title: The Effectiveness of the BITSEA as a Tool to Early Detect Psychosocial Problems in Toddlers, a Cluster Randomized Trial.
abstract: OBJECTIVE
  Effective early detection tools are needed in child health care to detect psychosocial problems among young children. This study aimed to evaluate the effectiveness of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), in reducing psychosocial problems at one year follow-up, compared to care as usual.
  
  
  METHODS
  Well-child centers in Rotterdam, the Netherlands, were allocated in a cluster randomized controlled trial to the intervention condition (BITSEA--15 centers), or to the control condition ('care-as-usual'- 16 centers). Parents of 2610 2-year-old children (1,207 intervention; 1,403 control) provided informed consent and completed the baseline and 1-year follow-up questionnaire. Multilevel regression analyses were used to evaluate the effect of condition on psychosocial problems and health related quality of life (i.e. respectively Child Behavior Checklist and Infant-Toddler Quality of Life). The number of (pursuits of) referrals and acceptability of the BITSEA were also evaluated.
  
  
  RESULTS
  Children in the intervention condition scored more favourably on the CBCL at follow-up than children in the control condition: B = -2.43 (95% confidence interval [95%CI] = -3.53; -1.33 p<0.001). There were no differences between conditions regarding ITQOL. Child health professionals reported referring fewer children in the intervention condition (n = 56, 5.7%), compared to the control condition (n = 95, 7.9%; p<0.05). There was no intervention effect on parents' reported number of referrals pursued. It took less time to complete (parents) or work with (child health professional) the BITSEA, compared to care as usual. In the control condition, 84.2% of the parents felt (very) well prepared for the well-child visit, compared to 77.9% in the intervention condition (p<0.001).
  
  
  CONCLUSIONS
  The results support the use of the BITSEA as a tool for child health professionals in the early detection of psychosocial problems in 2-year-olds. We recommend future studies in large and varied populations to replicate these findings.
  
  
  BACKGROUND
  Current Controlled Trials NTR2035.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kruizinga
authors.affiliation: Department of Youth Policy, Rotterdam Municipal Health Service (GGD Rotterdam- Rijnmond), Rotterdam, the Netherlands.
authors.forename: Wilma
authors.initials: W
authors.lastname: Jansen
authors.affiliation: Public Health Care for Youth Rijnmond, Rotterdam, The Netherlands.
authors.forename: Nicolien C
authors.initials: NC
authors.lastname: van Sprang
authors.affiliation: Department of Psychology, University of Massachusetts Boston, Boston, United States of America.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Carter
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000523:psychology; D002675:Child, Preschool; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011788:Quality of Life / Q000523:psychology*