Guide Parenting and Family Processes in Child Maltreatment and Intervention

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The review focused on primary prevention; evidence on interventions in children with signs or symptoms of maltreatment or known exposure to child maltreatment is outside the scope of work of the USPSTF. The USPSTF reviewed studies of children without signs or symptoms of maltreatment who received interventions to prevent child maltreatment delivered in or referred from primary care. The main outcomes were reduced exposure to maltreatment; improved behavioral, emotional, mental, or physical well-being; and reduced mortality.

Of those 22 trials, 12 were included in the review and 10 were newly identified.

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Although most trials featured home visits, the components of the interventions varied by content, personnel, intensity, duration, and use of other supporting elements. Fifteen of the 21 home visitation trials used clinical personnel in some capacity. These personnel included nurses 7 trials , mental health professionals 2 trials , paraprofessionals 4 trials , and peer home visitors 1 trial. Of the 21 home visitation trials, 8 featured home visits as the sole intervention. The duration of interventions varied from 3 months to 3 years, and the number of planned sessions ranged from 5 to Overall, evidence on the effect of interventions did not demonstrate benefit, or outcomes were mixed.

Fourteen trials provided results on CPS reports and actions and included data collected during, at the end of, or within a year of completion of the intervention.

Psychosocial Intervention

Long-term follow-up 2. Five trials reported on removal of the child from the home. There was no significant difference between study groups pooled OR, 1. The evidence review demonstrated mixed results for several outcomes. Outcomes related to emergency department visits and hospitalizations were reported in 11 and 12 trials, respectively.

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Statistically significant reductions in all-cause hospitalization, average number of hospital days, and rates of admission were demonstrated in a minority of trials. Only 2 studies that reported outcomes within 2 years of intervention noted statistically significant reductions in the average number of all-cause emergency department visits.

Four trials reported on child mortality, all with follow-up between 6 months and 9 years. None of the mortality outcomes reported reached statistical significance, 21 , 26 , 36 , 37 although 1 trial did report higher mortality rates in the intervention group.

The role of home-visiting programs in preventing child abuse and neglect

One study reported on mental development at 24 months as well as school performance at 9 years and showed no statistically significant difference between control and intervention groups. Overall, the USPSTF found limited and inconsistent evidence on the benefits of primary care interventions to prevent child maltreatment. It found no evidence related to the harms of primary care interventions to prevent child maltreatment. The USPSTF reviewed all suggested studies and found that they did not meet eligibility requirements for inclusion, primarily because the studies were rated as poor quality or did not report eligible outcomes.

Studies that included the SEEK model were included in the sensitivity analysis but did not change outcomes. Comments also voiced concern about the accuracy of disparities statistics, noting that racial biases can affect reporting of child maltreatment. Comments noted that the USPSTF conflated the potential harms of primary prevention of maltreatment with harms associated with reporting maltreatment.

The Current Practice section indicates that this recommendation applies to children who do not have signs or symptoms of maltreatment and that professionals and caregivers are obligated by law to report suspected child maltreatment. In , the USPSTF found insufficient evidence to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. The current recommendation reaffirms this position.

Primary Prevention of Child Abuse

There are varying recommendations related to the primary prevention of child maltreatment. In , the American Academy of Family Physicians concluded that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment. Corresponding Author: Susan J. Curry, PhD; Alex H. Barry, MD; Aaron B. Wong, MD. Author Contributions: Dr Curry had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Barry reported receiving grants and personal fees from Healthwise, a nonprofit, outside the submitted work. Dr Doubeni reported being an author for UpToDate and serving as director of a Health Resources and Services Administration center on training in integrated behavioral health in primary care, outside the submitted work. No other disclosures were reported. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

All Rights Reserved. Figure 1. View Large Download. Child maltreatment Published February 1, Accessed October 11, Version 1. Child Welfare Information Gateway. Definitions of Child Abuse and Neglect. The evaluation of suspected child physical abuse. Child Abuse Negl. What Is Child Abuse and Neglect? Recognizing the Signs and Symptoms.

Home visiting. HRSA webite. Preventive Services Task Force. Screening for intimate partner violence and abuse of elderly and vulnerable adults: U. Ann Intern Med.

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Child abuse and neglect prevention. CDC website. Updated April 10, Results were mixed for effects on discipline and behavior management. On the Negative Discipline scale of the Discipline Interview, both caregivers and children reported baseline frequency of scores near 1. Baseline scores on the Positive Discipline scale of the Discipline Interview averaged between 2.

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We detected no treatment effect on this Positive Discipline scale, suggesting no increased use of strategies such as time out and privilege removal. On the discipline-related questions from the Discipline Module of the Multiple Indicator Cluster Survey that assess both harsh and non-harsh discipline strategies together, we detected no treatment effects. As the internal consistency reliability values were lower for these scales, some caution should be taken in interpreting these results. Positive treatment effects were detected on multiple dimensions of family functioning assessed by the Burmese Family Functioning Scale.

Overall, results suggested that the improvements the treatment group experienced post-intervention remained at these same improved levels six months later. Scores remained at their improved levels for positive parent-child interactions based on child and caregiver reports on the PBI and PAR-Q. For negative parent-child interactions as measured by the PAR-Q, children, but not caregivers, reported that their scores remained at the improved levels. Improved scores on family functioning and negative discipline remained according to both children and caregivers. This study documented promising results regarding the impact of the Happy Families intervention among migrant Burmese families displaced in Thailand.

Results provide consistent evidence that the treatment improved the quality of parent-child relationships among migrant Burmese families through both increased positive relationship behaviors and decreased negative interactions.

Consistent with these improvements in dyadic relationships, the intervention also influenced overall family functioning, with results reflecting small- to medium-sized effects on family cohesion and small effects on decreasing negative interactions in the family. Results for family communication were mixed, with children, but not caregivers, reporting a significant improvement; this may reflect that caregivers experienced improvements in the overall emotional quality of family relationships but without perceiving increases in specific communication behaviors related to problem-solving and planning together.

These positive findings on parent-child relationship quality and overall family relationships are consistent with the goals of Happy Families that emphasizes teaching skills for relationship improvement and facilitating in-session practice—two intervention characteristics associated consistently in the literature with parenting program effectiveness [ 52 ].

Effect sizes found in this study were generally comparable to those documented in other studies in LMICs, though most of those were conducted to evaluate interventions with younger children and did not include measures of overall family functioning [ 23 ]. Intervention effects on discipline practices were less clear, with inconsistent results across constructs and assessment tools. Caregivers reported a significant reduction in the use of harsh discipline on the Discipline Interview with an effect size comparable to those reported for similar programs in the US [ 22 ] and in other LMICs [ 23 ].

Child-report did not corroborate this, however, suggesting that children did not perceive as large of a shift in their parents use of harsh discipline strategies.


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