| Screening Instrument |
Author, Year |
N |
Population and Settings |
Instruments |
Results |
Quality Rating and Limitations |
| Self-administered Questionnaires |
Stevens-Simon, 200144 |
262 |
Adolescents (13-19 y) in a maternity program at the University of Colorado Hospital In Denver (32% African American, 22% Hispanic, 92% Medicaid recipients, 94% unmarried). |
Kempe Family Stress Inventory (KFI). |
At 1 and 2 years, the KFI was the only significant predictor of maltreatment using multiple outcome measures (RR 8.41, 95% CI, 5.77-10; RR 5.19, 95% CI, 1.99-13.60). |
Good-fair
Differential loss to followup. |
| CCAPR, 199645,46 |
287 |
Pregnant women at hospital obstetric clinics in 6 counties in Oahu (Hawaii Healthy Start) (mean age 23 y, 65% poor, 89% multi-cultural, 40% poor maternal mental health, 45% domestic violence in the home, 30% parental substance use, 28% no high school diploma). |
2 step screening:
1) 15 item Hawaii Risk Indicators Screening Tool (medical record or interview)
2) KFI |
89% sensitivity and 28% specificity with high scores on the Child Abuse Potential (CAP) inventory. |
Fair
No abuse outcomes, high attrition. |
| Katzev, 199747 |
2,870 |
At-risk pregnant women from 12 counties in Oregon (Healthy Families) (72% single parents, 68% with story of child abuse or neglect, 57% less than high school education, 37% history of substance abuse, 29% 17
y or younger). |
2 step screening:
1) 15 item Hawaii Risk Indicators Screening Tool (medical record or interview)
2) If positive then, KFI. |
1,350 were given the KFI. Score was highly correlated with maltreatment rates (per 1000 children): 7 for low-risk scores, 18 moderate, 45 high, and 172 severe. Sensitivity 97%, specificity 21% for scores in high-severe risk range. |
Fair-poor
Many confirmed reports were made by home visitors to high-risk homes. |
| Clinical Staff-administered Questionnaires |
Brayden, 199348 |
1,089 |
Pregnant women receiving prenatal care at Metropolitan Nashville General Hospital, Tennessee (under 23 y, 60% single, 68% white, 25% unemployed). |
Maternal History Interview-2, open-ended questions and subscales including parenting skills, personality, discipline philosophy, life stress, and others; high risk based on percentile scoring on subscales; 314 identified as high risk. |
The Maternal History Inteview-2 predicted child abuse, but not neglect or sexual abuse. High-risk group 6.6% with child abuse reports compared with 2.3% in low risk group in first 36 months (RR 3.02, 95% CI, 1.02-8.90). |
Poor
Participation was low; requires trained interviewers. |
| Anderson, 199349 |
185 |
Abusive and nonabusive mothers recruited from a national sample of female nurses contacted through advertising and a mailing list. |
Parenting Profile Assessment (PPA), 21-item nurse interview for the primary care setting; 38 (21%) scored as high risk. |
75% sensitivity and 86% specificity for self-reported abuse. Most sensitive to high stress and poor marital relationships. |
Poor
Only self-reports of abuse by mothers, no actual abuse measured or verified; small sample with only 15 self-reported abusers. |
| Clinical Observation |
Leventhal, 199650 |
114 cases
114 controls |
Children at the Primary Care Center at Yale New Haven Hospital referred to the hospital's child abuse committee from the postpartum ward by clinicians. |
Clinician judgment of potential child abuse or neglect based on a number of criteria including parental substance use, income, social support, previous child abuse or neglect, and parenting behavior. |
After controlling for baseline variables, 1.8-fold increase in the rate of subsequent hospitalizations of the high risk children compared to others. (p<0.05). |
Poor
Risk criteria not fully defined or standardized. |
Note: KFI = Kemper Family Stress Inventory; RR = relative risk; CI = confidence interval; CAP = Child Abuse Potential
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