A Systematic Review of Assessment Tools for Screening at-Risk Families

Background and objects: Family is the place where child maltreatment happened most frequently. A recent study reported 81% of participants experienced physical abuse by parents, and 82% experienced psychological abuse at home. A tremendous body of studies suggested child maltreatment is detrimental to victims in a lifelong period. Assessing at-risk families has long been adopted worldwide as a useful method to prevent future child maltreatment. However, a consensus on how best to measure family risk via family risk assessment tools is not evident. This systematic review aims to summarize and critically appraise the characteristics, risk factors, methodological quality, and strength of evidence in psychometric properties to determine which assessment tool is capable of providing adequate information in locating at-risk families.

Method: A systematic search for electronic databases, APA PsycINFO, British Nursing Index, Sociological Abstracts, and Social Services Abstracts, was performed using three groups of search terms: 1) family; 2) risk (safety OR maltreatment OR abuse); 3) assessment (evaluation OR measure OR scale). An initial search of electronic databases was conducted on November 30^th, 2019 restricting the studies to peer-reviewed English articles published between December 1^st, 2009 to November 30^th, 2019. Reference lists of included studies were hand-searched for relevant studies. Two independent reviewers screened all articles and extracted the data. All differences were resolved by a third reviewer. This study evaluated the family risk assessment tools according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. All results on psychometric properties (internal consistency, reliability, measurement error, content validity, structural validity, hypothesis testing, cross-cultural validity, and criterion validity) from available studies were summarized into the psychometric property per assessment tool based on a modified Criteria for Good Psychometric Properties.

Result: 80 studies representing 34 family risk assessment tools were screened in from a total of 8243 studies. Four dimensions, individual level, interpersonal level, community level and societal level, are generated. The risk and protective factors at the individual and interpersonal level was most frequently measured, whereas the risk and protective factors at community and societal levels are less assessed. High-quality evidence was limited. No assessment tool reported adequate levels of evidence in all criteria. No criteria were met by all assessment tools.

Conclusion: Available evidence concerning the quality of assessment tools is limited. Based on the evaluation results of this studies, it is reasonable to conclude that no assessment tool is worth to be recommended as a suitable assessment tool with higher quality and stronger evidence than all others. Parenting Stress Index-Short Form and Physical Abuse and Neglect Scale show promising results in more criteria than other assessment tools, but still, need further validation. This study recommends practitioners to take caution when adopting Check List of Child Safety due to its low to moderate evidence in three available criteria. Further studies are needed to validate the quality and properties of family risk assessment tools.