A Family Psychosocial Risk Questionnaire for Use in Pediatric Practice

Abstract

The objective of this study is to develop new methods to better identify psychosocial risk such that children with the greatest risk of poor future outcomes receive more intensive preventive health services. Based on structured literature review and secondary data analysis, a 52-item psychosocial risk questionnaire was administered to 2,083 families of children (<36 months). To quantify the questionnaire's construct validity, developmental concern was assessed with the Ages and Stages Questionnaire version II (ASQ) [n = 1,163]. An iterative model selection process was used to produce the most parsimonious predictive model. Model fit was examined using c-statistics, the Hosmer-Lemeshow test, and a heuristic measure of model overfit based on the fitted log-likelihood values and associated number of degrees of freedom. We found 13 items easily obtained from parental report produced a regression model with a c-statistic of 0.70. Using an integer scoring system derived from the regression model, we calculated stratum specific likelihood ratios to revise a given prior probability of ASQ failure. The posterior probability of ASQ failure was 44.9 % for a child in the highest risk group (score >25) on the questionnaire, more than double our observed average failure rate of 19.5 %, while it was less than 7 % for a child with the lowest possible score on the questionnaire. Thirteen parent-reported items can be compiled into a summary psychosocial risk questionnaire that predicts failure on developmental screening among preschool children. With further validation, this questionnaire could conceivably be used by clinicians to tailor pediatric preventive care to children at varying levels of risk.

Enriched Medical Home Intervention Using Community Health Worker Home Visitation and ED Use

“…Covariates known to influence ED and hospital utilization were collected by using a validated family psychosocial risk questionnaire. 21,24,28,29 These variables included characteristics of the child, family, home and/or child care environment, and neighborhood. These data were collected in the field by KFH staff (ie, by CHWs for the intervention group and trained research assistants for the usual care group) at the time of enrollment via tablet computer and automatically uploaded to the Research Electronic Database Capture system by using electronic case reporting forms.…”

Comparative use of the Ages and Stages Questionnaires in the USA and Scandinavia: a systematic review

“…Evidence from the included articles, combined with knowledge of the Scandinavian model of preventive care, highlights many opportunities. First steps include norming the latest versions of the ASQ and ASQ:SE and then evaluating their impact in home‐visit, primary care medical, and early learning/preschool settings.…”

Program, cultural and neighbourhood factors related to attrition from a community‐based enriched medical home program in the United States

“…Family and patient characteristics were reported by the families by completing the Pediatric Personal Profile (P3) (Pati et al., 2013) during program enrolment. The P3 is composed of 52 parent‐reported psychosocial risk items that include adaptations of several validated psychosocial instruments such as the Maternal Social Support Index (MSSI) (Pascoe et al., 1988), the Children with Special Health Care Needs screener (CSHCN) (Bethell et al., 2011), Short Form 36 Health Survey Questionnaire (SF‐36) (Jenkinson et al., 1993) and the Patient Health Questionnaire‐2 (PHQ‐2) (Kroenke et al., 2003).…”

“…The EMHI is a nationally recognised award‐winning protocol‐based CHW visitation program that aims to help families achieve self‐sufficiency in following recommended clinical care (American Academy of Pediatrics, 2020). Program participation has been correlated with higher vaccination rates and decreased preventable emergency room visits (Justvig et al., 2017; Pati, 2015; Pati et al., 2013). The program is offered to families with a child 0–17 years old whom medical providers believe may have difficulty in managing one or more aspects of their child's medical care.…”

“…Home visits lasted for about 45–60 min and occurred monthly. CHWs utilised various strategies tailored to each family's specific needs and strengths based on their responses to an evidence‐based comprehensive psychosocial risk assessment administered during the initial visit (Pati et al., 2013). CHW tasks spanned seven broad goals such as assistance with navigating the healthcare system and care coordination as well as health education support (Justvig et al., 2017).…”