Evidence-based Shared Decisions

Family Stress Grant Summary - Child Abuse and Neglect

Family Stress Grant Summary - Child Abuse and Neglect 

Child abuse and neglect often confer short- and long-term impairment of the physical, emotional, and cognitive development of children. The proposed project builds on promising data from previous randomized control trials, based on application of a screening tool in primary care pediatric practice that identifies the Family Stressors and use of harsh punishment, which are known to put children at risk for child abuse and neglect.

Pediatric check-ups are ideal for early identification because of nearly universal and repeated access. However, these visits, also known as “child health supervision” have been charged with a heavy public health burden of early detection and preventive counseling for a wide variety of issues related to health risks, safety, and promoting child development during narrow time constraints. We have previously built a system to assist with this challenge by off-loading the burden of information gathering to an online pre-visit platform called CHADIS that has been used by over one million parents already. However, when the visit scope is broadened to addressing sensitive family stressors, the challenge for PCPs becomes one of clinical interviewing skills, that, in part, is best addressed with the evidence based approach known as motivational interviewing (MI). PCPs have not been trained for MI and it typically takes longer than the time allotted for the visit. The innovation proposed here is to collect data online before visits to not only identify problems, but also divide the interview process so that the computer collects data in a way that guides the PCP during the visit with details and suggested words (“teleprompters”) for the human elements of empathy and reflective listening that can be delivered briefly. In addition, the innovation also reduces documentation burden and creates follow-up psycho-education and tracking.

This new Family Stress Module supports not only a single problem visit but also acts across visits in creating the psychosocial orientation for parents of children of all ages to confide in the PCP as well “anticipatory guidance” reinforced by “MemoryBook” and text messages. Electronic linking will be created with local referral resources, such as agencies or therapists, so when a referral is made two way communication is facilitated as well as tracking of appointment completion with the parent’s consent. There are no other clinical process support systems of similar scope and none connected to an electronic system of care bridging medical and social domains. The project involves first refining a prototype with parent and doctor feedback and then conducting a cluster randomized intervention trial. Hypothesized outcomes are lower rates of child abuse and neglect reports, less harsh punishment, as well as improved developmental and behavioral outcome in the intervention group. Parent satisfaction with the enhanced clinical process and collateral benefits, such as lower rates of missed visits and delayed vaccines will also be assessed.

Supporter Testimonials

“Dr. Lindgren’s patients access a cool web tool, called CHADIS, that allows them to help him screen for all kinds of conditions including developmental delays, behavioral issues, or even learning problems.  You see, this doc is big into prevention. But it’s hard to get the info he needs in a regular office visit since parents often have their hands full with a sick child.  Now his patients can be way ahead of the game and parents love it.”


Dr. Carl Lindgren
Healthy Futures Pediatrics

CHADIS has been a really great resource for my practice. With CHADIS, I have access to a comprehensive list of screening and assessment tools. I can use the tools to accomplish multiple goals, including early screening and intervention. As a physician, I know that early intervention DOES WORK!



Janice Loeffler, MD

Treehouse Pediatrics has used Chadis as a part of its day to day operations for the past couple of years. We have found it to be a tremendous asset in our operational efficiencies.  Parents appreciate the convenience of completing their child’s developmental, ADHD, and asthma questionnaires at home, and it has proven to help make all of our visits requiring questionnaires run more smoothly.  Furthermore, we appreciate the interpretation and documentation that Chadis provides for these questionnaires. We feel that Chadis has become an integral part of our operational efficiencies.  We do not know what we would do without it.

Bill James, MHA
Treehouse Pediatrics

“I just wanted to say thank you for such a wonderful opportunity…so so helpful for me to better understand my patient, and to have ideas on where to go next. So thank you so much for a really incredible opportunity to be part of CHADIS.”

Laura Lieberman, MD