Early detection of parenting and developmental problems in young children: a structured dialogue with parents

Aim:This study aims to improve the early detection of parenting and/or psychological, somatic and social developmentproblems in toddlers. Methods:The study was divided into two parts, based on the research questions: What are the content, structure, and psychometric properties of a newly developed instrument for the early detection of parenting and/or developmental problems in toddlers? What is the added value of a home visit and the newly developed instrument compared to a visit to the well-baby clinic for the early detection of parenting and/or developmental problems in toddlers? In part A, we developed a broad-scope structured interview that assesses parents’ concerns and their need for support, using both the perspectives of the parent(s) and the experience of the child health care nurse: the Structured Problem Analysis of Raising Kids (SPARK). The SPARK instrument was tested in daily practice for feasibility (n=1140), inter-rater reliability, convergent validity, discriminative validity, predictive value, and usability of parents as well as nurses (n=2012). In part B, we compared a home visit using the SPARK (n=2243) with a visit to the well-baby clinic either with the SPARK (n=2238) or with only care as usual (n=2200), (i.e., without the SPARK). Results:The SPARK is suitable for the combined task of early problem detection and assessment of care needs of parents, which can immediately be put to use in preventive child health care. The inter-rater reliability was very good (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). The SPARK proved itself to be discriminative. The only psychometric property that was below expectations was that of convergent validity. Users were satisfied with the SPARK and identified some topics for improvement that were used to adapt the SPARK. The overall risk assessment of the SPARK is the strongest predictor for reports to the Advice and Reporting Centers for Child Abuse and Neglect and the Youth Care Agency 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]. 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. Parents as well as child health care nurses more often expressed the need for support and reported significantly better experiences at home. Professionals with usual care visits found less children with high (1.2 vs. 2.6%) or increased risk (14.5 vs. 20.7%) than in visits with the SPARK (p=0.002), but indicated that more help was needed. Contrary, no additional contacts were advised in 25% of the children labeled as high risk by the professionals in the care-as-usual group, while all high risk children visited with the SPARK received additional contacts. Conclusions: The results offer several possibilities to improve the early detection of parenting and/or psychological, somatic and social development problems among young children.