Validity of a family-centered approach for assessing infants' social-emotional wellbeing and their developmental context:a prospective cohort study

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

The added value of a family-centered approach to optimize infants' social-emotional development:A quasi-experimental study

Family-centered care (FCC) has been related to positive healthcare outcomes in pediatric care. Our aim was to assess whether an FCC approach also leads to better and earlier identification of social-emotional problems and less child psychosocial problems at age 18 months.In a quasi-experimental study within routine well-child care in the Netherlands, we compared those regions in which an FCC approach was implemented (FCC-JointStart) to those regions with "care-as-usual" (CAU), including all children. In all regions, professionals performed well-child visits (2-18 months) and assessed social-emotional problems, or risks developing these, by rating outcomes of assessments as "not optimal" or as "a problem." We compared FCC-JointStart and CAU regarding the rates of newly identified (risks for) social-emotional problems, the pace of identification over time, and the child's psychosocial wellbeing at eighteen months as measured by the Child Behavior Checklist (CBCL). For participants that received extra care, we compared FCC-JointStart and CAU regarding the severity of parent-reported problems. Parents were blinded, professionals were not.5658 parents (68%) agreed to participate in the study. In the FCC-JointStart group, risks were identified more frequently, though differences were small (24.7% versus 22.0%, odds ratio (95%-confidence interval) adjusted for confounders: 1.44 (0.96; 2.18), Phi = .03). Risks were also identified earlier (p = .008), and additional care was provided to more severe cases than in CAU. Effect sizes r ranged from 0.17 (PSBC) to 0.22 (FAD). CBCL scores at 18 months did not differ between groups.FFC-JointStart may contribute to more and earlier identification of risks for social-emotional problems and of families that need additional care, but not to fewer child psychosocial problems at age 18 months.Netherlands Trial Register NTR2681

Effectiveness of a family-centered method for the early identification of social-emotional and behavioral problems in children: a quasi experimental study

Background: Social-emotional and behavioral problems are common in childhood. Early identification of these is important as it can lead to interventions which may improve the child's prognosis. In Dutch Preventive Child Healthcare (PCH), a new family-centered method has been implemented to identify these problems in early childhood. Its main features are consideration of the child's developmental context and empowerment of parents to enhance the developmental context. Methods/design: In a quasi-experimental study, embedded in routine PCH in the Netherlands, regions in which the family-centered method has been implemented (intervention condition) will be compared to "care as usual" regions (control condition). These regions are comparable in regard to socio-demographic characteristics. From more than 3,500 newborn babies, 18-month follow-up data on social-emotional and behavioral development will be obtained. PCH professionals will assess development during each routine well-child visit; participating parents will fill in standardized questionnaires. Primary outcomes in the study are the proportion of social-emotional and behavioral problems identified by PCH professionals in children aged 2-14 and 18 months in both conditions, and the proportion of agreement between the assessment of PCH professionals and parents. In addition, the added value of the family-centered approach will be assessed by comparing PCH findings with standardized questionnaires. The secondary outcomes are the degree to which the needs of parents are met and the degree to which they are willing to disclose concerns. Discussion: The family-centered method seems promising for early identification of social-emotional and behavioral problems. The results of this study will contribute to evidence-based public health. Trial registration: NTR2681

The value of a family-centered approach in preventive child healthcare: Monitoring the social-emotional development of infants

Gezinsgericht consultatiebureau levert betere zorg Consultatiebureaus hanteren een nieuwe, gezinsgerichte, werkwijze (het DMO-gespreksprotocol) onder het motto ‘vroeg er bij, beter voor het kind’. In de nieuwe werkwijze wordt in plaats van alleen naar het kind, ook veel meer naar de omgeving van het kind gekeken. Het DMO-gespreksprotocol is er verder op gericht om de kracht van ouders te versterken. Samen met hen wordt naar oplossingen gezocht wanneer dit nodig is. De nieuwe werkwijze wordt uitgevoerd binnen het programma ‘Samen Starten’, dat een goede samenwerking tussen ketenpartners beoogt. De nieuwe werkwijze is in Drenthe ingevoerd en vergeleken met de standaard werkwijze in de regio IJssel-Zwartewaterland. Daartoe volgde de onderzoeker de ontwikkeling van meer dan 5500 kinderen van hun geboorte tot 18 maanden. Zij keek daarbij naar de mate waarin consultatiebureau medewerkers risico’s signaleerden, naar de tevredenheid van ouders en medewerkers over de nieuwe werkwijze, naar de validiteit van het DMO-protocol en naar de sociaal-emotionele ontwikkeling van kinderen. De resultaten laten zien dat met het DMO-gespreksprotocol vaker en eerder risico’s worden gesignaleerd met betrekking tot de sociaal-emotionele ontwikkeling van kinderen. Dit kunnen factoren zijn van het kind zelf, maar ook factoren in de directe omgeving van het kind. Artsen en verpleegkundigen van de consultatiebureaus waarderen de oplossingsgerichte manier van werken en ouders zijn meer tevreden. Het onderzoek laat zien dat een deel van het DMO-protocol valide is. De onderzoeker vond geen verschil tussen regio’s met en zonder DMO-protocol wat betreft de sociaal-emotionele ontwikkeling van kinderen op de leeftijd van 18 maanden. Het onderzoek werd gefinancierd door ZonMw

