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. 2026 Oct 20;19(10):e274343. doi: 10.1136/bcr-2026-274343

Two-year outcomes and feedback after a parenting assessment is integrated into primary care

Tina S Chai 1, Amy H Evans 2, Margaret M Benningfield 3, Seth J Scholer 4,✉
PMCID: PMC13683933  PMID: 42901698

Summary

Some parenting practices (eg, physical punishment, yelling, threatening and humiliation), if used excessively, are associated with childhood behaviour problems and over 20 adverse health outcomes. Assessing parenting behaviours in primary care is not routinely performed. We interviewed a paediatrician who uses a parenting assessment tool and two parents whose family was affected by an elevated screen. The paediatrician counselled the mother and gave her a handbook; the mother shared it with the father who did not attend a clinic visit. Over 2 years, the approach was associated with changes in parent and child behaviours and relationships. The mother reported that the screening process resulted in less ‘yelling’, ‘a lot of happiness’, and ‘a lot more harmony’. The father relayed, “We stopped spanking him” and that health providers should screen for parenting. The findings have implications for supporting parents in their use of healthy discipline, improving family relationships and improving global health.

Keywords: Preventative pediatrics, General practice / family medicine, Global Health, Public health, Child and adolescent psychiatry

Background

Supporting parents in their discipline practices is recognised as an important step in improving children’s well-being and population health.1 2 Primary care clinics offer a unique setting to support parents.3 The standard of care is to use experience and intuition (ie, a gestalt-based approach) to identify parents in need of support.4 A problem with this approach is that less than 50% of parents report receiving parenting education from their healthcare provider, resulting in missed opportunities to support parents.4–6 Another option is to routinely screen for parenting behaviours.4 7 There are validated parenting assessment tools yet most are lengthy and have not been tested in clinical practice.8

To our knowledge, the Quick Parenting Assessment (QPA) is the first validated parenting assessment tool to be integrated into practice, starting in 2020.7–11 The brief, 12-item QPA assesses for parenting behaviours that can, if used excessively, be detrimental to child health: physical punishment, yelling, threatening, humiliation and use of other punitive discipline.7 12–15 The tool applies to the presenting parent and other caregivers, an important feature given fathers’ role in child-rearing.2 Of note, the tool never diagnoses child abuse, nor does it judge or shame parents. Although the ultimate goal of the screening tool is to prevent child abuse, the approach for using the tool is to support parents in their journey to become the best parents that they can be.7

If parenting assessments are elevated, healthcare providers will need effective parenting interventions, of which there are many.16–21 One of the briefest is the Play Nicely programme.21–23 After 5–10 min of viewing the programme during a primary care visit, 83% of parents of 1–5-year-old children planned to change how they discipline compared with 8% of controls.23 Over a dozen other studies in the USA and other countries attest to the programme’s effect on parenting attitudes and behaviours.21–31

Before parenting assessments and educational interventions are used more broadly in primary care, they should be studied in the real world. Case studies can add to what is known. In this report, we interviewed parents of a young child and the paediatrician after a validated parenting assessment tool, the QPA, and an evidence-based educational intervention, the Play Nicely programme, were integrated into practice. Interview questions focused on benefits and drawbacks. We report on the parents’ and the child’s behaviours pre-intervention and over the succeeding 2 years, as gathered from the medical record and interviews.

Case presentation

A mother presented with her son to his 3-year visit with several months of behavioural concerns, including increased generalised worry, poor sleep, decreased eye contact, temper tantrums and attention-seeking behaviour. At this visit, the QPA was elevated (QPA=6) wherein the mother reported that yelling, spanking, threatening language and use of other punitive discipline were being used occasionally as disciplinary strategies (Table). The family assessment revealed an intact marriage, extended family support, financial stability, skilled parents and no substance use/abuse.

The paediatrician provided counselling and an evidence-based healthy discipline handbook to the mother.27 Following the visit, the mother shared the handbook with the father who had not attended the clinic visit. At the 4-year well check, the QPA was low risk (QPA=0) and remained low risk at the 5-year well check (QPA=0). Both parents reported a decrease in yelling and spanking (see section Patient’s perspective). All behaviour problems present at the 3-year and 4-year visits were resolved at the 5-year visit (table 1).

Table 1. Parent responses to the QPA and behavioural concerns at the boy’s well visits at 3, 4 and 5 years.

