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.

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.

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.

Family relationships and the psychosocial adjustment of school-aged children in intact families.

The authors investigated whether the quality of three family relationships (i.e., marital, parent-child, sibling) in intact families are associated with each other and with children's psychosocial adjustment. Data were collected by means of maternal and child reports (N = 88) using standardized instruments (i.e., Marital Satisfaction Scale, Strengths and Difficulties Questionnaire). The findings confirm associations between the marital and the parent-child relationship, and between the parent-child and the sibling relationship, Further, both father-child relationships and sibling relationships predict children's adjustment. Father-child conflicts contribute to children's problem behavior, while father-child acceptance and sibling affection contribute significantly to children's general self-esteem. However, contrary to previous studies no support was found for the association between marital relationship and sibling relationship, or for that between marital relationship quality and children's adjustment.

Children's experiences with chat support and telephone support.

BACKGROUND: In line with the wider trend of offering support via the Internet, many counseling and referral services for children have introduced online chat, often in addition to a traditional telephone service. METHODS: A comparative study was conducted between the telephone service and the confidential one-on-one online chat service of the Dutch Kindertelefoon. The design included a concise pretest and a posttest (n = 902). The study also comprised a follow-up test (n = 213), which included the Strengths and Difficulties Questionnaire. RESULTS: Children experienced a higher sense of well-being and a reduced severity of their problems after consulting the Kindertelefoon. The results were slightly more favorable for the chat service than for the telephone service. The follow-up survey showed that many of the children who contact the Kindertelefoon suffer from relatively severe emotional problems. CONCLUSIONS: Both the telephone and the web-based support improved the children's well-being and decreased their perceived burden of problem. The results of this study underline the need for closer cooperation between child helplines and mental health and child welfare services.

The experiences of involuntarily childless Turkish immigrants in the Netherlands.

The consequences of involuntary childlessness are influenced by culture in several ways. In this study we explored the experiences and responses of infertile Turkish immigrants in the Netherlands. Twenty in-depth interviews were conducted with involuntarily childless Turkish immigrants in the Netherlands (11 couples and 9 women). Interviews were transcribed verbatim and were analyzed using interpretative phenomenological analysis (IPA). The respondents' experiences were clustered around six superordinate themes: effects on self; effects on the relationship with the partner; effects on the relationship with others; disclosure; coping; and the future. Most transcripts revealed that involuntary childlessness has a profound negative influence on multiple aspects of the lives of the respondents. Strong pronatalist ideology, misconceptions about infertility and treatment, and migration-related aspects such as language difficulties, appear to play a role in the negative experiences of Turkish immigrants. Respondents reported several ways of coping (to some extent) with these negative experiences.

Effectiveness of the home-start parenting support program: Behavioral outcomes for parents and children.

This study examined effectiveness of Home-Start, a program designed to support parents with young children. The aims were (a) to examine whether Home-Start improved maternal well-being and (b) to examine whether Home-Start led to changes in the behavior of mothers or children. Self-reported and observational data were collected in two waves, using data from 54 mothers and their children between 1.5 and 3.5 years of age who participated in this intervention program for 6 months. These data were compared to 51 comparison families who reported need for parenting support. The results showed a significant improvement in perceived parenting competence, but no effects on maternal depressive moods. Mixed results were found for parenting behavior: Parental consistency and observed sensitivity improved significantly in the Home-Start group whereas no effects were found on the other parenting variables. Child behavioral problems seemed to diminish at the second measurement in both groups, and therefore these changes cannot be attributed to Home-Start.

Parenting style as a mediator between children's negative emotionality and problematic behavior in early childhood.

Negative emotionality is considered to be the core of the difficult temperament concept (J. E. Bates, 1989; R. L. Shiner, 1998). In this correlational study, the authors examined whether the relations between children's negative emotionality and problematic behavior (internalizing and externalizing) were partially mediated by parenting style (authoritative and authoritarian) in a community sample of 196 3-year-old children and their mothers. The authors assessed maternal perception of child negative emotionality using the Children's Behavior Questionnaire (M. K. Rothbart, S. A. Ahadi, K. L. Hershey, & P. Fisher, 2001) and assessed problematic child behavior by means of maternal report using the Child Behavior Checklist (T. M. Achenbach, 1992). The results showed that the relations between child negative emotionality and internalizing and externalizing behaviors were partially mediated by mothers' authoritative parenting style. Moreover, when the authors used confirmatory factor analysis to decontaminate possible overlap in item content between measures assessing temperament and problematic behavior, the association between negative emotionality and internalizing behavior was fully mediated by authoritative parenting.

