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Validity of a family-centered approach for assessing infants' social-emotional wellbeing and their developmental
Margriet Hielkema1, Andrea F De Winter2, Sijmen A Reijneveld2
1Department of Health Sciences, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, Groningen, The Netherlands. m.hielkema@umcg.nl.
Insights
Family-centered care in pediatrics shows promise for identifying infant social-emotional risks. However, agreement on risk factors was lower than for protective factors.
Area of Science:
- Pediatrics
- Developmental Psychology
- Public Health
Background:
- Family-centered care is a promising approach in preventive pediatrics.
- Evidence is limited regarding its effectiveness in identifying risks to infants' social-emotional development.
Purpose of the Study:
- To examine the validity of a family-centered approach in assessing infants' social-emotional development risks.
- To determine the contribution of different domains to the overall risk assessment.
Main Methods:
- Prospective cohort study involving 2976 children aged 2-15 months.
- Preventive Child Healthcare (PCH) professionals used a family-centered approach during well-child visits.
- PCH assessments were compared against validated questionnaires (gold standards) completed by parents.
Main Results:
- Spearman's rank correlation coefficients ranged from 0.17-0.39, indicating reasonable agreement.
- Agreement was reasonable to excellent for protective factors but lower for risk factors.
- Barriers or life events within the care-giving context most contributed to an "at risk" assessment (OR 100.1).
Conclusions:
- The family-centered approach shows partial convergent validity for assessing infant social-emotional wellbeing and developmental context.
- The approach is more reliable in identifying protective factors than risk factors.
- Further refinement may be needed to improve the identification of risks.
Background:
Family-centered care seems promising in preventive pediatrics, but evidence is lacking as to whether this type of care is also valid as a means to identify risks to infants' social-emotional development. We aimed to examine the validity of such a family-centered approach.
Methods:
We conducted a prospective cohort study. During routine well-child visits (2-15 months), Preventive Child Healthcare (PCH) professionals used a family-centered approach, assessing domains as parents' competence, role of the partner, social support, barriers within the care-giving context, and child's wellbeing for 2976 children as protective, indistinct or a risk. If, based on the overall assessment (the families were labeled as "cases", N = 87), an intervention was considered necessary, parents filled in validated questionnaires covering the aforementioned domains. These questionnaires served as gold standards. For each case, two controls, matched by child-age and gender, also filled in questionnaires (N = 172). We compared PCH professionals' assessments with the parent-reported gold standards. Moreover, we evaluated which domain mostly contributed to the overall assessment.
Results:
Spearman's rank correlation coefficients between PCH professionals' assessments and gold standards were overall reasonable (Spearman's rho 0.17-0.39) except for the domain barriers within the care-giving context. Scores on gold standards were significantly higher when PCH assessments were rated as "at risk" (overall and per domain).We found reasonable to excellent agreement regarding the absence of risk factors (negative agreement rate: 0.40-0.98), but lower agreement regarding the presence of risk factors (positive agreement rate: 0.00-0.67). An "at risk" assessment for the domain Barriers or life events within the care-giving context contributed most to being overall at risk, i.e. a case, odds ratio 100.1, 95%-confidence interval: 22.6 - infinity.
Conclusion:
Findings partially support the convergent validity of a family-centered approach in well-child care to assess infants' social-emotional wellbeing and their developmental context. Agreement was reasonable to excellent regarding protective factors, but lower regarding risk factors.
Trial Registration:
Netherlands Trialregister, NTR2681. Date of registration: 05-01-2011, URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2681 .
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