title: Accuracy of caregiver identification of developmental delays among young children involved with child welfare.
abstract: Underidentification of developmental delays among young children involved with child welfare/child protective services (CW) is problematic. Caregivers of young children involved with CW may help increase identification of young children with developmental delays, but the accuracy of caregiver identification in this population and whether this varies by caregiver type is not known. This study uses data from the National Survey of Child and Adolescent Well-Being to determine if (1) caregivers of young children involved with CW accurately identify children with developmental delays and (2) foster caregivers are better able to identify developmental delays compared with other caregivers. Close to half the children had a delay in language, cognitive, and/or adaptive behavior (45%). Overall sensitivity for caregiver identification was 35% (95% confidence interval [CI]: 29%, 41%); specificity was 84% (95% CI: 80%, 87%). After controlling for certain child and caregiver characteristics, in-home caregivers had 0.15 times the odds of identifying a child with a developmental delay compared with foster caregivers (95% CI 0.1, 0.4). Results suggest that caregiver identification of developmental delays is specific but not sensitive, and that foster caregivers were more likely to identify a child with a developmental delay compared with in-home caregivers. Policy implications include improving educational programs regarding child development and developmental services for foster, kinship, as well as in-home caregivers in the hopes of increasing sensitivity of caregiver identification of developmental delays for the population of young children involved with CW.
authors.affiliation: Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. molly_berkoff@med.unc.edu
authors.forename: Molly Curtin
authors.initials: MC
authors.lastname: Berkoff
authors.forename: Laurel K
authors.initials: LK
authors.lastname: Leslie
authors.forename: Aubyn C
authors.initials: AC
authors.lastname: Stahmer
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D017028:Caregivers; D002649:Child Abuse; D002657:Child Development; D002669:Child Welfare / Q000523:psychology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis*; D002658:Developmental Disabilities / Q000175:diagnosis*; D005190:Family; D005260:Female; D005581:Foster Home Care; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007805:Language Development Disorders / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010552:Personality Assessment; D012680:Sensitivity and Specificity