title: Early detection of parenting and developmental problems in toddlers: A randomized trial of home visits versus well-baby clinic visits in the Netherlands.
abstract: OBJECTIVE
  The early detection of parenting and developmental problems by preventive child health care (CHC) services in the Netherlands takes place almost exclusively at the well-baby clinic. This study assesses whether, compared to a visit to the well-baby clinic, a home visit improves early detection.
  
  
  METHODS
  4481 eligible 18-month-old children and their parents were randomized to either a visit to the well-baby clinic or a home visit in the period from December 2006 to January 2008. A CHC nurse held structured interviews using the validated Structured Problem Analysis of Raising Kids (SPARK). Differences in the percentage of children with high or increased risks of parenting and developmental problems as assessed by the SPARK were analyzed with ordinal regression. Secondary outcomes included the percentage of parents attending, parents' concerns, needs assessment by parents and CHC professionals and user experience.
  
  
  RESULTS
  Response rates were 94.0% for the home visit group and 93.2% for the well-baby clinic group. Using the SPARK at home identified significantly more high-risk children compared to clinic visits (3.7 vs. 2.6%) and fewer children with increased risk (19.1 vs. 20.7%; overall p=0.028). Home visits more often involved both parents and other children. At home, parents reported more concerns. Both parents and CHC nurses more often expressed the need for support and reported significantly better experiences at home.
  
  
  CONCLUSIONS
  Aided by a validated structured interview, CHC professionals detect more children with high risks of parenting and child-developmental problems during home visits than during clinic visits.
  
  
  BACKGROUND
  www.trialregister.nl Identifier: NTR1413.
authors.affiliation: Department of Preventive Child Health Care, Municipal Health Service Zeeland, Goes, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: ingrid.staal@ggdzeeland.nl.
authors.forename: Ingrid I E
authors.initials: II
authors.lastname: Staal
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: h.vanstel@umcutrecht.nl.
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
authors.affiliation: Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: jhermanns@hsconsult.nl.
authors.forename: Jo M A
authors.initials: JM
authors.lastname: Hermanns
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: mail@guusschrijvers.nl.
authors.forename: Augustinus J P
authors.initials: AJ
authors.lastname: Schrijvers
mesh_terms: D000553:Ambulatory Care; D002657:Child Development; D002662:Child Health Services / Q000592:standards*; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D005260:Female; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D009426:Netherlands; D016487:Parenting; D011314:Preventive Health Services / Q000379:methods*
keywords: Child Health Care; Home visiting; Prevention; Well-baby clinic