Child negative emotionality and parenting from infancy to preschool: a meta-analytic review.

This meta-analytic review (k = 62 studies; N = 7,613 mother-child dyads) shows that effect sizes for the association between child negative emotionality and parenting were generally small and were moderated by sample and measurement characteristics. The association between more child negative emotionality and less supportive parenting was relatively strong in lower socioeconomic status families, reversed in higher socioeconomic status families, and limited to studies with relatively high percentages of participants from ethnic minorities and studies using parent report to assess negative emotionality. Higher levels of child negative emotionality were associated with more restrictive control in samples with less than 75% 1st-born children, as well as in infants and preschoolers, and in studies using parent report or composite measures to assess both negative emotionality and restrictive parenting. Finally, more child negative emotionality was associated with less inductive control.

Emotional distress and infertility: Turkish migrant couples compared to Dutch couples and couples in Western Turkey.

The present study investigates cultural differences in the effects of infertility on emotional distress. The study compares emotional distress among infertile people in three samples: Turkish migrants (n = 58), Turkish people living in Western Turkey (n = 46), and Dutch people (n = 199). Participants answered structured questionnaires on self-image, blame-guilt, sexual problems, depression, anxiety, and anger-hostility. Separate analyses were conducted for men and women. In general, the levels of emotional distress were higher for infertile Turkish migrant women and infertile Turkish women than they were for infertile Dutch women. Turkish migrant women reported more self-image problems and fewer feelings of blame-guilt than did Turkish women. Among men, Turkish migrant men showed the highest overall levels of emotional distress, and Dutch men showed the lowest. Our results indicate that the experience of infertility among Turkish migrants is more similar to those of Turkish people than it is to that of Dutch people, especially among women. The importance of having children in the different cultures may offer a possible explanation for these findings.

Effects of PMTO in Foster Families with Children with Behavior Problems: A Randomized Controlled Trial.

The present randomized controlled trial examined the effectiveness of Parent Management Training Oregon for foster parents with foster children (aged 4-12) with severe externalizing behavior problems in long-term foster care arrangements. Foster children's behavior problems are challenging for foster parents and increase the risk of placement breakdown. There is little evidence for the effectiveness of established interventions to improve child and parent functioning in foster families. The goal of Parent Management Training Oregon, a relatively long and intensive (6-9 months, with weekly sessions) parent management training, is to reduce children's problem behavior through improvement of parenting practices. We specifically investigated whether Parent Management Training Oregon is effective to reduce foster parenting stress. A significant effect of Parent Management Training Oregon, compared to Care as Usual was expected on reduced parenting stress improved parenting practices, and on reduced child behavior problems. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 foster families (46 Parent Management Training Oregon, 40 Care as Usual) using a pre-posttest design. Multilevel analyses based on the intention to treat principle (retention rate 73 %) showed that Parent Management Training Oregon, compared to Care as Usual, reduced general levels of parenting stress as well as child related stress and parent-related stress (small to medium effect sizes). The clinical significance of this effect was, however, limited. Compared to a decrease in the Care as Usual group, Parent Management Training Oregon helped foster mothers to maintain parental warmth (small effect size). There were no other effects of Parent Management Training Oregon on self-reported parenting behaviors. Child behavior problems were reduced in both conditions, indicating no additive effects of Parent Management Training Oregon to Care as Usual on child functioning. The potential implication of reduced foster parenting stress for placement stability is discussed.

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.

Peer and professional parenting support on the Internet: a systematic review.

The Internet offers many opportunities to provide parenting support. An overview of empirical studies in this domain is lacking, and little is known about the design of web based parenting resources and their evaluations, raising questions about its position in the context of parenting intervention programs. This article is a systematic review of empirical studies (n=75), published between 1998 and 2010, that describe resources of peer and professional online support for parents. These studies generally report positive outcomes of online parenting support. A number of recent experimental studies evaluated effects, including randomized controlled trials and quasi-experimental designs (totaling 1,615 parents and 740 children). A relatively large proportion of the studies in our sample reported a content analysis of e-mails and posts (totaling 15,059 coded messages). The results of this review show that the Internet offers a variety of opportunities for sharing peer support and consulting professionals. The field of study reflects an emphasis on online resources for parents of preschool children, concerning health topics and providing professional support. A range of technologies to facilitate online communication is applied in evaluated Web sites, although the combination of multiple components in one resource is not very common. The first generation of online resources has already changed parenting and parenting support for a large group of parents and professionals. Suggestions for future development and research 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.