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Maximizing the return on investment in Early Childhood Home Visiting through enhanced eligibility screening
Child Abuse & Neglect ( IF 4.863 ) Pub Date : 2021-09-21 , DOI: 10.1016/j.chiabu.2021.105339
Kenneth A Dodge 1 , W Benjamin Goodman 1 , Yu Bai 1 , Robert A Murphy 1 , Karen O'Donnell 1
Affiliation  

Background

The MIECHV (Maternal, Infant, and Early Childhood Home Visiting) program invests substantial federal resources to prevent child maltreatment and emergency medical costs. Eligibility is based on screening of demographic or clinical risk factors, but because screening accuracy in predicting poor outcomes is unknown, assignment to home-visiting might miss high-risk families or waste resources on low-risk families.

Objectives

To guide eligibility decisions, this study tested accuracy of demographic and clinical screening in predicting child maltreatment and emergency medical care.

Participants and setting

A population-representative sample of 201 birthing mothers (39.8% Black, 33.8% Latina) in Durham, NC, was enrolled between July 2009, and December 2010, and followed through December 2015.

Methods

Participants were screened demographically (i.e., Medicaid, first-born, teenage, no high school diploma) and clinically (i.e., health/health care, parenting readiness, home safety, and parent mental health) at birth and followed through age 60 months, when Child Protective Services and hospital records were reviewed. Cox hazard models tested accuracy of prediction from screening variables.

Results

Demographic factors did not significantly predict outcomes, except having Medicaid/uninsured predicted more emergency medical care and being first-born was a (surprising) protective factor against a child maltreatment investigation. In contrast, clinical factors strongly predicted both maltreatment investigations (Hazard Ratio = 4.01 [95% CI = 1.97, 8.15], sensitivity = 0.70, specificity = 0.64, accuracy = 0.65) and emergency medical care (Hazard Ratio = 2.14 [95% CI = 1.03, 2.14], sensitivity = 0.50, specificity = 0.69, accuracy = 0.58).

Conclusions

Even with added costs for clinical screening, selecting families for home visiting based on assessed clinical risk will improve accuracy and may yield a higher return on investment. The authors recommend a universal system of screening and care to support birthing families.



中文翻译:

通过加强资格筛选,最大限度地提高幼儿家访的投资回报

背景

MIECHV(孕产妇、婴儿和幼儿家访)计划投入大量联邦资源来防止儿童虐待和紧急医疗费用。资格基于对人口或临床风险因素的筛查,但由于预测不良结果的筛查准确性未知,因此分配家访可能会错过高风险家庭或在低风险家庭上浪费资源。

目标

为了指导资格决策,本研究测试了人口统计和临床筛查在预测儿童虐待和紧急医疗护理方面的准确性。

参加者及设置

2009 年 7 月至 2010 年 12 月期间,对北卡罗来纳州达勒姆市 201 名分娩母亲(39.8% 黑人,33.8% 拉丁裔)进行了人口代表性样本登记,并跟踪至 2015 年 12 月。

方法

参与者在出生时接受了人口统计(即医疗补助、第一胎、青少年、没有高中文凭)和临床(即健康/保健、育儿准备、家庭安全和父母心理健康)筛查,并随访至 60 个月。当审查儿童保护服务和医院记录时。考克斯风险模型测试了筛选变量预测的准确性。

结果

人口统计因素并不能显着预测结果,除了医疗补助/无保险可以预测更多的紧急医疗护理,并且第一胎是针对儿童虐待调查的(令人惊讶的)保护因素。相比之下,临床因素强烈预测虐待调查(风险比 = 4.01 [95% CI = 1.97, 8.15],敏感性 = 0.70,特异性 = 0.64,准确性 = 0.65)和紧急医疗护理(风险比 = 2.14 [95% CI = 1.97, 8.15] = 1.03, 2.14],灵敏度 = 0.50,特异性 = 0.69,准确度 = 0.58)。

结论

即使临床筛查的成本增加,根据评估的临床风险选择家庭进行家访也将提高准确性,并可能产生更高的投资回报。作者建议建立一个普遍的筛查和护理系统来支持分娩家庭。

更新日期:2021-09-21
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