Article| Volume 28, ISSUE 3, P208-216, May 2014

Parenting Support Needs Assessment: Screening for Child Maltreatment Risk in Young Families



      The objective of the study was to examine the Parenting Support Needs Assessment (PSNA) for content validity, internal consistency reliability, and clinical usefulness. The PSNA was designed for use by primary care clinicians who care for young children and their families, to identify families with risk factors for child maltreatment.


      Phase I of the study consisted of the content validity assessment by child maltreatment experts, and phase II was a pilot test of the PSNA and referral algorithm by nurse practitioners (NPs) for clinical usefulness. Data obtained during the pilot testing were used to examine individual PSNA items, establishing an estimate of internal consistency reliability and identify the instrument's clinical usefulness.


      The PSNA instrument and referral algorithm was found to have content validity and clinical usefulness. The number of referrals to family support social service agencies increased from 4 to 22 over the pre-PSNA use (with different children) and the instrument exceeded the internal consistency reliability threshold of .80.


      The PSNA instrument was found to be valid, reliable, and clinically useful in the primary care setting. The PSNA represents a significant step forward in screening for child maltreatment risk in families of young children during routine primary care.

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        • Adams B.L.
        Assessment of child abuse risk factors by advanced practice nurses.
        Pediatric Nursing. 2005; 31: 498-502
        • Alvarez K.M.
        • Kenny M.C.
        • Donohue B.
        • Carpin K.M.
        Why are professionals failing to initiate mandated reports of child maltreatment, and are there any empirically based training programs to assist professionals in the reporting process?.
        Aggression and Violent Behavior. 2004; 9: 563-578
        • Barlow S.
        • Freeborn D.
        • Cole B.
        • Williams M.
        Advanced practice nurse barriers to reporting child maltreatment.
        APSAC Advisor. 2012; 24: 10-17
        • Brown J.
        • Cohen P.
        • Johnson J.G.
        • Salzinger S.
        A longitudinal analysis of risk factors for child maltreatment: Findings of a 17-year prospective study of officially recorded and self-reported child abuse and neglect.
        Child Abuse & Neglect. 1998; 22: 1065-1078
        • Browne K.
        • Saqi S.
        Approaches to screening for child abuse and neglect.
        in: Browne K. Davies C. Stratton P. Early prediction and prevention of child abuse. Wiley, New York, NY1988: 57-85
        • Casanueva C.E.
        • Cross T.P.
        • Ringeisen H.
        Developmental needs and individualized family service plans among infants and toddlers in the child welfare system.
        Child Maltreatment. 2008; 13: 245-258
      1. Centers for Disease Control and Prevention. (2008a). Child maltreatment surveillance; uniform definitions for public health and recommended data elements. Retrieved from

        • Centers for Disease Control and Prevention
        Nonfatal maltreatment of infants—United States, October 2005–September 2006.
        Morbidity and Mortality Weekly Report. 2008; 57 (Retrieved from): 336-339
      2. Child Welfare Policy and Practice Group. (2008). The functional assessment process. Retrieved from