QPA item 3-year well visit 4-year well visit 5-year well visit
In the past month, what have YOU done when your child needed to be disciplined?
1. You redirected your child toward a good behaviour Yes Yes Yes
2. In general, more than once per day, you used time-out or took away privilege Yes No No
3. In general, more than once per day, you spoke angrily or raised your voice Yes No No
4. You told your child that they are going to be spanked, smacked, popped or slapped No No No
5. You gave your child a spanking, smack, pop or slap No No No
6. You told your child something like “You are a bad child” No No No
7. You spent more time with your child to talk about or show them how to improve behaviour Yes Yes Yes
In the past month, what have your child’s OTHER CAREGIVERS done when your child needed to be disciplined?
8. In general, more than once per day, they used time-out or took away privilege Yes No No
9. In general, more than once per day, they spoke angrily or raised their voice Yes No No
10. They told your child that they are going to be spanked, smacked, popped or slapped Yes No No
11. They gave your child a spanking, smack, pop or slap Yes No No
12. They told your child something like “You are a bad child” No No No
13. I would like to discuss healthy ways to respond to my child’s behaviour Yes Yes No
QPA score* 6 0 0
Behaviour concerns noted in chart review? Yes† Yes‡ No
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Copyright 2019 Vanderbilt University.

*

The QPA is scored by assigning 1 point for each at-risk response for questions 2–6 and 8–12. A QPA score >2 is considered elevated. At the 3-year visit, parents indicated use of potentially unhealthy discipline, including spanking, yelling, threatening and excessive use of other punitive discipline (eg, time-out or taking away a privilege).

†

Behaviour concerns at the 3-year visit were anxiety and delayed social development.

‡

Behaviour concerns at the 4-year visit were anxiety and frequent meltdowns.

QPA, Quick Parenting Assessment.

Summary of interview findings

After IRB approval and obtaining informed consent, we interviewed the parents and their paediatrician for their perspectives on the QPA review process, the educational resource, and whether these office-based initiatives led to improvements in parenting methods and child behaviour. Transcripts of key interview questions and participants’ answers are provided in the Patient’s perspectives section. In this section, we summarise the interview findings and include exemplary quotes. Figure 1 illustrates the clinical flow in our case compared with standard care.

Figure 1. Comparison of patient flow from this report (A) in which a parenting assessment is integrated into the well-child visit with routine care (B).

Flow diagrams contrast parenting screening tool integration versus routine care at well-child visits, showing improved discipline outcomes and reduced specialist referrals when standardised assessment replaces subjective provider judgement.

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Screening and intervention were associated with changes in parenting

Screening for parenting, the handbook resource and the paediatricians’ counselling were associated with changes in parents’ disciplinary behaviours, including stopping spanking and decreasing yelling.

The mother was asked, “What specific aspects of your parenting strategies changed after the QPA?”

Exemplary quote by mother: “The biggest thing I did was stop yelling.”

The father was asked, “Did you do anything differently in terms of discipline after viewing the handbook with your wife, or did your parenting style stay about the same?”

Exemplary quotes by father: “We definitely made some changes” and “We stopped spanking him, tried not to yell as much.”

Screening and intervention were associated with changes in child behaviours

The mother reported improvement in their son’s behaviour problems, noting increased confidence, less attention-seeking behaviour and less anxiety.

The mother was asked, “What specific behaviour changes did you witness after the clinic visit with the QPA?”

Exemplary quote by mother: “He definitely was a lot less anxious and more self-assured and confident.”

Screening and intervention were associated with improved family relationships

The mother reported that the initiatives were associated with improved family relationships.

Exemplary quotes by mother: “There’s a lot more harmony in the house. [My husband] and the boys have all this fun time. It’s really nice to see him [my husband] bond with them.”

Screening and intervention facilitated discussion between parents

Following the QPA review by the paediatrician, the mother shared the educational resource with the father, who was unable to attend the clinic visit. The mother noted that the handbook facilitated conversation between her and her spouse. The father reviewed the handbook, which started a discussion on discipline methods between the parents and was an impetus for parenting behaviour change.

The mother was asked, “Tell me more about your experience with the Play Nicely handbook?”

Exemplary quotes by mother: “It [the handbook] made it really easy to talk to your spouse” and “The handbook outlined it [spanking] in a way that made it more comfortable to talk about it [spanking]”.

Screening for parenting was uncomfortable yet overall beneficial for parents

The mother reported that discussing the QPA was ‘uncomfortable’. Still, she felt that the discussion was beneficial and necessary, noting that it allowed her to confront her actions and unhealthy parenting strategies. The father reported that paediatricians should consider helping other families by screening for parenting and educating parents about options to discipline.

