Validation of the ALPHA-NL (antenatal psychosocial health assessment)

The Dutch prevalence of child abuse and neglect is estimated at 119.000
children a year (Alink et al, NPM-2010). According to Stith et al (2009) in
the National Guideline Child Abuse & Neglect for Youth Health Care
professionals (Vink et al, 2016) the strongest risk factors for child abuse and
neglect are not child-related but are risk factors related to (both) parents
and the way they cope with these risk factors. Risk factors are: poverty,
family violence, mentally challenged, psychiatric disease, substance abuse.
Strong predictors for child abuse and neglect are the ways in which parents
cope with these issues: with depression, hyperreactivity, anger, perception of
child as a problem ... These experiences can have a life-long effect on
children (Felitti, 1998).
Because these risk factors are parent-related, they can already be identified
before birth. The prenatal period therefore offers a window of opportunity for
the prevention of child abuse and neglect. Prenatal caregivers see
parents-to-be frequently during pregnancy and are pre-eminently in the position
to recognize the first risk factors. When recognition is followed by adequate
services for these families at risk this can be very beneficial in the
prevention of child abuse and neglect.

Many midwives and obstetricians in the Netherlands use the ALPHA-NL as an
assessment instrument for riskfactors for child abuse and neglect.
De ALPHA-NL is the Dutch version of the Canadian ALPHA (Antenatal Psychosocial
Assessment; Caroll, 2005; Robertson, 2006), a self-report questionnaire with 48
questions (mostly 5-point Likert) concerning 15 risk factors for child abuse
and neglect. The ALPHA-NL is administered before the 20-weeks gestation period.
The results form the starting-point for a dialogue on these issues, between
midwife/obstetrician and parents-to-be.

The aim of our study is to validate the ALPHA-NL. This is important for
midwives/obstetricians, and in the end clients, to be able to work
evidence-based.

Research questions are:
- What is the reliability of the ALPHA-NL?
- What is the concurrent criterium validity of the ALPHA-NL?
- To what extent is the conclusion of the midwife/obstetrician based on the
ALPHA-NL, in accordance with the conclusion of the psychologist based on
reference questionnaires and interview?

Our study will be conducted by observational design.

Recruitment of participants is done by midwives/obstetricians. Subsequently
participants have an appointment with a psychologist to fill in a questionnaire
and for an interview.

The correlation between the outcomes with the psychologist and the outcomes
with midwives/obstetrician through 'care as usual' is identified.

There are no risks for participants.
The burden consists of the time necessary (max 1 hour) to fill in the
questionnaire and have the validation interview with a psychologist (at the
location of the midwifery practice). Each participants receives a compensation
of 30 euro.
The burden may also be psychological. The reference-questionnaire (consisting
of SCL-90, CISS-NL, PSS-14, ZIL, AV-AL or DHS ) concerns issues such as mental
well-being, coping en stress. In the validation-interview issues such as family
violence, child abuse and neglect during childhood are discussed. With some
participants this may trigger awareness and emotional arousal. These
participants will be offered an additional consultation with the psychologist
and/or referral to her midwife/obstetrician and/or GP.