Research Institute of Child Development and Education, University of Amsterdam, The Netherlands.
Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
Child Abuse Negl. 2017 Aug;70:160-168. doi: 10.1016/j.chiabu.2017.05.016. Epub 2017 Jun 12.
For preventive purposes it is important to be able to identify families with a high risk of child maltreatment at an early stage. Therefore we developed an actuarial instrument for screening families with a newborn baby, the Instrument for identification of Parents At Risk for child Abuse and Neglect (IPARAN). The aim of this study was to assess the predictive validity of the IPARAN and to examine whether combining actuarial and clinical methods leads to an improvement of the predictive validity. We examined the predictive validity by calculating several performance indicators (i.e., sensitivity, specificity and the Area Under the receiver operating characteristic Curve [AUC]) in a sample of 4692 Dutch families with newborns. The outcome measure was a report of child maltreatment at Child Protection Services during a follow-up of 3 years. For 17 children (.4%) a report of maltreatment was registered. The predictive validity of the IPARAN was significantly better than chance (AUC=.700, 95% CI [.567-.832]), in contrast to a low value for clinical judgement of nurses of the Youth Health Care Centers (AUC=.591, 95% CI [.422-.759]). The combination of the IPARAN and clinical judgement resulted in the highest predictive validity (AUC=.720, 95% CI [.593-.847]), however, the difference between the methods did not reach statistical significance. The good predictive validity of the IPARAN in combination with clinical judgment of the nurse enables professionals to assess risks at an early stage and to make referrals to early intervention programs.
出于预防目的，重要的是能够在早期识别出高虐待儿童风险的家庭。因此，我们开发了一种针对有新生儿家庭的风险评估工具，即儿童虐待和忽视风险识别父母工具（IPARAN）。本研究的目的是评估 IPARAN 的预测有效性，并检验将风险评估和临床方法相结合是否能提高预测有效性。我们通过计算了 4692 个荷兰有新生儿家庭样本中的几个性能指标（即敏感性、特异性和接收器操作特征曲线下的面积 [AUC]）来评估预测有效性。结局测量是儿童保护服务在 3 年随访期间报告的儿童虐待情况。有 17 名儿童（0.4%）报告了虐待情况。IPARAN 的预测有效性明显优于偶然（AUC=0.700，95%CI [0.567-0.832]），而青年保健中心护士的临床判断的预测有效性则较低（AUC=0.591，95%CI [0.422-0.759]）。IPARAN 与临床判断的结合产生了最高的预测有效性（AUC=0.720，95%CI [0.593-0.847]），然而，两种方法之间的差异没有达到统计学意义。IPARAN 与护士的临床判断相结合具有良好的预测有效性，使专业人员能够在早期评估风险，并将其转介到早期干预计划。
