Improving the quality of decision making in child protection cases

*The study was signed up in may 2015. Due to unknown reasons the study wasn't registered earlier*

Decisions about out- of- home placement of the child, custody, or termination of parental rights have enormous consequences for both parents and children. These decisions are often based on clinical evaluations of parenting capacities. It is crucial for both the child and the parents that a careful evaluation of the parents’ capacities to take care of the children is performed. Unfortunately, most assessments of parenting capacities are not evidence-based. This is also true for the Netherlands. In addition, substantial limitations of diagnostic evaluations in child abuse cases have been reported, such as using only a single session, no home visit, little use of behavioral
observations, and no description of the parent’s caregiving qualities or the child’s relationship with the parent. In addition, it has been shown that professionals can be reluctant to revise their initial judgments despite evidence against these judgments.

To empirically test the effectiveness of parenting capacity assessments in order to have evidence-based methods for diagnosis, a framework for conceptualizing parenting capacity assessments is needed. It is proposed that parenting capacity assessments should include observations of the parent-child relationship in everyday situations in order to assess whether a minimal parenting standard is met and whether the parent has the potential to meet this minimal parenting standard. Based on attachment theory, one of the most influential theories in the area of child development, a competent parent is able to respond to the child’s emotional and physical needs and adapt to the child’s developing capacities in a changing environment (Ainsworth et al., 1974) also defined as a sensitive parent. Parental sensitivity to the child’s emotional and physical needs fosters the development of a secure relationship between the child and the parent, which is predictive of a large number of positive developmental outcomes (Sroufe et al., 2005). In line with this, Juffer argues that the quality of the parent-child relationship and the parent’s capability of responding sensitively to the child should be an essential factor in child protection decisions. To be able to assess improvement in the parent’s capacity to provide security for the child, evidence-based interventions are needed. Unfortunately, the number of evidence-based parenting interventions in the Netherlands is alarmingly low. The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) is one of the few evidence-based interventions in the Netherlands.

The proposed study will test whether the intervention-based parenting assessment of the parents’ capacity to improve (VIPP-APP; Video-Feedback intervention to promote Positive Parenting for the Assessment of Parenting Potential) contributes to improved decision making in a child protection context. The aims of the study are as follows:
1. To test whether children with an advice about out-of-home placement based on VIPP-APP will show fewer emotional and behavioral problems in comparison to children with an advice based on regular assessments.
2. To test whether the advice about the necessity of out-of-home placement based on initial assessments are more often modified by professionals after VIPP-APP.
3. To test whether professionals feel more certain about their advice following VIPP-APP as compared to regular assessments.
4. To test whether children who returned to their parents after assessment based on VIPP-APP experience fewer reoccurrences of child maltreatment than children with an advice based on the regular assessment procedure.

This study is based on a RCT with an experimental and control group. Families who are referred to one of the four family psychiatric facilities in the Netherlands for an evaluation of their parenting capacities in the context of an out-of-home placement decision with a child between the age of 0-6 years old will be recruited. If the parents give informed consent to participate in the study, they will be included and randomly placed in one of the two treatment groups. In week 1 mother and child will be asked to participate in a pre-test, to assess different parent and child factors. The family therapist will be asked to formulate a preliminary advice about the placement decision for the
child. The treatment, either the treatment with VIPP-APP or the care as usual, will start after the pre-test and will take place from week 2-7. In week 8 a post-test will take place to measure the same aspects of the mother and child as in the pre-test. The family worker who works with the family will be asked to formulate a final advice about the placement of the child. After six and twelve months, two follow-up assessments will take place, either through home visits or phone calls, depending on the parents' preference. During these assessments an interview is conducted and questionnaires are filled out by the parents, and, in case the child is living in a foster family, by the foster
parents.

The goal of this study is to test the effects of the VIPP-APP within a Randomized Controlled Trial (RCT).
The primary goal of this study is to test the following hypotheses:

(1) Clinicians feel more confident on their recommendations based on VIPP-APP than on their recommendations based on the regular assessment procedure
(2) Recommendations about the necessity of out-of-home placement based on initial assessments at the beginning of families’ assessment period are more often modified by professionals after VIPP-APP than after the regular assessment procedure
(3) Children for whom a recommendation was based on VIPP-APP show fewer emotional and behavioral problems than children for whom a recommendation was based on the regular assessment procedure
(4) Children who returned to their parents after assessment based on VIPP-APP experience fewer reoccurrences of child maltreatment than in families after assessment based on the regular assessment procedure.

Additionally, this study aims to test the following secondary hypotheses:

(1) A stronger decrease in physiological stress regulation (cortisol and alpha-amylase production) for parents and children in the experimental group compared to parents and children in the “‘care as usual condition”’.
(2) More improvement of primary caregiver’s parenting skills in the VIPP condition compared to care-as-usual.
(3) More improvement on the quality of the attachment relationship between the child and the primary caregiver in the VIPP condition compared to care-as-usual.

1. Baseline measure;

2. Effect measure;

3. Follow-up measurement;

The intervention method used in this study is called the Video- feedback Intervention to promote Positive Parenting for the Assessment of Parenting Potential (VIPP-APP). The VIPP-APP is based on the VIPP-SD (Video- feedback Intervention to promote Positive Parenting and Sensitive Discipline), a preventive intervention aimed at parental sensitivity and sensitive discipline, which in turn will improve the parent- child relationship and interaction and will prevent or decrease behavioral problems in young children. The VIPP-APP is an adapted version of the VIPP-SD for families in a child protection context.