Appendix 4. Screening Instruments

Hawaii Risk Indicators Screening Tool¹

Based on medical record or interview; score true, false, unknown

1. Unmarried.
2. Partner unemployed.
3. Inadequate income.
4. Unstable housing.
5. No phone.
6. Education under 12 years.
7. Inadequate emergency contacts.
8. History of substance use.
9. Inadequate prenatal care.
10. History of abortions.
11. History of psychiatric care.
12. Abortion unsuccessfully sought or attempted.
13. Adoption sought or attempted.
14. Marital or family problems.
15. History of depression.

Positive screen: 1 true score on item number 1, 9, or 12; 2 or more true scores; 7 or more unknowns.

Kempe Family Stress Inventory (KFI)^2,3

Score 1 point for each positive response:

1. Parent history of abuse as child (beaten or deprived).
2. Parent history of criminal activity, mental illness, or substance abuse history.
3. Previous or current Child Protective Services involvement.
4. Parent with isolation, low self-esteem, or depression.
5. Multiple stresses or crises.
6. Potential for violent temper outbursts.
7. Unrealistic, rigid expectations of child's behavior or development.
8. Harsh punishment of child.
9. Child perceived by parent to be difficult and/or provocative.
10. Child unwanted or at risk for poor bonding.

For each item score: 0 = no problem, 5 = mild problem, 10 = severe problem

Positive assessment (100 points possible): a total score of 25 or more for either parent.

Parenting Profile Assessment (PPA)⁴

Questions directed to mother (score for item):

1. Moderate to severe discipline as a child (5).
2. Past or present spousal abuse (3).
3. Perception of stress (4.5).
4. Moderate to severe life change score (4.5).
5. High school education or less (3).
6. Rare involvements out of home (1.25).
7. Little or no prenatal care (2.5).
8. Does not feel good about herself (3.5).
9. Feels like running away (3).
10. Age at first birth under 20 (2).
11. Unlisted or no phone (1).
12. Difficulty communicating with family members (3.5).
13. History of unemployment over a two-month period (of usual provider) (2).
14. Currently under or unemployed (of usual provider) (2).
15. Family involvements with police (2).
16. Less than $20,000 a year income (2.5).
17. Curses at child(ren) when disciplining (3.5).
18. Child(ren) shows evidence of punishment after discipline (3).
19. Perceives discipline of children as harsh (3).
20. Calls child(ren) names when disciplining (3.5).

For each "yes" answer, add scores for items. Also assess for presence of clustered items (4, 5, 15, 16, 19).

Possible risk: 21 points or more or presence of all items in cluster
Low risk: less than 21 points and not all items in cluster present
Uncertain risk: unsure of answers to questions

References

1. Duggan A, Windham A, McFarlane E, Fuddy L, Rohde C, Buchbinder S, et al. Hawaii's healthy start program of home visiting for at-risk families: evaluation of family identification, family engagement, and service delivery. Pediatrics 2000;105(1 Pt 3):250-9.

2. Korfmacher J. The Kempe Family Stress Inventory: a review. Child Abuse Negl 2000;24(1):129-40.

3. Murphy S, Orkow B, Nicola RM. Prenatal prediction of child abuse and neglect: a prospective study. Child Abuse Negl 1985;9(2):225-35.

4. Anderson CL. The parenting profile assessment: screening for child abuse. Appl Nurs Res 1993;6(1):31-8.

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