        • Dombrowski S.C.
        • Timmer S.G.
        • Blacker D.M.
        • Urquiza A.J.
        A positive behavioural intervention for toddlers: Parent-child attunement therapy.
        Child Abuse Review. 2005; 14: 132-151
        • Doueck H.J.
        Screening for child abuse: Problems and possibilities.
        Applied Nursing Research. 1995; 8: 191-198
        • Eigsti I.M.
        • Cicchetti D.
        The impact of child maltreatment on expressive syntax at 60 months.
        Developmental Science. 2004; 7: 88-102
        • English D.J.
        • Thompson R.
        • Graham J.C.
        • Briggs E.C.
        Toward a definition of neglect in young children.
        Child Maltreatment. 2005; 10: 190-206
        • Flaherty E.G.
        • Sege R.
        • Price L.L.
        • Christoffel K.K.
        • Norton D.P.
        • O’Connor K.G.
        Pediatrician characteristics associated with child abuse identification and reporting: Results from a national survey of pediatricians.
        Child Maltreatment. 2006; 11: 361-369
        • Gershater-Molko R.M.
        • Lutzker J.R.
        • Wesch D.
        Project safecare: Improving health, safety, and parenting skills in families reported for and at-risk for child maltreatment.
        Journal of Family Violence. 2003; 18: 377-386
        • Glaser D.
        Child maltreatment.
        Influences of Psychopathology. 2008; 7: 295-298
      3. Green M. Bright futures: Guidelines for health supervision of infants, children and adolescents. National Center for Education in Maternal and Child Health, Arlington, VA1994
        • Hartley C.C.
        The co-occurrence of child maltreatment and domestic violence: Examining both neglect and child physical abuse.
        Child Maltreatment. 2002; 7: 349-358
        • Higgins P.A.
        • Straub A.J.
        Understanding the error of our ways: Mapping the concepts of validity and reliability.
        Nursing Outlook. 2006; 54: 23-29
        • Kantor G.K.
        • Holt M.K.
        • Mebert C.J.
        • Straus M.A.
        • Drach K.M.
        • Ricci L.R.
        • Brown W.
        • et al.
        Development and preliminary psychometric properties of the multidimensional neglectful behavior scale—child report.
        Child Maltreatment. 2004; 9: 409-428
        • Kellogg N.D.
        Evaluation of suspected child physical abuse.
        Pediatrics. 2007; 119: 1232-1241
        • Lynn M.R.
        Determination and qualification of content validity.
        Nursing Research. 1986; 35: 382-385
        • Magnusson M.
        • Lagerberg D.
        • Sundelin C.
        How can we identify vulnerable mothers who do not reach the cutoff 12 points in EPDS?.
        Journal of Child Health Care. 2011; 15: 39-49
        • Maikovich A.J.
        • Jaffee S.R.
        • Odgers C.L.
        • Gallop R.
        Effects of family violence on psychopathology symptoms in children previously exposed to maltreatment.
        Child Development. 2008; 79: 1498-1512
        • Milner J.S.
        • Gold R.G.
        • Ayoub C.
        • Jacewitz M.M.
        Predictive validity of the child abuse potential inventory.
        Journal of Consulting and Clinical Psychology. 1984; 52: 879-884
        • Murry S.K.
        • Baker A.W.
        • Lewin L.
        Screening families with young children for child maltreatment potential.
        Pediatric Nursing. 2000; 26: 47-65
        • Nygren P.
        • Nelson H.D.
        • Klein J.
        Screening children for family violence: A review of the evidence for the US Preventative Services Task Force.
        Annals of Family Medicine. 2004; 2: 161-169
        • Olds D.
        • Henderson Jr., C.R.
        • Cole R.
        • Eckenrode J.
        • Kitzman H.
        • Luckey D.
        • Powers J.
        • et al.
        Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial.
        Journal of the American Medical Association. 1998; 280: 1238-1244
        • Ondersma S.J.
        • Chaffin M.J.
        • Mullins S.M.
        • LeBreton J.M.
        A brief form of the child abuse potential inventory: Development and validation.
        Journal of Clinical Child and Adolescent Psychology. 2005; 34: 301-311
        • Patten M.L.
        Understanding research methods.
        5th ed. Pyrczak Publishing, Glendale, CA2005
        • Paavilainen E.
        • Astedt-Kurki P.
        • Paunonen-Ilmonen M.
        • Laippala P.
        Risk factors of child maltreatment within the family: Toward a knowledgeable base of family nursing.
        International Journal of Nursing Studies. 2000; 38: 297-303
        • Peters R.
        • Barlow J.
        Systematic review of instruments designed to predict child maltreatment during the antenatal and postnatal periods.
        Child Abuse Review. 2003; 12: 416-439
        • Polit D.F.
        • Beck C.T.
        The content validity index: Are you sure you know what’s being reported? Critique and recommendations.
        Research in Nursing & Health. 2006; 29: 489-497
        • Polit D.F.
        • Beck C.T.
        • Owen S.V.
        Is the CVI an acceptable indicator of constant validity? Appraisal and recommendations.
        Research in Nursing & Health. 2007; 30: 459-467
        • Reynolds A.J.
        • Mathieson L.C.
        • Topitzes J.W.
        Do early childhood interventions prevent child maltreatment?.
        Child Maltreatment. 2009; 14: 182-206
        • Roberts J.
        Why are some families more vulnerable to child abuse?.
        in: Browne K. Davies C. Stratton P. Early prediction and prevention of child abuse. Wiley, New York, NY1988: 43-55
        • Saunders T.R.
        • O’Brien D.E.
        Child maltreatment: Case studies in assessment and intervention.
        Psychotherapy. 1997; 34: 498-508
        • Scarborough A.A.
        • McRae J.S.
        Maltreated infants. Reported eligibility for Part C and later school-age special education services.
        Topics in Early Childhood Special Education. 2008; 28: 75-89
        • Slack K.S.
        • Holl J.
        • Altenbernd L.
        • McDaniel M.
        • Stevens A.B.
        Improving the measurement of child neglect for survey research: Issues and recommendations.
        Child Maltreatment. 2003; 8: 98-111
        • Slack K.S.
        • Holl J.L.
        • McDaniel M.
        • Yoo J.
        • Bolger K.
        Understanding the risks of child neglect: An exploration of poverty and parenting characteristics.
        Child Maltreatment. 2004; 9: 395-408
        • Socolar R.R.
        • Reives P.
        Factors that facilitate or impede physicians who perform evaluations for child maltreatment.
        Child Maltreatment. 2002; 7: 377-381
        • Straus M.A.
        • Smith C.
        Family patterns and primary prevention of family violence.
        Trends in Health Care, Law & Ethics. 1993; 8: 17-25
        • Taylor J.
        • Baldwin N.
        • Spencer N.
        Predicting child abuse and neglect: Ethical, theoretical and methodological challenges.
        Journal of Clinical Nursing. 2008; 17: 1193-1200
      4. U.S. Department of Health & Human Services, Administration for Children and Families. (2011). Child maltreatment 2010. Retrieved from


      Susan Murry, Family Nurse Practitioner, Fulton County Health Center, Delta Medical Center, Delta, OH.


      Linda Lewin, Assistant Professor of Nursing, College of Nursing, Wayne State University, Detroit, MI.