Studies of Child Abuse Screening Instruments
| Author, Year | No. | 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 follow-up |
| 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% multicultural, 40% poor maternal mental health, 45% domestic violence in the home, 30% parental substance use, 28% no high school diploma) | 2 step screening:
| 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:
| 1,350 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. Korfmacher52 reports 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 (<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, 21-item nurse interview for the primary care setting; 38 (21%) scored as high risk | 75% sensitivity, 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 |
| Clinician 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 with others (P <.05) | Poor Risk criteria not fully defined or standardized |