2681.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-017-0898-5) contains supplementary material, which is available to authorized users.

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

OBJECTIVE

Determine whether the early detection of parenting problems and developmental problems in young children improves with the help of a validated structured interview.

DESIGN

Non-randomized controlled trial held from December 2006 until January 2008.

SETTING

Preventive child health care services in the Netherlands.

PARTICIPANTS

4438 eligible 18-month-old children and their parents.

INTERVENTIONS

A visit to the well-baby clinic with and without (usual care) the use of a validated structured interview for the early detection of parenting problems and developmental problems in young children: the Structured Problem Analysis of Raising Kids.

OUTCOME MEASURES

The primary outcome consists of the difference in the number of 18-month-old children with high or increased risk for parenting and developmental problems. Secondary outcomes are the differences in care needs as expressed by child health care nurses, the percentage of parents and other children of the family attending, follow-up actions, the scores of parent report questionnaires and the time needed for the consultation. Data were analyzed by means of ordinal regression with propensity score adjustment.

RESULTS

Certain discrepancies were noticed: during usual care visits, nurses found fewer children with high (1.2 versus 2.6%) or increased risk (14.5 versus 20.7%) than during visits in which the Structured Problem Analysis of Raising Kids was used (p=0.002), but they also indicated that more help was needed. Conversely, no additional contacts were advised for 25% of the children whom the nurses in the care-as-usual group labelled as high risk, while all high-risk children visited with the Structured Problem Analysis of Raising Kids received additional contacts.

CONCLUSIONS

The Structured Problem Analysis of Raising Kids, a validated structured interview, improves the early detection of parenting and child-developmental problems in young children, compared to regular visits without an instrument. Structuring the collection of information about parents' concerns and care needs gives nurses information beyond their professional viewpoint and results in joint decisions that better match parental care needs and risk levels determined.

TRIAL REGISTRATION

www.trialregister.nl. Identifier: NTR1413.

Early detection of parenting and developmental problems in toddlers: A randomized trial of home visits versus well-baby clinic visits in the Netherlands

OBJECTIVE

The early detection of parenting and developmental problems by preventive child health care (CHC) services in the Netherlands takes place almost exclusively at the well-baby clinic. This study assesses whether, compared to a visit to the well-baby clinic, a home visit improves early detection.

METHODS

4481 eligible 18-month-old children and their parents were randomized to either a visit to the well-baby clinic or a home visit in the period from December 2006 to January 2008. A CHC nurse held structured interviews using the validated Structured Problem Analysis of Raising Kids (SPARK). Differences in the percentage of children with high or increased risks of parenting and developmental problems as assessed by the SPARK were analyzed with ordinal regression. Secondary outcomes included the percentage of parents attending, parents' concerns, needs assessment by parents and CHC professionals and user experience.

RESULTS

Response rates were 94.0% for the home visit group and 93.2% for the well-baby clinic group. Using the SPARK at home identified significantly more high-risk children compared to clinic visits (3.7 vs. 2.6%) and fewer children with increased risk (19.1 vs. 20.7%; overall p=0.028). Home visits more often involved both parents and other children. At home, parents reported more concerns. Both parents and CHC nurses more often expressed the need for support and reported significantly better experiences at home.

CONCLUSIONS

Aided by a validated structured interview, CHC professionals detect more children with high risks of parenting and child-developmental problems during home visits than during clinic visits.

CLINICAL TRIAL REGISTRATION

www.trialregister.nl Identifier: NTR1413.

How do public child healthcare professionals and primary school teachers identify and handle child abuse cases? A qualitative study

Background

Public child healthcare doctors and nurses, and primary school teachers play a pivotal role in the detection and reporting of child abuse, because they encounter almost all children in the population during their daily work. However, they report relatively few cases of suspected child abuse to child protective agencies. The aim of this qualitative study was to investigate Dutch frontline workers’ child abuse detection and reporting behaviors.

Methods

Focus group interviews were held among 16 primary school teachers and 17 public health nurses and physicians. The interviews were audio recorded, transcribed, and thematically analyzed according to factors of the Integrated Change model, such as knowledge, attitude, self-efficacy, skills, social influences and barriers influencing detection and reporting of child abuse.

Results

Findings showed that although both groups of professionals are aware of child abuse signs and risks, they are also lacking specific knowledge. The most salient differences between the two professional groups are related to attitude and (communication) skills.

Conclusion

The results suggest that frontline workers are in need of supportive tools in the child abuse detection and reporting process. On the basis of our findings, directions for improvement of child abuse detection and reporting are discussed.

Risk assessment of parents' concerns at 18 months in preventive child health care predicted child abuse and neglect

OBJECTIVE

As child maltreatment has a major impact, prevention and early detection of parenting problems are of great importance. We have developed a structured interview which uses parents' concerns for a joint needs assessment by parents and a child health care nurse, followed by a professional judgment on the risk level of future parenting and developmental problems: the Structured Problem Analysis of Raising Kids (SPARK). Previous results have shown that the risk assessment of the SPARK is associated with risk factors for child maltreatment. This study reports the predictive value of the SPARK for reports on high impact parenting problems and child abuse and neglect.

METHOD

Cross-sectional study with a 1.5-year follow-up based on 1,850 18-month old children, living in Zeeland, a province of the Netherlands. Data on the SPARK were obtained in the period of June 2007 to March 2008. Outcomes of the SPARK were in October 2009 compared to reports of the Advice and Reporting Centers for Child Abuse and Neglect (ARCAN) and Youth Care Agency (YCA). Univariate and multivariate logistic regression analysis was done using the risk assessment, parents' concerns, the perceived need for support and known risk factors as predictors.

RESULTS

The overall risk assessment of the SPARK is the strongest predictor for reports to ARCAN and YCA in the 1.5 years after completing the SPARK (odds ratio of high versus low risk: 16.3 [95% confidence interval: 5.2-50.8]. Controlling for the risk assessment, only the sum of known risk factors and an unemployed father remained as significant predictors. The reported groups differ significantly from the children without a report with regard to family characteristics, but not with regard to child characteristics.

CONCLUSIONS

A structured assessment of the concerns and care needs of toddlers' parents by a child health care nurse is a valuable predictor of reports on child abuse and neglect and serious parenting problems in toddlers.

PRACTICAL IMPLICATIONS

Systematically exploring and evaluating parental concerns with an instrument like the SPARK can contribute to the early recognition of families at risk for major child rearing problems.