Exemplary quotes by mother:

“It made me uncomfortable but in a good way.”

“I wish that somebody would’ve asked my parents things on the QPA.”

“Thank you guys for this questionnaire. I feel like a much better mom because I confronted my prior actions. Not yelling at my kids feels much better than yelling. That’s brought me a lot of happiness, to feel like a better mom. It feels good to feel like I’m serving [our son] better.”

The father was asked, “What, if anything, do you think paediatricians could be doing to help families like yours?”

Exemplary quote by father: “Just getting parents to do something like this [the QPA] to look at their parenting style and presenting them with options and tools to help with current behaviour.”

Screening is feasible for the paediatrician

The paediatrician routinely administers the QPA at all 15-month, 30-month, 5-year and 7-year well visits and more frequently as needed for behavioural concerns. The mother believed the screening tool helped the paediatrician ask about discipline methods in a non-confrontational and objective manner.

Screening is efficient for the paediatrician

The paediatrician reported that the QPA can be reviewed in less than a minute for low scores and less than 10 min for elevated scores during the well-child visit. The paediatrician offers follow-up appointments when needed to further discuss behaviour and discipline.

Global health problem list

  • Exposure to potentially unhealthy parenting is a global health problem.

  • Healthcare providers are missing opportunities to support parents and prevent child abuse and other health problems—screening for parenting could address this gap in services.

  • Challenges related to screening and intervening for potentially unhealthy parenting in primary care can be overcome.

Global health problem analysis

To our knowledge, this is the first report of long-term qualitative feedback from parents who experienced brief initiatives designed to assess and intervene for potentially unhealthy parenting in primary care. Parents report that a parenting assessment, integrated into primary care and linked with resources, was associated with changes in parenting behaviours, their child’s behaviour and their family relationships. Lessons from this family, combined with data from other studies and statements from leading organisations, indicate relevance across different populations, cultures, healthcare systems and global settings.

Exposure to potentially unhealthy parenting is a global health problem

Excessive use of unhealthy parenting has the potential to escalate and cause problems over time; thus, it is recognised as a global health problem. In 2016, the WHO reported that poor parenting practices are a root cause of violence against children, a problem that is associated with over 20 direct and indirect adverse outcomes.1 The WHO categorised these outcomes as injuries (eg, head injury, fractures and burns), mental health problems (eg, depression, anxieties and suicide), maternal and child health problems (eg, adolescent pregnancy), communicable diseases and risk behaviours (eg, sexually transmitted diseases, alcohol and drug use), and non-communicable diseases and risky behaviours (eg, smoking, obesity, heart disease and diabetes).1 (It should be noted that the child in this report had anxieties.) Numerous other studies7 13 32 and statements from leading organisations2 3 33 confirm the links between parenting and health. Given these associations, supporting parents in their use of healthy discipline, before serious problems arise, should be a global health priority.1

Providers are missing opportunities to support parents and prevent adverse outcomes

Healthcare providers, a trusted resource for parenting advice,3 34 are missing opportunities to support parents in their use of healthy discipline and, subsequently, likely missing opportunities to prevent the many adverse outcomes associated with poor parenting practices.5 In a primary care clinic, parents of 2–10-year-old children completed instruments that measured attitudes about corporal punishment and potentially unhealthy parenting behaviours, without the knowledge of healthcare providers.5 Then, research assistants reviewed the medical record to determine whether parents received parenting support during the clinic visit. Of concern, less than 20% of parents who had potentially unhealthy parenting attitudes and behaviours received support.5 This study was conducted at one site.5 Still, given that unhealthy parenting practices such as corporal punishment are used around the globe1 33 and that parenting assessments are not routinely administered,4 7 10 11 it is plausible that professionals in other geographic areas are also missing opportunities to support parents.

Challenges to screening for parenting in primary care can be overcome

One option to support more parents in their use of healthy parenting is for health providers to screen for parenting in primary care before parenting behaviours might become problematic.4 Efforts are needed to test this approach, locally and globally.4 For screening to be successful, clinicians need to validly assess a complex construct in which parents’ attitudes and behaviours interact with a child’s development over the course of years. Screening should never diagnose child abuse or be judgemental. Validated parenting assessment tools have been developed but most are lengthy and may not be practical to integrate into a busy primary care setting.8 Time constraints and lack of reimbursement are recognised hurdles of educating parents about healthy discipline.35 Even if a brief, valid parenting assessment tool could be developed, there are other considerations before widespread use. Principles for screening for social determinants of health include (1) being patient-centred and family-centred, (2) linking to effective services, (3) being population-focused, and (4) taking an asset-building approach.36 A related challenge, specific to supporting parents in their use of healthy discipline, is how to reach fathers and other caregivers who do not attend the clinic visit.2

This case report, coupled with other research,7–11 16–31 suggests that challenges related to screening and intervening for potentially unhealthy parenting in primary care can be overcome, including reaching parents who do not attend the clinic visit. Herein, we expand on other research that relates to the findings in this report. The QPA, the first screening tool to be integrated into primary care, screens for five recognised potentially unhealthy parenting practices: physical punishment, yelling, threatening, humiliation and excessive use of other punitive discipline (eg, time-out and taking away a privilege).7 12–15 Children exposed to these five parenting strategies had a ninefold increased risk of behaviour problems, providing evidence that the tool is valid.7 Before valid tools can be scaled up in other settings, perspectives of providers and parents are needed.10 11 Providers report that the QPA works from their standpoint.10 Most providers (68%) and parents (81%) report that a QPA review adds value to the clinic visit.10 11 Parents report that, when the QPA is reviewed with them by their healthcare provider compared with no review, the process increases the likelihood of discussions about discipline (89.2% vs 32.4%; p<0.01) and the likelihood that they will plan to change how they discipline their child at home (85% vs 31%; p<0.01).11 A limitation of this study of QPA feedback is lack of long-term follow-up, highlighting the importance of this report with longitudinal outcomes.

Screening tools and educational intervention can be practical and inexpensive—for example, the QPA can be completed in 1 min and reviewed by health providers in less than 2 min, acknowledging that more time can be added with a follow-up visit as is performed by the paediatrician in this report.10 The QPA and Play Nicely multimedia programme are available for free for non-commercial purposes.9 21 Screening tools such as the QPA can be family-centred. For the family in this report, the screening process was associated with improved family relationships. Tools can assess parenting behaviours of all caregivers, including those who may not attend the clinic visit.7 Of note, the father in this report changed his parenting behaviour (eg, less physical punishment and less yelling) even though he did not attend a clinic visit.

An important screening principle is that positive screens should link to effective resources. Providers can, as time allows, educate parents in the clinic. Depending on local resources and provider discretion, there are numerous evidence-based parenting programmes that could be used to respond to elevated QPA scores.16–21 In this report, an elevated QPA screen prompted the delivery of the Play Nicely programme that is brief and can be viewed independently.21–30 The findings in this case report of more harmony, decreased yelling and decreased physical punishment are consistent with published research. Numerous studies have found that the Play Nicely programme affects parents’ attitudes and behaviours related to physical punishment.22 23 25 28 30 31 A longitudinal randomised controlled trial was conducted comparing Play Nicely and Triple P, one of the most studied parenting programmes in the world.19 22 Compared with Triple P Level 2 (TP) and a control (C) group, the Play Nicely (PN) programme was associated with increased communication (PN+44%; +TP 27%; C+25%; p<0.001) and decreased physical punishment (PN −22%; TP −8%; C −10%; p<0.001) and yelling (PN −15%; TP −6%; C −8%; p=0.007) 3 months post-intervention.22

The Play Nicely programme has been found to be culturally sensitive for people from varying demographic backgrounds. Parents from diverse backgrounds report that the programme addressed their family needs, explained things in a way they could understand, respected their family values and was sensitive to their personal beliefs.29 The Play Nicely resource can reach caregivers who do not present to the clinic visit, including fathers.27 A mother in a study of the handbook reported, “My husband has gotten better with disciplining our children,”27 corroborating the experience of the father in this case report. These findings overlap with a priority issue, identified by the National Academies of Medicine, that efforts are needed to conduct more parenting research on fathers.2 In addition to this case report from a practice in rural southeastern USA, the programme has been studied in many different populations, healthcare systems and countries, including Brazil and Colombia.21–30

Screening tools such as the QPA can take a population-based approach, screening all parents of young children every 2–3 years in the first decade of life. Most of the QPA items focus on potentially unhealthy parenting because these are the parenting behaviours that are most strongly associated with poor outcomes.7 The tool also measures healthy parenting strategies such as redirecting and setting future expectations, which can launch asset-building discussions between paediatric providers and parents.7

Limitations

There are limitations of this report. Confounders could have played a role in behaviour changes—examples include child maturation, exposure to other parenting information and parental awareness. Parenting practices can also be influenced by social determinants of health. Separation/divorce, poverty and employment were not concerns with the family in this case; however, we did not control for all confounders. To decrease the effect of confounders, parents were asked about behaviour changes that specifically resulted from the screening process or educational intervention. As mentioned by the paediatrician in this report, time is a limitation. Another challenge is how to train healthcare professionals to use screening tools and counsel parents accordingly. To overcome this limitation, an instruction document and a 20 min training are available online.9 This report is limited to the interview of one paediatrician and two parents. We did not address all barriers related to addressing parenting in practice (e.g. cultural and/or language barriers). For example, parenting assessment tools that ask about physical punishment will likely need to be modified for use in countries where it is banned.37 The parents were recruited for the interview because the paediatrician perceived there had been success supporting a family after a high QPA score was identified. Social desirability bias could have affected the results. Future studies could collect data on confounders and information from both parents throughout the QPA review process. Parenting assessment tools other than the QPA and parenting programmes other than Play Nicely could be tested in the future.

Conclusion

Findings from this and other studies have implications for (1) supporting parents, including those who do not attend the clinic visit, in their use of healthy discipline, (2) improving family relationships and (3) improving global health. Addressing the construct of parenting during the well-child visit is a complex issue that requires careful consideration. One option is to continue the status quo in which parenting support is offered at the discretion of healthcare professionals. Another option, that may benefit some families and that has potential to improve population health, is for providers to routinely screen for potentially unhealthy parenting practices (figure 1). More studies and implementation projects are needed to guide preventive efforts in this area. If this work can be advanced, parenting assessments, integrated into practice, may lay the foundation for improvements in population health at a global level.

Patient’s perspective.

Interview with the mother

Question: Before clinic visits, what behaviour problems were your son having?

A: When I initially talked to [the paediatrician] about [our son], we were concerned he was presenting with a lot of anxious behaviour. A lot of worry and concern that didn’t feel right for his age the time.

Question: What were your parenting styles like?

Answer: I was trying to talk through it with him. We did try some redirecting, probably not as much. [His dad] might’ve been doing more redirecting than I was. We got really frustrated. At this point, we were spanking. We both would yell at him.

Question: What specific aspects of your parenting strategies changed after the QPA [Quick Parenting Assessment]?

Answer: The biggest thing I did was stop yelling. There were things that I needed to address in myself, so I took care of that on my end. Very rarely do I yell at them.

Question: After the clinic visits with [the paediatrician], do you feel like your child’s behaviour improved with time? In what ways?

Answer: Yes, we did see a big improvement.

Question: What specific behaviour changes did you witness after the clinic visit with the QPA?

Answer: We definitely saw less anxiety, better sleep patterns, more independent play than before. Before it was very, needed our attention all the time. He definitely was a lot less anxious and more self-assured and confident. He was able to focus more on being happy and being a kid. It was nice to see that improvement.

Question: How did you feel about filling out the QPA?

Answer: It made me uncomfortable but in a good way. It kind of called me out. It called me out in a good way. It made me really think about [my husband’s] behaviour too. A lot of the times we’re just kind of making it as parents, and we don’t necessarily stop and retroactively think ‘How can I help my spouse parent my child too? How can I encourage him?’ [Play Nicely] facilitated that conversation. I had to face up to my actions, and that was a little uncomfortable at times, but overall it was a good experience. It didn’t make me feel uncomfortable in the sense that something was wrong with it or that I felt it was out of line. It just made me confront my actions.

Question: Do you think it’s reasonable for paediatricians to ask parents how they discipline their children?

Answer: I do. I believe that mental health is health. I feel like it’s incredibly important. I wish that somebody would’ve asked my parents things on the QPA because it could’ve had a really good impact on my anxiety, which stems back from childhood. I don’t know how other people would feel about it. I felt it was a good experience and very helpful. The other part of it is I was asking, I was seeking out this information and wanted to make sure that I’m staying ahead of things. Because, I wish somebody had asked my parents ‘Hey, is this really the best way to discipline?’ It hurt a little, but it was good.

Question: Do you think the QPA helped [the paediatrician] as she tried to help your family?

Answer: I do. I think it gave her an opportunity to get the answers without having to directly be like ‘Do you spank?’ It kind was like ‘here’s this questionnaire’. And she told us ‘you guys are kind of in the high risk or red area’, and talked to me about the results.

Question: Tell me more about your experience with the Play Nicely handbook.

