Known groups validity of the SPARK36: To guide nurse-led consultations for the early detection of child developmental and parenting problems.

AIM: Early detection of child developmental and parenting problems is important for timely prevention. The SPARK36 (Structured Problem Analysis of Raising Kids aged 36 months) is a novel broad-scope structured interview guide aimed at assessing parenting concerns and needs for support for child developmental and parenting problems, using the parental and professional's (Youth Health Care nurses) perspective. The applicability of the SPARK36 in practice was already demonstrated. Our aim was to evaluate its known groups validity. DESING/METHODS: SPARK36 data were collected in a cross-sectional study in 2020-2021. The known groups validity was assessed by testing two hypotheses: the SPARK36 risk assessment shows a higher risk of parenting and child developmental problems in children (1) from parents with a lower socioeconomic status and (2) from families with ≥4 risk factors for child maltreatment. To test the hypotheses, Fisher's exact tests were applied. RESULTS: In total, 29 Youth Health Care nurses from four School Health Services performed SPARK36-led consultations with 599 parent-child pairs to assess the risk for child developmental and parenting problems. Both hypotheses were accepted at a significant p level. CONCLUSION: The results of the known groups validity support the hypothesis that the SPARK36 risk assessment for child developmental and parenting problems is carried out in a valid way. Future research is needed to assess other aspects of the validity and reliability of the SPARK36. IMPACT: This is a first step in validating the instrument for use during a nurse-led consultation with parents of 3-year-olds in Flemish School Health Services. Thereby, SPARK36 supports the nurses in accomplishing their assignment, making a risk assessment, and contributes to quality of care. PATIENT OR PUBLIC CONTRIBUTION: This study aimed to evaluate the known groups validity of the SPARK36. Therefore, it was not conducted using input from the public or the patient population.

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.

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.

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.

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.

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.