INCAS Validation: Parenting capacity in mothers with severe mental illness

Physicians and psychiatrists regularly encounter infants at developmental risk
due to maternal severe mental illnesses (SMI). Maternal SMI predicts a higher
risk of child mortality; deficits in cognitive development; child
psychopathology and behavioral problems. Parenting is a multidimensional
construct, consisting of basic provision and knowledge, but also sufficient
planning and flexibility, empathy, and warmth. Parenting domains can be
negatively affected by factors such as executive functioning deficits, mother*s
bad experiences in close relationships, and maternal psychopathology. Deficits
in parenting domains are related to neurobiology in the mother and the child,
such as lower maternal oxytocin levels and elevated child cortisol stress
response. There are however no instruments that can assess the combination of
specific parenting dysfunctions. Furthermore, there are no evidence-based
criteria available to decide whether parenting offered by SMI mothers is *good-
enough* and provides for the necessary care for the child. In this study, the
*Infant Caregiving Assessment Scales* (INCAS) instrument will be validated for
the Dutch population, in collaboration with the Universities of Sydney (the
initiator of the INCAS) and Oregon. With this instrument parenting of SMI
mothers will be divided in multiple testable domains of basic skills,
flexibility, and planning (instrumental care), and empathy, affection, and
interaction (emotional care). This fine-grained information will allow
practitioners to conduct focused assessment and treatment to benefit both
mothers and children.

The main goal of this study is to establish the reliability (internal
consistency and interrater reliability) and validity (discriminant, contruct
and predictive validity) of the INCAS. Differences between the SMI and healthy
group will be studied (discriminant validity). The association between specific
INCAS domains and other measures of parenting capacity and maternal correlates,
such as psychiatric disorder and executive functioning will be investigated
(construct validity). Furthermore, the predictive value of the INCAS domains on
specific aspects of child development and cortisol stress response are
investigated (predictive validity).

In this naturalistic follow-up study at 30 weeks (pregnancy) and at 1.5, 6, 9,
and 14 months post partum, parenting capacity, maternal correlates of parenting
and parenting outcomes are assessed. The INCAS yields ratings of early
parenting capacity that are task-specific, criterion-referenced, and
ecologically valid. Parenting will be assessed from videotaped interactions in
naturalistic settings during core tasks of caring, to approach real-life
situations. Clinical impressions and subjective views are excluded from this
assessment. With this 60-minute assessment, parenting will be divided in sub
domains of instrumental and emotional care needs resulting in a more specific
quantification of parenting on nine-point Likert scales.

There are no known specific risks associated with participation in this study.
The study will contribute significantly to clinical practice and the existing
scientific knowledge base in the field of early parenting capacities and
psychopathology. With the results of this study the INCAS instrument can be
further improved and the empirical foundation of observational diagnostics can
be strengthened and expanded.