Guideline 16

Guideline 16: Parent Child Interaction Assessment

Purpose: 
A healthy relationship between a caregiver and their infant is essential for ensuring optimal physical, cognitive, social and emotional development. Infants are born with innate biological behaviors that signal a caregiver to respond and aid. When a caregiver responds appropriately over and over, the infant learns trust and forms crucial attachments to the caregiver. These early relationship experiences form the basis for infant's understanding of how relationships work, and secure attachment requires warm, nurturing and consistent caregiving. Promoting positive parent/caregiver-child interaction is a key component of home visiting, as home visitors are in a unique position to assess, support and enhance those interactions during the first year of life. 

Process 

Assessment 

• Nurse home visitors with training in a validated parent-child interaction (PCI) assessment tool (e.g., DANCE, Parent Child Relationship Assessment/NCAST.KIPS) should use that assessment tool. Use the tool-specific scores to identify when parents would benefit from interventions (see Interventions section below). 
• It is recommended that programs who are planning to provide parent education and attachment promotion seek training and certification in a validated PCI tool like the ones noted above; however, when a validated parent-child assessment tool is not in use by an agency, the Bright Futures Age Specific Observations of Parent­ Child Interactions may be used: https://www.brightfutures.org/mentalhealth/pdf/professionals/in/observation.pdf   Although this is not a formal screening tool, it contains assessment criteria to help identify strengths and opportunities to promote parent child interaction.
  

It is not possible to determine a cutoff point for referral without using a validated tool; however, it is important to make sure that parent-child interactions are positive and opportunities for improvement are not missed; nurses should have a low threshold for instituting strength-based interventions. MCH State Nurse Consultants trained in validated tools are available for consultation as needed. 

• Parent-child interaction assessments should be culturally sensitive and completed per program guidelines or more often as needed based on assessment. 
  
• Each parent-child assessment should have accompanying documentation that includes assessment results, nursing diagnosis, expected outcomes, planning and interventions. 

Interventions

When a concern is identified by the nurse or parent, provide follow-up. Follow-up may include: 

1. Providing anticipatory guidance on infant cues, child behaviors and responses 
2. Interventions from evidenced based curricula designed to strengthen attachment and overall parent-child interaction: 
3. Circle of security (parent education handouts and videos available online: https:// www.circleofsecurityinternational.com/ ) 
4. Partnering in Parenting Education (PIPE) curriculum (materials must be purchased) 
   
• Promoting First Relationships 
• Zero-3 (parent education handouts available under specific topics) https://www.zerotothree.org/resources/series/parent-favorites#social-emotional­ development 
5. Referral to a mental health provider trained to address parent child interaction. Contact your CCO for a list of providers who are training in evidenced based practices Dyadic therapies such as Parent-Child Psychotherapy, PCI and others. (also see a list of sites that provide Parent-Child Psychotherapy and Parent Child Interaction Therapy). If not possible or practical, consider referral to primary pediatrician.
6. Treatment of underlying conditions contributing to PCI interruption such as mental health disorders, substance use disorder, or social drivers of health concerns (e.g. housing or food instability) 

Additional Training resources 

1. Oregon Infant Mental Health Association 
2. National Alliance of Infant Mental Health 
3. Essentials of Home Visiting Trainings (contact the MCH Workforce Development team for access) include some courses that relate to this topic: 
   
• Foundations of Infant Mental Health Practice in Home Visiting 
• Exploring Values and Beliefs around Parenting 
• Home Visiting with Families During Pregnancy 
• Promoting Effective Parenting with Motivational Interviewing 

 References 

1. Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017. 
   

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