Pregnancy Psychosocial Risk Screening Validation Study
Project Number: R40 MC 07840-02 Project Date: 1/1/2007 Grantee: City of Minneapolis Department/Center: Health and Family Support
Final Report
Pending
Principal Investigator
Patricia Ann Harrison Ph.D., Research Director, City of Minneapolis Health and Family Support, 250 South 4th Street RM 510 Minneapolis, Minnesota 55415-1377 pat.harrison@ci.minneapolis.mn.us
Abstract
The primary objective of the Pregnancy Psychosocial Risk Screening Validation Study is to validate a structured, multidimensional screening interview, the Prenatal Risk Overview (PRO), in clinical settings. The PRO assesses risk in 13 domains with 52 questions, largely drawn from other instruments. PRO responses are entered online by the interviewer and automatically scored to produce a psychosocial risk profile to guide case management activities and ensure that scarce resources are directed toward patients with greatest need. Improving the precision and validity of psychosocial risk measurement is a critical step toward ultimately determining the relationships between specific risk factors and poor birth outcomes. Improved measures are also essential to determining whether appropriate and timely psychosocial interventions reduce infant mortality and the frequency of preterm and low-weight births. The study will be conducted within the context of Twin Cities Healthy Start, a program funded by HRSA since 1999 as a collaboration between two community clinics and the Minneapolis public health department.
Validation of the PRO will include assessing its sensitivity and specificity in identifying depression, alcohol use levels and disorders, and drug use levels and disorders against the Structured Clinical Interview for DSM-IV and in identifying intimate partner violence against the Composite Assessment Screen. Validation analyses will also include comparisons of PRO results with diagnostic and procedure codes for psychiatric and substance use disorders and assault injury codes recorded on medical claims and encounter forms, and indications of substance use recorded on birth certificates.
A sample of 2,265 pregnant women will complete the PRO interview. Birth certificate and medical claims/encounter data will be matched to PRO results for consenting patients. A randomized subsample of 1,000 English-speaking patients (half who screen positive for at least one domain of interest) are expected to complete the validation interview.
Two sub-studies will address concerns related to resource allocation. The interviewer equivalence component will entail randomization to either a Registered Nurse (n = 500) or a Community Health Worker (n = 500) to determine whether professionals and paraprofessionals elicit similar levels of risk reporting. The re-screening component (n = 500) includes randomization to a readministration of the PRO eight weeks after the first interview to determine whether a second administration appears justified based on the level of additional risks reported.
The study addresses three of the four Maternal and Child Health Bureau (MCHB) Strategic Research Issues and builds on the MCHB investment in Healthy Start programs nationally. Validating the PRO will help to improve the perinatal health community infrastructure (Research Issue #1). This step is a significant contribution toward ensuring a standard of quality of care (Research Issue #3). By implementing a standardized screening process that reduces clinician bias, the project also aims to foster improved access to appropriate health care and social services, with the goal of reducing racial health disparities (Research Issue #2) in infant mortality, preterm birth and low birth weight. Study findings will have direct application for improved delivery of prenatal care and the enabling services designed to address psychosocial needs of pregnant women. A valid, clinically useful tool will facilitate universal screening and systematic referral for needed health and social services.
