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Implementing early detection of parenting and developmental problems in toddlers with the SPARK in preventive child healthcare: long-term outcomes and cost-effectiveness

Projectomschrijving

Implementeren van de SPARK in de preventieve jeugdgezondheidszorg: langere termijn uitkomsten en kosteneffectiviteit

Vraagstuk

Vroegsignalering van risico op opvoedings- en ontwikkelingsproblemen bij jonge kinderen is belangrijk om het ontstaan van problemen te voorkomen en te kunnen ingrijpen voordat problemen onnodig groot worden of zelfs leiden tot een crisis. De SPARK is een gestructureerd interview die professionals in de preventieve jeugdgezondheidszorg (JGZ) helpt bij deze taak. De validiteit en betrouwbaarheid van de SPARK is uitgebreid onderzocht.

Onderzoek

Kennis over langere termijn effecten en kosteneffectiviteit ontbreken daarbij nog. Deze kennis is belangrijk voor organisaties en gemeenten om een weloverwogen besluit te kunnen nemen over het implementeren van de SPARK.

Verwachte uitkomst

Dit onderzoek zal uitwijzen of implementatie van de SPARK in JGZ organisaties, leidend tot verbetering van vroegsignalering, resulteert in betere gezondheidsuitkomsten voor het kind, betere ervaringen met zorg door ouders en lagere kosten. Dit in vergelijking met de huidige zorg van de JGZ bij kinderen van 18 maanden oud.

Producten

Titel: SPARK-methode : een gestructureerd vraaggesprek
Auteur: I.I.E.Staal ism SPARK onderzoeksgroep en communicatie GGD Zeeland
Link: https://www.youtube.com/watch?v=95cELicKp7Q
Titel: SPARK (2020) -niet richtlijnmodules in de JGZ Academie - NCJ
Auteur: I.I.E. Staal ism SPARK onderzoekgroeps en PlusPort
Link: https://www.ncj.nl/actueel/nieuws/artikel/vernieuwde-spark-e-learning
Titel: Website: SPARK, een optimale start voor een leven lang meedoen
Auteur: I.I.E. Staal ism SPARK onderzoeksgroep en Julius Centrum UMC Utrecht
Link: https://www.spark-methode.nl/

Verslagen


Samenvatting van de aanvraag

RATIONALE: A major task of preventive child healthcare (PCHC) is early detection of parenting and developmental problems. The validated Structured Problem Analysis of Raising Kids (SPARK) is a broad-scope structured interview for this early detection, using both the perspective of the parent(s) and the experience of the PCHC nurse. Our research has shown that the SPARK is effective, valid, reliable and usable in daily practice. Early detection and intervention in preschool children is expected to result in better wellbeing of child and parents, and less use of expensive specialized youth social care. Broad implementation of existing validated instruments for early detection of parenting and developmental problems is hindered by the missing knowledge about long-term impact on parents and children, and by missing knowledge about the cost-effectiveness from the perspectives of different stakeholders. This way, society misses out on the short- and long-term revenues of early intervention in families with young children. We identified the lack of evidence of long-term impact and cost-effectiveness as major barriers for further implementation of the SPARK. Robust evidence about long-term outcomes for the child, experiences from parents and cost-effectiveness of using the SPARK is essential for evidence-informed policy decisions by municipalities and PCHC-organizations. DESIGN: A cluster-randomized stepped-wedge trial with 1.5 year follow-up will answer whether implementing the SPARK in PCHC-organizations leads to an improvement in detecting parenting and development problems, results in better health outcomes for children, better care experiences for parents, and lower total costs, compared to the current loosely structured regular consultation for children aged 18 months. Health outcomes for children are measured with the ITQOL (Infant Toddler Quality of Life Questionnaire); outcomes for parents are measured with our new Balance Measure on caregiver strain and resilience, the ColloboRATE for shared decision making, and a short experience questionnaire. Costs are measured from the perspective of the child/parent and from the perspective of professionals. All participating PCHC-teams from GGD Zaanstreek-Waterland will start with their current consultation, and switch to using the SPARK using a randomized stepped-wedge design. In total 2400 children from 10 teams are needed to detect 7% more children with increased/high risk identified by the SPARK, compared to the regular consultation. Analysis will consist of a generalized linear mixed model in R, cost-effectiveness and cost-consequence analysis, and a process analysis. KNOWLEDGE TRANSLATION: We will develop an online, locally adaptable decision support tool (i.e. business case) to help municipalities and PCHC-organizations with their evidence-informed policy decision regarding implementing the SPARK, and a roadmap to guide implementation. Parents will be involved and informed via Stichting Opvoeden (online parents panel, website). Professional stakeholders will be informed via their respective interest groups. Results will be made available for updating relevant guidelines. PLANNING: Month 1-3 trial preparation; month 4-18 cluster RCT with stepped wedge design, 1 PCHC-unit per month; month 10-36 follow-up period; writing first papers; month 33-39 data-analysis + writing papers on follow-up and CEA + preparing knowledge translation; month 37-40 finalizing knowledge translation activities.

Kenmerken

Projectnummer:
531002022
Looptijd: 100%
Looptijd: 100 %
2019
2023
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
Dr. I.I.E. Staal
Verantwoordelijke organisatie:
GGD Zeeland