Adolescents at risk for mistreating their children. Part I: Prenatal identification.
OBJECTIVE
To determine if the Family Stress Checklist helps prenatal care providers identify adolescents who are at risk for mistreating their children.


METHODS
We studied 262 participants in a comprehensive, adolescent-oriented maternity program. During the prenatal period, the Family Stress Checklist was used to quantify abuse potential, with scores >25 defining high risk. Information about the social context of the pregnancy and the pattern of health care utilization was obtained with a self-administered questionnaire, and by reviewing the medical records. Major disruption of primary care giving by the adolescent mother was classified hierarchically as abuse, neglect, and abandonment.


RESULTS
Family Stress Checklist scores ranged from 0 to 65 (mean + SD = 20.1 + 1.4); 113 (43%) of the 262 teenagers were classified as high risk. High and low risk adolescent mothers made an equivalent number of health maintenance and Emergency Department visits, but the high risk group initiated significantly more acute care visits (6.0 + 4.1 compared to 3.9 + 3.3; p < .0001). After controlling for pre-existing sociodemographic differences, high risk 1-year-olds were 8.41 (95% CI: 1.77-40.01) times and high risk 2-year-olds 5.19 (95% CI: 1.99-13.60) times more likely to have been mistreated than their low risk counterparts.


CONCLUSIONS
Prenatal care providers can use the Family Stress Checklist to systematically identify a subgroup of adolescent mother whose excessive use of the acute medical care services and propensity for mistreating their children suggests the need for additional support services.
Stevens-Simon
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Department of Pediatrics, University of Colorado Health Sciences Center, The Children's Hospital, Denver, CO 80218, USA.
Nelligan
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Kelly
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D000293:Adolescent; D002649:Child Abuse / Q000706:statistics & numerical data*; D003120:Colorado / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008499:Medical Records; D009035:Mothers / Q000523:psychology*; D016487:Parenting / Q000523:psychology*; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology* / Q000706:statistics & numerical data; D011295:Prenatal Care; D018570:Risk Assessment / Q000145:classification*; D013315:Stress, Psychological / Q000145:classification* / Q000150:complications; D011795:Surveys and Questionnaires