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Table 2 Family longitudinal and clinic staff survey measures

From: The Mitigating Toxic Stress study design: approaches to developmental evaluation of pediatric health care innovations addressing social determinants of health and toxic stress




Family Measures

Home and Neighborhood Environments

 Safe Environment for Every Kid–Parent Questionnaire (SEEK™) [27]

Environmental Safety

14-item screening tool used by child healthcare professionals for identifying psychosocial risk factors. Validated among pediatric primary care populations [28,29,30].

 Housing Quality Scale [31]

Perception of housing quality

5-item self-report scale of housing quality including physical condition of current housing. Reliability of this measure was established by developers; reliability confirmed and validity established through pilot testing in this study.

 Housing Instability Index [32]

Housing stability

10-item self-report scale assessing instability over the previous 6 months, including items related to eviction, difficulty paying for housing, and transiency. Reliability of this measure was established by developers; reliability confirmed and validity established through pilot testing in this study.

 Neighborhood Disorder Scale [31]

Neighborhood safety climate

5-item self-report assessing perceptions of neighborhood disorder (e.g. drug use, graffiti, loitering, and buildings in disrepair). Reliability of this measure was established by developers; reliability confirmed and validity established through pilot testing in this study.

 Neighborhood Danger Scale [31]

Perception of neighborhood safety

5-item self-report scale measuring perception of safety at home at night, on neighborhood stress during the day, and on neighborhood stress at night. Reliability of this measure was established by developers; reliability confirmed and validity established through pilot testing in this study.

Experiences of Life Stressors

 Center for Youth Wellness–Adverse Childhood Experiences Youth Version (adapted) [33]

Caregiver experiences of childhood adversity

19-item self-report tool measuring childhood experience with stressful live events such as physical, emotional, and sexual abuse, physical and emotional neglect, household dysfunction, parental incarceration or death, and. Longitudinal studies are currently working to establish validity and reliability for this tool. Results reported in the current study are twelve of the nineteen total items that were asked of caregivers during the first interview.

 Functional Impact of Life Events for Parents (FITS-P) [34]

Functional impact of exposure to toxic stress

4-item binary self-report scale assessing caregiver functional impact resulting from exposure to toxic stress, developed and validated for this study.

Experiences of Resilience and Personal Mastery

 Connor-Davidson Resilience Scale (CD-RISC) [35]


25-item Likert self-report scale of resilience widely used across service systems and populations with established psychometric properties including test-retest and internal consistency reliability, and convergent, and divergent validity with a wide breadth of established measures.

 Pearlin Mastery Scale [36]

Parental mastery

7-item Likert self-report scale assessing individual mastery defined as the extent to which individuals perceive their life as under their own control. This scale assesses beliefs about mastery over current circumstances, future possibilities, and ability to solve problems independently. This scale has established internal consistency and test-retest reliability, and correlations with other scales and variables [36,37,38].

Parenting Experiences

 Infant Development Questionnaire (IDQ) [39]

Infant development knowledge

15-item binary-response self-report measure of maternal knowledge of infant development. Psychometric properties of this measure have not been established.

 Parental Stress Scale (PSS) [40]

Parenting stress

18-item Likert self-report measure of stress in parenting. Psychometric properties for this scale are robust, suggesting that the scale has sufficient internal consistency reliability, convergent validity with other parenting stress measures, and divergent and predictive validity.

 Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) [7]

Development-ally supportive parenting behaviors

29-item brief observational measure of four positive parenting practices: affection, responsiveness, encouragement, and teaching. This tool has been shown to be reliable and valid for use with parents [41]

Child Health and Development

 Brief Infant-Toddler Social and Emotional Assessment (BITSEA) [42]

Child social-emotional development

42-item self-report screening tool for identifying child social-emotional and behavioral problems and delays among children ages 12 through 36 months of age. The BITSEA is a well-established tool with robust psychometric properties, including excellent test-retest reliability, concurrent and predictive and discriminant validity and acceptable specificity [43].

 National Survey of Children’s Health (Adapted) [44]

Child health status

The NSCH is designed to produce national and state-level data on the physical and emotional health of children 0–17 years old in the United States. Number of items vary due to response but estimated average time for collection of data per survey is 2.5 h. Psychometric information is generally not available for the 14-month wave, but is for the 24- and 36- month waves.

Access to Social Support and Resources

 Health Families Parenting Inventory Mobilizing Resources Subscale [45]

Caregiver ability to access and use community resources

5-item Likert subscale of the 63-item self-report measuring assessing parenting domains. Assesses caregiver ability to access and use community and societal resources. The full scale has well-established psychometric properties, including construct validity, internal consistency reliability, and promising results related to sensitivity to change [46].

 DULCE Social Connectedness [19]

Social connections in the community

2-item self-report scale assessing caregiver access to emergency care and support when needed. Psychometric properties of this scale have not been tested [19]..

 Early Head Start Community-Based Partner Measure [47]

Use/access to community-based services

A subset of items adapted from the 36-month exit interview conducted by Mathematica Policy Research, Inc. and the U.S. DHHS Administration on Children, Youth, and Families as part of the 2001 Early Head Start Evaluation. While not psychometrically validated, this measure provides an established means of inquiring about connection to a variety of community-based family support programs.

 Help Me Grow Protective Factors Survey (adapted) [47]

Protective factors

10-item self-report measure of caregiver knowledge of child needs, perceived access to support, and functional and relational coping. We pilot tested this measure for this study and established construct validity and internal consistency reliability (α = .93).

Patient Engagement with Clinic

 Clinic Inclusivity and Regard for Parents Scale (CIRP)

Inclusion in primary care decisions

11-item self-report Likert scale assessing parenting perceptions of engagement and inclusion in healthcare decision-making for their children. The CIRP was developed and pilot tested for this study. We established construct validity as well as internal consistency reliability (α = .93).

 Parent Patient Activation Measure (PPAM) [48]

Caregiver activation in pediatric primary care

13-item self-report Likert scale that measures healthcare activation – or ability to manage a child’s health and healthcare. The PPAM was developed based on the Patient Activation Measure [49], which has well-established psychometric properties of internal consistency and test-retest reliability, criterion and construct validity.

Clinic Staff Measures

 Maslach Burnout Inventory, Human Services Survey for Medical Personnel© [50]

Professional burnout

50-item scale derived from the Human Services Survey for Medical Personnel assessing degree of emotional exhaustion, depersonalization, and personal accomplishment in work. This measure is validated by the extensive research that has been conducted for more than 35 years with this tool.

 AAP Periodic Survey of Fellows (adapted) [51]

Screening and referral practices to address SDoH

This national survey has collected more than 75,000 pediatrician responses on hundreds of topics to inform policy, education, and advocacy. This measure is validated by the extensive research that has been conducted for more than 20 years with this tool.

  1. Licenses were required and obtained for the following instruments: BITSEA; CD-RISC; Maslach Burnout Inventory Copyright©1981, 2016 by Christina Maslach & Susan E. Jackson; PICCOLO; PPAM; SEEK™© University of Maryland, Baltimore 2016