A Controlled Trial in Community Pediatrics to Empower Parents Who Are at Risk for Parenting Stress: The Supportive Parenting Intervention.

The goal of the Supportive Parenting Intervention is to prevent and/or decrease parenting stress and provide a sense of empowerment to parents with a newborn child. We evaluated the effectiveness of the Supportive Parenting Intervention in terms of parenting skills, social support, self-sufficiency, resilience, and child psychosocial health. A controlled trial with pre- and post-intervention testing was conducted in the setting of community pediatrics among parents at risk for developing parenting stress. The 177 parents in the control group received care-as-usual, whereas the 124 parents in the intervention group received six home visits by a trained Youth Health Care nurse during the first 18 months of the child's life. The result with respect to parenting skills, social support (both from family and friends, and the partner), self-sufficiency, and resilience at the 18-month follow-up was either unchanged or (p < 0.05) worse compared to the respective baseline score for both groups. We found no significant difference between intervention and control group with respect to the child's Child Behavior Check List (CBCL). This study shows no positive effect with respect to the indicators of parental empowerment. We recommend research to strengthen the intervention and its application in daily practice, for example by increasing the intervention duration, and to evaluate it in a large randomized controlled trial.

Concurrent validity, discriminatory power and feasibility of the instrument for Identification of Parents At Risk for child Abuse and Neglect (IPARAN).

OBJECTIVES: To determine the feasibility, concurrent validity and discriminatory power of the instrument for Identification of Parents At Risk for child Abuse and Neglect (IPARAN) among Dutch parents with a newborn child. SETTING: Community paediatrics. PARTICIPANTS: Data from a controlled trial were used. In total, 2659 Dutch parents with a newborn child were invited to participate. Of the 2659 parents, 759 parents filled in the consent form and participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: Concurrent validity was determined by calculating correlations-using the Pearson's correlation (r)-between the IPARAN score and related constructs from the following instruments: the Empowerment Questionnaire 2.0, the Family Functioning Questionnaire and the Parenting Stress Questionnaire. Discriminatory power was determined by calculating receiver operating characteristic (ROC) curves between high-risk mothers and low-risk mothers according to their scores on the related constructs. Feasibility was determined by examining the percentage of missing answers. RESULTS: In terms of concurrent validity, we found that 3 out of 12 correlations between the IPARAN score and related constructs were strong (ie, r>0.50) and 4 out of 12 were medium (ie, r=0.30-0.49). In terms of discriminatory power, mothers with a score in the borderline/clinical range or lowest 10 percent (P10) range of the related constructs (high-risk mothers) had a higher IPARAN score than mothers with a score in the normal range or highest 90 percent (P90) range of the related constructs (low-risk mothers). Effect sizes varied from d=0.37 to d=1.93, and the area under the ROC curve varied from 0.62 to 0.93. Regarding feasibility, the part of the IPARAN filled in by the mother had on average 0.7% missing answers, whereas the part of the IPARAN filled in by the father had on average 1.7% missing answers. CONCLUSION: The results of this study support the concurrent validity, discriminatory power and feasibility of the IPARAN among a population of Dutch parents with a newborn child.

Screening for potential child maltreatment in parents of a newborn baby: The predictive validity of an Instrument for early identification of Parents At Risk for child Abuse and Neglect (IPARAN).

For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC=.700, 95% CI [.567-.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC=.591, 95% CI [.422-.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC=.720, 95% CI [.593-.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs.