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.

van Stel HF, Staal II, Hermanns JM, Schrijvers AJ.

BMC Pediatr. 2012 Jun 14;12:71. doi: 10.1186/1471-2431-12-71.

Abstract

BACKGROUND:

Preventive child health care is well suited for the early detection of parenting and developmental problems. However, as far as the younger age group is concerned, there are no validated early detection instruments which cover both the child and its environment. Therefore, we have developed a broad-scope structured interview which assesses parents' concerns and their need for support, using both the parental perspective and the experience of the child health care nurse: the Structured Problem Analysis of Raising Kids (SPARK). This study reports the psychometric characteristics of the SPARK.

METHOD:

A cross-sectional study of 2012 18-month-old children, living in Zeeland, a province of the Netherlands. Inter-rater reliability was assessed in 67 children. Convergent validity was assessed by comparing SPARK-domains with domains in self-report questionnaires on child development and parenting stress. Discriminative validity was assessed by comparing different outcomes of the SPARK between groups with different levels of socio-economic status and by performing an extreme-groups comparison. The user experience of both parents and nurses was assessed with the aid of an online survey.

RESULTS:

The response rate was 92.1% for the SPARK. Self-report questionnaires were returned in the case of 66.9% of the remaining 1721 children. There was selective non-reporting: 33.1% of the questionnaires were not returned, covering 65.2% of the children with a high-risk label according to the SPARK (p < 0.001). Inter-rater reliability was good to excellent with intraclass correlations between 0.85 and 1.0 for physical topics; between 0.61 and 0.8 for social-emotional topics and 0.92 for the overall risk assessment. Convergent validity was unexpectedly low (all correlations ≤0.3) although the pattern was as expected. Discriminative validity was good. Users were satisfied with the SPARK and identified some topics for improvement.

CONCLUSION:

The SPARK discriminates between children with a high, increased and low risk of parenting and developmental problems. It does so in a reliable way, but more research is needed on aspects of validity and in other populations.

PMID:

 

22697218

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC3465192

 

Free PMC Article

Study of Well-Child Visits Analyzes Content and Satisfaction

September 19, 2011 — Although most well-child visits for children under 3 years of age are of "short duration," parent satisfaction is generally high, according to the results of a cross-sectional national survey in the October 2011 issue of Pediatrics (published onlineSeptember 19).

Among a subset of 1428 parents who participated in the 2000 National Survey of Early Childhood Health (NSECH), one third reported spending 10 minutes or less with the clinician during their well-child visit, 47% reported visits lasting 11 to 20 minutes, and 20% reported visits of 21 minutes or more, reported Neal Halfon, MD, from the Center for Healthier Children, Families and Communities at the University of California, Los Angeles, and colleagues.

"Longer visits are associated with more developmental screening, discussions of more psychosocial risks, and greater parent satisfaction," they write. However, "even with the shortest visits parent-reported satisfaction generally was high."

The NSECH included 2068 parents of children aged 4 to 35 months, of whom 1428 provided details about their well-child visit within the past year.

Participants were asked about the length of the visit, their satisfaction with the visit, and the content of care in terms of anticipatory guidance, psychosocial assessment of risks, developmental assessment, and family-centered care.

Regardless of the length of visit, more than 80% of parents reported receiving anticipatory guidance on immunizations and breastfeeding, with more issues such as sleeping position, feeding issues, and car seats being included in longer visits.

"The pattern indicated that traditional topics that have been part of anticipatory guidance for decades are most likely to be addressed, whereas topics added more recently are less likely to get mentioned when time is short," the authors write.

"Overall, many anticipatory guidance topics were provided more frequently than a developmental assessment (which ranged between 50% and 68% depending on the visit length)," they note.

Ninety-nine percent of parents reported having adequate time with their doctors when the visit was 21 minutes or longer, compared with 76% of parents whose visits lasted 10 minutes or less.

Parental satisfaction remained higher with longer visits even after adjustment for the content of the visit, supporting the notion that "a trusting relationship and good communication between parents and their child’s pediatrician is a key component of optimal well-child care," they suggest.

The authors note that demands on pediatricians performing well-child visits continue to expand as new directives clash with time constraints and lack of reimbursement.

"Efforts to improve preventive services will require strategies that address the time devoted to well-child care," they note.

A focus on parent-identified concerns, the integration of previsit questionnaires, tiered systems that allot more time to higher-risk children, and the division of some care with nonphysician clinicians are among suggested strategies that might enhance care, they write.

"Ultimately, greater reimbursement for preventive and developmental services may best encourage the devotion of time and attention to their provision," they conclude.

The study was supported by the Commonwealth Fund and the Gerber Foundation. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online September 19, 2011.

Clinical Report−−Health Supervision for Children With Down Syndrome

Marilyn J. Bull and the COMMITTEE ON GENETICS
PEDIATRICS Volume 128, Number 2, August 2011
These guidelines are designed to assist the pediatrician in caring for
the child in whom a diagnosis of Down syndrome has been confirmed
by chromosome analysis. Although a pediatrician’s initial contact with
the child is usually during infancy, occasionally the pregnant woman
who has been given a prenatal diagnosis of Down syndrome will be
referred for review of the condition and the genetic counseling provided.
Therefore, this report offers guidance for this situation as well

Guideline Title Evidence-based clinical practice guideline on linear growth measurement of children.

Guideline Title
Evidence-based clinical practice guideline on linear growth measurement of children.
Foote JM, Brady LH, Burke AL, Cook JS, Dutcher ME, Gradoville KM, Groos JA, Kinkade KM, Meeks RA, Mohr PJ, Schultheis DS, Walker BS. Evidence-based clinical practice guideline on linear growth measurement of children. Des Moines (IA): Blank Children's Hospital; 2009. 29 p. [128 references]
Guia elaborada para ayudar a los profesionales de la salud en la aplicación de conocimientos basados en pruebas para el proceso de medir el crecimiento lineal en los lactantes, niños y adolescentes que utilizan instrumentos y técnicas estandarizadas que son exactos y fiables.
Un equipo multidisciplinario de profesionales de la salud con distintas capacidades y perspectivas se organizó para desarrollar la guía de práctica clínica. El equipo estuvo integrado por enfermeras, pediatras y médicos de cabecera enfermera pediátrica y neonatal especialistas en enfermería clínica, enfermería educadores, un supervisor de enfermería, una enfermera investigadora, un endocrinólogo pediátrico, un pediatra de atención primaria, y un nutricionista pediátrico. El investigador enfermera tenía experiencia en los procesos de la práctica basada en la evidencia y sirvió como un experto en procesos. Los miembros del equipo eran todos los modelos de papel respetado y líderes dentro de sus propias disciplinas que compartían un interés en la evaluación del crecimiento y la práctica basada en la evidencia. En conjunto, representaban los puntos de vista de la práctica, la investigación, la educación, y las partes interesadas administrativas, así como usuarios previstos directriz. El equipo se reunió una vez al mes durante un periodo de un año, con los miembros del equipo con las asignaciones entre las reuniones.