The value of a family-centered approach in preventive child healthcare: Monitoring the social-emotional development of infants

This thesis focuses on the effectiveness of a family-centered approach (in Dutch “DMOprotocol”, further referred to as the family-centered approach), designed for monitoring and enhancing children’s social-emotional development in Preventive Child Healthcare (PCH). The effectiveness study took place at a Dutch PCH organization (Icare JGZ). In a quasi-experimental design, regions in which the family-centered approach had already been implemented (northern and southeastern part of Drenthe) were compared to regions in which care-as-usual had been maintained (northern part of Overijssel). The aim was to assess the added value of the family-centered approach from different perspectives. Therefore several research questions were answered in analyses that are reported in different chapters of this thesis

The added value of a family-centered approach to optimize infants' social-emotional development:A quasi-experimental study

OBJECTIVE: Family-centered care (FCC) has been related to positive healthcare outcomes in pediatric care. Our aim was to assess whether an FCC approach also leads to better and earlier identification of social-emotional problems and less child psychosocial problems at age 18 months.METHODS: In a quasi-experimental study within routine well-child care in the Netherlands, we compared those regions in which an FCC approach was implemented (FCC-JointStart) to those regions with "care-as-usual" (CAU), including all children. In all regions, professionals performed well-child visits (2-18 months) and assessed social-emotional problems, or risks developing these, by rating outcomes of assessments as "not optimal" or as "a problem." We compared FCC-JointStart and CAU regarding the rates of newly identified (risks for) social-emotional problems, the pace of identification over time, and the child's psychosocial wellbeing at eighteen months as measured by the Child Behavior Checklist (CBCL). For participants that received extra care, we compared FCC-JointStart and CAU regarding the severity of parent-reported problems. Parents were blinded, professionals were not.RESULTS: 5658 parents (68%) agreed to participate in the study. In the FCC-JointStart group, risks were identified more frequently, though differences were small (24.7% versus 22.0%, odds ratio (95%-confidence interval) adjusted for confounders: 1.44 (0.96; 2.18), Phi = .03). Risks were also identified earlier (p = .008), and additional care was provided to more severe cases than in CAU. Effect sizes r ranged from 0.17 (PSBC) to 0.22 (FAD). CBCL scores at 18 months did not differ between groups.CONCLUSIONS: FFC-JointStart may contribute to more and earlier identification of risks for social-emotional problems and of families that need additional care, but not to fewer child psychosocial problems at age 18 months.TRIAL REGISTRATION: Netherlands Trial Register NTR2681.</p

Impact of a Family-Centered Approach on Attunement of Care and Parents' Disclosure of Concerns:A Quasi-Experimental Study

Objective:To assess the importance parents place on family-centered care aspects in Preventive Child Healthcare (PCH) and to evaluate whether a family-centered approach influences the attunement of care to these preferences and the willingness of parents to disclose concerns.Methods:Parents of infants (mean age = 11.4 weeks) attending Dutch PCH participated in the quasi-experimental study. Parents of infants receiving family-centered care (intervention condition) and parents of infants receiving care-as-usual (control condition) filled in a questionnaire regarding the importance of PCH professionals' attitude, parents' empowerment, and monitoring the broad developmental context. They also assessed their experiences regarding these aspects of care. Furthermore, parents rated their willingness to disclose concerns. We compared the 2 conditions, adjusting for background characteristics, and assessed interactions by socioeconomic status (SES) and the child's social-emotional status.Results:Data were provided by a sample of 2542 parents of infants receiving family-centered care and 2328 parents of infants receiving care-as-usual (return rate of questionnaires 86%). Parents rated the PCH professionals' attitude as most important and monitoring the broad developmental context as least important. Scores were high in both conditions. Compared with care-as-usual, parents receiving family-centered care reported better attunement of care to their preferences (p <.001, effect sizes = 0.10-0.27). Parents' willingness to disclose concerns was similar in both conditions (p = .09). Effects were stable across SES and child's social-emotional status groups.Conclusions:The family-centered approach improves attunement of care to parents' preferences, but it does not increase their already high willingness to disclose concerns

Flow of participants through the study.

<p>Flow of participants through the study.</p

Overview of the earliest assessment rated as “<i>not optimal</i>” or “<i>a problem</i>” per child, as compared to all children participating, in the Family-centered care approach (FCC-JointStart) and Care-as-usual group.

<p>Overview of the earliest assessment rated as “<i>not optimal</i>” or “<i>a problem</i>” per child, as compared to all children participating, in the Family-centered care approach (FCC-JointStart) and Care-as-usual group.</p