Development and Evaluation of a Tool for Observing Parent-Child Interaction

Introduction:  This study illustrates an approach to addressing vulnerabilities in evidence-based programs as they are implemented in community practice. Nurse Family-Partnership (NFP) nurses in community practice spend significantly less time during home visits in promoting competent caregiving than did nurses in the randomized controlled trials of the program.  As competent parenting is a core mediator of several NFP program goals (e.g., decreased abuse and neglect, improved child language development), determining the reasons behind the decreased time spent in promoting competent parenting and addressing potential program improvements to ameliorate this difference is of critical importance. Failure to address this program vulnerability may lead to diminished program impacts of public health importance.  

Methods: We present findings from an investigation of potential causes of nurses’ decreased time spent with families on caregiving, and how these findings were used to guide a research and development project designed to address this issue. We conducted a multi-phase, multi-site development project designed to develop a valid, reliable, and clinically useful measure of caregiver-child interactions (Dyadic Assessment of Naturalistic Caregiver-child Experiences [DANCE] program) and associated parenting intervention pathways (DANCE STEPS). We compared the reliability of the DANCE to two commonly used observational tools, by coding over 300 videotaped interactions from families who participated in the Denver trial of the NFP when their children were 6, 12, and 21 months old and related these measures to behavior, language, and academic achievement assessed at ages 2, 4, 6 and 9 years. We also conducted a field-based feasibility test of DANCE with over 150 nurses to evaluate the adequacy of the DANCE education approach, feasibility of observing caregiver-child interactions using the DANCE during home-visits, nurses’ acceptance of DANCE, and nurses’ beliefs about the clinical utility of the DANCE and DANCE STEPS.     

Results:  DANCE is a reliable tool that predicts children’s outcomes across a range of developmental domains through child age 9. DANCE achieved equal or superior predictive validity in comparison to the other tools.  Nurses report that the DANCE is substantially more useful in supporting program delivery and in targeting the program to meet specific family needs than other dyadic observation tools they previously were using.

Conclusions: Careful examination of implementation metrics, and rigorous approaches to addressing evidence based program vulnerabilities can improve clinical practice without undue burden.