A cumulative risk index for use in the medical home. (8th March 2021) - Cunningham, Maureen
Abstract: Background and Objective: Previous studies have described the effect of sociodemographic factors on early development. We describe development of a simple cumulative risk index (CRI) based on four sociodemographic factors and explore the concurrent and predictive relationship of this index to a measure of the cognitive home environment in early childhood and to later school functioning. Methods: This was a secondary data analysis of children from an urban pediatrics clinic. Baseline data were collected at 10–23 months ( n = 324) with primary follow‐up 6 months later at 18–35 months ( n = 179) and secondary follow‐up at 8–10 years ( n = 68). A CRI score was derived at baseline using maternal education, marital status, race/ethnicity and child insurance. Baseline and primary follow‐up included three subscales of the STIMQ, a measure of the cognitive home environment. Effectiveness of CRI was examined using analysis of variance (ANOVA) with linear contrasts. Chi‐square examined differences in school function between children from CRI high‐risk (CRI 3–4) and low‐risk (CRI 0–2) families. Results: CRI had a negative impact in early childhood on STIMQ subscale scores ( p < 0.007–0.05) that increased as the number of risk factors increased ( p < 0.05). Significantly more children from high‐risk families (CRI 3–4) were rated as having poor school performance than children from low‐risk families (CRI 0–2) ( p < 0.05). Conclusions: We showed that a practice‐friendly CRI, based on characteristics typically available in the medical record, could help identify families less likely to support development concurrently at 1 year of age and predictively at 2–3 years. School functioning at 8 to 10 years was also significantly better in children with a low CRI at 1 year. The CRI could be a useful tool for both clinicians and researchers needing a simple tool for risk assessment.