In-the-moment ratings on the Early Relational Health Screen: A Pilot Study of Application in Home Visiting and Primary Care

Access: Institutional Access

Publication year

2022

study description

Findings reported from two pilot studies.

core topic(s)

Early Relational Health

Exposures, Outcomes, Other

Home Visitation , Implementation and Evaluation , Screening and Tools , Validity, Reliability, Feasibility, and Acceptability

metric(s)

Early Relational Health Screen (ERHS)

objectives

We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS).

exposure

Early Relational Health Screen (ERHS).

outcomes evaluated

ERHS reliability and feasibility.

setting

Study 1: relational health promotion in pediatric primary care. Study 2: Infant Mental Health Home Visiting (IMH-HV) model.

methods

We report findings from two pilot studies conducted in the United States that describe the reliability and validity of a relational health screening tool, the Early Relational Health Screen (ERHS). Across both studies, a trained clinician rated the ERHS following real-time observation of interaction (i.e., “in-the-moment” ratings). Reliability was assessed by comparing “in-the-moment” ERHS ratings to subsequent coding of the same interaction from video by an independent evaluator. In addition, Study 2 data permitted evaluation of the validity of “in-the-moment” ERHS ratings.

sample size

n=2 (studies)

measures

Measure of Reliability: we capitalized on data previously collected and had independent, reliable coders, blind to information about the dyads, rate the videos to determine the reliability of the initial clinician ratings.

 

Measure of Validity: available home visiting study data also permitted a preliminary examination of the validity of clinician “in-the-moment” ERHS ratings compared to another well-validated measure of dyadic interaction developed by the NICHD Early Child Care Research Network.

results

Results from both studies indicated reliability of “in-the-moment” ERHS ratings. In addition, Study 2 clinician “in-the-moment” ratings were associated with maternal depression and ratings of child-parent interaction derived from a separate observational task coded by independent evaluators using a different well-validated research-based measure.

conclusions

Discussion highlights the potential of the ERHS as a screening, promotion, and prevention tool that may be feasibly administered by providers across pediatric primary care and home visiting settings.

limitations

There are a number of limitations to the current studies, including the small sample sizes and the need for more diverse samples, including more broad representation of parent risk status, child age, and other demographic characteristics, including family race and ethnicity. Furthermore, as described separately for each study, only those scales that are coded for 6-month-olds were included in analyses, leaving the possibility that reliability may be different for ERHS scales used for children at older time points. In addition, the ERHS was developed, in part, to address the absence of other gold standard relationship-focused screening tools. Yet the lack of an obvious gold standard, dichotomous criterion to demonstrate criterion validity represents a significant challenge for demonstrating sensitivity and specificity analyses... Future research should aim to replicate these findings in both settings with larger and more diverse samples, with a broader array of measures in order to more fully test convergent and divergent validity of the ERHS ratings in both contexts.