A major task of preventive child healthcare (PCHC) is early detection of parenting and developmental problems. The validated Structured Problem Analysis of Raising Kids (SPARK) is a broad-scope structured interview for this early detection, using both the perspective of the parent(s) and the experience of the PCHC nurse. Our research has shown that the SPARK is effective, valid, reliable and usable in daily practice. Early detection and intervention in preschool children is expected to result in better wellbeing of child and parents, and less use of expensive specialized youth social care. Broad implementation of existing validated instruments for early detection of parenting and developmental problems is hindered by the missing knowledge about long-term impact on parents and children, and by missing knowledge about the cost-effectiveness from the perspectives of different stakeholders. This way, society misses out on the short- and long-term revenues of early intervention in families with young children. We identified the lack of evidence of long-term impact and cost-effectiveness as major barriers for further implementation of the SPARK. Robust evidence about long-term outcomes for the child, experiences from parents and cost-effectiveness of using the SPARK is essential for evidence-informed policy decisions by municipalities and PCHC-organizations.
A cluster-randomized stepped-wedge trial with 1.5 year follow-up will answer whether implementing the SPARK in PCHC-organizations leads to an improvement in detecting parenting and development problems, results in better health outcomes for children, better care experiences for parents, and lower total costs, compared to the current loosely structured regular consultation for children aged 18 months. Health outcomes for children are measured with the ITQOL (Infant Toddler Quality of Life Questionnaire); outcomes for parents are measured with our new Balance Measure on caregiver strain and resilience, the ColloboRATE for shared decision making, and a short experience questionnaire. Costs are measured from the perspective of the child/parent and from the perspective of professionals.
All participating PCHC-teams from GGD Zaanstreek-Waterland will start with their current consultation, and switch to using the SPARK using a randomized stepped-wedge design. In total 2400 children from 10 teams are needed to detect 7% more children with increased/high risk identified by the SPARK, compared to the regular consultation. Analysis will consist of a generalized linear mixed model in R, cost-effectiveness and cost-consequence analysis, and a process analysis.
We will develop an online, locally adaptable decision support tool (i.e. business case) to help municipalities and PCHC-organizations with their evidence-informed policy decision regarding implementing the SPARK, and a roadmap to guide implementation. Parents will be involved and informed via Stichting Opvoeden (online parents panel, website). Professional stakeholders will be informed via their respective interest groups. Results will be made available for updating relevant guidelines.
Month 1-3 trial preparation; month 4-18 cluster RCT with stepped wedge design, 1 PCHC-unit per month; month 10-36 follow-up period; writing first papers; month 33-39 data-analysis + writing papers on follow-up and CEA + preparing knowledge translation; month 37-40 finalizing knowledge translation activities.