Early assessment of the risk of child abuse in well-child care: The predictive validity of a family-centered approach

Objective: To prevent child abuse, effective early detection of risk factors is essential. In the Netherlands, a family-centered approach is used by well-child clinics for assessing infants’ social-emotional wellbeing and their developmental context. We aimed to assess the predictive validity of this family-centered approach for predicting future child welfare involvement, as a proxy for child abuse, and whether this clinical assessment could be improved by using a sum score (actuarial assessment).
Methods: Analyses were conducted on long-term outcomes of well-child assessments on a community-based sample of 2,778 infants obtained during 2009–2013. Register data from Statistics Netherlands on child protection orders and residential youth care over a 7-year follow-up period were linked to these assessments, as a proxy for child abuse. We compared sum scores per domain of the family-centered approach with the overall clinical assessment.
Results: The predictive validity of domain scores was good for ‘role of the partner’ (area under the ROC curve, AUC = 0.75, large effect); medium for ‘competence of the parent(s)’ (AUC = 0.65), ‘social support’ (AUC = 0.67), and ‘perceived barriers and life events’ (AUC = 0.69); and small for ‘wellbeing of the child’ (AUC = 0.53).
Further, the predictive validity of the sum score was good in terms of outcomes (AUC = 0.73; large) and significantly outperformed the clinical risk estimate (AUC = 0.59; small).
Conclusions: The family-centered approach enables professionals to better assess the risk of future child welfare involvement, with its summary assessment outperforming clinical assessment. This may help to target the families most vulnerable and offer preventive interventions