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Updated: May 28, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Evaluation of a newborn screen for predicting out-of-home placement
Marni D Brownell1, Mariette Chartier, Robert Santos
1Manitoba Centre for Health Policy, Winnipeg, Manitoba, Canada. marni_brownell@cpe.umanitoba.ca
Insights
A newborn screening tool for family risk showed moderate predictive validity for identifying children needing out-of-home placement. However, the screening missed many families requiring support, indicating a need for improved identification of vulnerable populations.
Area of Science:
- Child welfare research
- Public health screening
- Family risk assessment
Background:
- Newborn screening aims to identify at-risk families for early intervention.
- Assessing the effectiveness of such tools is crucial for optimizing child protection strategies.
- Previous research highlights the importance of comprehensive data linkage for evaluating public health interventions.
Purpose of the Study:
- To evaluate the screening of all families with newborns for potential risks.
- To determine the predictive validity of a newborn screen for out-of-home placement risk.
- To identify specific screening items most predictive of out-of-home placement.
Main Methods:
- Utilized linked population-based datasets for 40,886 infants born in Manitoba (2000-2002).
- Included newborn screening data (biological, psychological, social risks), demographic data, hospital records, and out-of-home care data.
- Followed infants until March 31, 2004, to track out-of-home placements.
Main Results:
- 18.4% of infants were not screened; 3.0% experienced out-of-home placement.
- Unscreened infants were twice as likely to enter care (4.9% vs. 2.5%).
- Infants screening "at risk" were 15 times more likely to enter care; sensitivity was 77.6%, specificity 83.3%.
Conclusions:
- The newborn screening tool has moderate predictive validity for identifying children at risk of out-of-home placement.
- Current screening practices missed a significant number of families needing support.
- Enhancements to screening protocols are needed to improve identification of vulnerable families and children.
Abstract:
A newborn screen designed to predict family risk was examined to: (a) determine whether all families with newborns were screened; (b) evaluate its predictive validity for identifying risk of out-of-home placement, as a proxy for maltreatment; (c) determine which items were most predictive of out-of-home placement. All infants born in Manitoba, Canada from 2000 to 2002 were followed until March 31, 2004 (N = 40,886) by linking four population-based data sets: (a) newborn screening data on biological, psychological, and social risks; (b) population registry data on demographics; (c) hospital discharge data on newborn birth records; (d) data on children entering out-of-home care. Of the study population, 18.4% were not screened and 3.0% were placed in out-of-home care at least once during the study period. Infants not screened were twice as likely to enter care compared to those screened (4.9% vs. 2.5%). Infants screening at risk were 15 times more likely to enter care than those screening "not at risk." Sensitivity and specificity of the screen were 77.6% and 83.3%, respectively. Screening efforts to identify vulnerable families missed a substantial portion of families needing support. The screening tool demonstrated moderate predictive validity for identifying children at risk of entering care in the first years of life.
