A Medical Home-Based Intervention to Prevent Child Neglect in High-Risk Families

This will be determined using chart review and parent report.

Adherence will be evaluated by chart review to determine a composite measure that includes numbers of medical visits attended, hospitalizations, missed appointments, delayed or missed prescriptions fills, and receiving recommended immunizations.

The Coping Health Inventory for Parents (CHIP) is a valid and reliable 45-item instrument designed to measure parents' response to managing family life when they have an ill child. It comprises three subscales (family integration, α=0.79; psychological stability, α=0.79; and understanding the child's medical situation, α=0.71) within which total mean scores are calculated.

The Pearlin Mastery Scale (PM) measures the degree to which individuals perceive themselves as in control of their lives.

Rosenberg Self-esteem Scale (RSES).

Perceived Stress Scale (PSS) - Stress domains include unpredictability, lack of control, burden overload, and stressful circumstances. Reliability studies show Cronbach α's of 0.78 -0.86. The PSS correlates with inventories of burnout & somatization.

Parenting Stress - Short Form (PSI) - The PSI assesses a wide range of parenting behaviors in a single instrument, including attachment to child, social isolation, competence, relationship with spouse, and parental health. Cronbach's α for the parent domain is 0.93 and the test-retest coefficient is 0.96.

Social Adjustment Scale Self-Report (SAS-SR) - We will use the SAS-SR, which examines social and role functioning in six areas: work; social activities; relationships with family; spouse or partner; parent; member of family unit. The SAS has high internal consistency (α=0.74) and test-retest reliability (r=0.80). It is sensitive to change in depressed patients undergoing treatment.

Medical Outcomes Survey Social Support (MOS-SS) - This tool comprises 4 functional support scales (emotional/informational, tangible, affectionate, and positive interaction) and an overall social support index. Subscales are reliable (α's > 0.91).

This will be measured using the WE-CARE survey. The survey consists of 14 questions used to identify seven unmet material needs (education, employment, food security, housing, childcare, household heat, language) and has been tested previously with low-income parents in the clinic setting.

Parenting Scale (PS) - The parenting scale is a 30-item questionnaire that measures parenting practices and consistency around discipline, with a focus on dysfunctional discipline: laxness, over-reactivity, and hostility. The scale has good internal consistency (α = 0.78-0.85) and test-retest reliability.

Parent-Child Conflict Tactics Scale (CTSPC) - This measure contains 5 subscales that look at different types of discipline. The measure has been validated and is used extensively in the child maltreatment literature.

Problem solving skills will be measured using the Social Problem Solving Inventory -Revised (SPSI-R). This 25 item instrument measures problem orientation and problem-solving skills in 5 dimensions: positive and negative orientation; avoidance; impulsivity; and rationality. The SPSI-R was validated with a diverse community sample and norms exist for adolescents and young adults. It is highly correlated with mood among caregivers of children with disabilities. Subscale internal consistency scores range from 0.76-0.92; test-retest reliability is reported in the range of 0.72-0.88.

We will measure caregiver depression using the Quick Inventory of Depressive Symptomatology (QIDS) - Because the QIDS has a wide scoring range, it can be used to detect depressive illness in populations with moderate and low-level symptoms.