Answer: We definitely looked through it and we still have it. It made it really easy to talk to your spouse about it. [The paediatrician] showed it to me, I was willing to bring it to [my husband]. Because you flip through it, and it has all the options, and it’s very clear and concise, it’s hard to argue with what’s there. It didn’t feel very shameful. It was like ‘okay, we know that parents sometimes spank their kids, it’s not the best option’. There was no shame in admitting that wasn’t the best option. As a parent, I remember feeling guilty when I would spank my kids, and I hear a lot of other people say they feel guilty when they spank, so the handbook outlined it in a way that made it more comfortable to talk about it.

Question: Anything else to share?

Answer: Thank you guys for this questionnaire. I feel like a much better mum because I confronted my prior actions. Not yelling at my kids feels much better than yelling. That’s brought me a lot of happiness, to feel like a better mum. It feels good to feel like I’m serving [our son] better. There’s a lot more harmony in the house. [My husband] and the boys have all this fun time. It’s really nice to see him bond with them. And it’s easier for everybody that way.

Interview with the father

Question: Did you and your wife use similar parenting styles that you both had been raised on when disciplining your sons?

Answer: Initially yes. We fell back into what we had seen and what we had experienced as kids, spanking and yelling.

Question: Did you do anything differently in terms of discipline after viewing the handbook with your wife, or did your parenting style stay about the same?

Answer: We definitely made some changes, tried to focus more on rewarding the positive things he was doing and give him more attention when he was doing something positive, as opposed to limited attention when he does something negative. We stopped spanking him, tried not to yell as much. And just recently we started talking to him about consequences. Encouraging him to assess what he’s doing and think about what the consequences are going to be, both good and bad. That has been really helpful for him.

Question: What, if anything, do you think paediatricians could be doing to help families like yours?

Answer: Just getting parents to do something like this, to look at their parenting style and presenting them with options and tools to help with current behaviour. I think it’s too easy for parents to fall into the same mistakes that their parents made raising them, and that’s kind of a default. If they don’t have other options given to them, they don’t know what else is out there.

Interview with the paediatrician

Question: How have you used the QPA screening in your clinic, generally?

Answer: There’s so much we have to do in a well visit. It’s like an inch deep and a mile wide. It’s about breadth, not depth, we’re not delving into things. Given all of the things we want to touch on, it’s just one of the things that we touch on. I start at 15 months, it’s a good place to start where there are no real issues. Then at 30 months. But mostly introduced as a way to support parents in their journey and to support healthy discipline practices. Then again at age 5 and 7 years. Every family is given the QPA at these well visits whether or not they bring up concerns about their child’s behaviour or have questions about discipline.

Question: How does the QPA screening affect your clinic flow?

Answer: Especially early on, I was excited about it, but I would get bogged down. I have learnt, now that I’ve been doing it for a few years, to be more concise and effective with less words. I actually have never mentioned a score. If the score is 0, I just say keep up the good work, though they will often say they need more help. If the score is high, it’s my opportunity, I will say ‘would it be okay to let me show you some good resources’ and then we can talk about it more in depth if you want to.

Question: How long do you tend to spend responding to low versus high QPA score?

Answer: A low, 15 s. A high, and that varies, depending on if a parent is ready to talk. Probably 2–8 min. If there aren’t other issues to address in the well-child visit, I will spend more time on the QPA. I schedule a follow-up visit to further discuss. If the score is high I’ll give him the Play Nicely handbook and say, ‘Why don’t you look at this at home, and then if you want to discuss this more in depth, make a follow-up appointment in a month’. I put it in and schedule it when parents are really asking for help. ‘Share this with the other caregivers and then let’s meet in a month if that works for you’.

Question: What are positive and negative experiences you’ve had with QPA screening?

Answer: [This mum’s] is the most positive and direct. In general, it’s very positive. Negatives, maybe, is just the time. I don’t have enough time in one visit if the score is elevated. And my uncertainty of how to address it if the parents really aren’t asking for help. This conversation is helping. What I might do is be more proactive and say ‘let’s meet again in a month and see how things are going’.

Learning points.

  • Five potentially unhealthy parenting behaviours are excessive use of physical punishment, yelling, threatening, humiliation and other punitive discipline.

  • A screening tool that assesses for these five parenting behaviours, along with an evidence-based parenting programme, can be integrated into a paediatric practice.

  • Screening for parenting behaviours can be associated with changes in child and parent behaviours and relationships.

  • Screening for parenting behaviours can be associated with changes in the parenting practices of other caregivers (eg, fathers) even if they do not attend a clinic visit.

Footnotes

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient consent for publication: Consent obtained from parent(s)/guardian(s).

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