Interventions to Prevent Child Maltreatment and Associated Impairment

Departments of Psychiatry and Behavioural Neurosciences and of Pediatrics, and Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada.
The Lancet (Impact Factor: 45.22). 01/2009; 373(9659):250-66. DOI: 10.1016/S0140-6736(08)61708-0
Source: PubMed


Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes-the Nurse-Family Partnership (best evidence) and Early Start-have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother-child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures.

    • "Our findings on partial or full mediation by multiple types of psychopathology (ASPD, alcohol dependence and psychotic disorder) highlight the importance of preventing children from developing mental health difficulties following childhood maltreatment. Potentially effective interventions include parent training for families in which there has been physical abuse and neglect, cognitive behavior therapy for children who have been sexually abused, and placement of children in foster care (Macmillan et al., 2009;Ramchandani & Jones, 2003). "
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    ABSTRACT: Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21–34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.
    No preview · Article · Feb 2016 · Child abuse & neglect
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    • "Nonetheless, these reviews did not follow a formal systematic review process that utilizes an explicit and auditable protocol, including the mechanisms that were used to search, select, and retrieve reports (Sandelowski, 2008). Most recently,MacMillan et al. (2009)included articles up to only 2008; therefore, an updated systematic review on the relevant literature is needed. Notably, there is one relatively recent systematic review on the effectiveness of universal and selective child maltreatment prevention programs, but it was a review of review studies that were published up to July 2008, and it also did not focus exclusively on parental education programs (Mikton & Butchhart, 2009). "
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    ABSTRACT: The present study aimed to review recent literature on universal violence and child maltreatment prevention programs for parents. The following databases were used: Web of Science, PsycINFO, PsycARTICLES, PubMed, LILACS, and SciELO. The keywords included the following: (Parenting Program or Parent Training or Parent Intervention) and (Maltreatment or Violence or Violence Prevention). For inclusion in this review, the programs had to be structured, working in groups of parents aiming to improve parenting practices. Twenty-three studies were included, and 16 different types of parenting programs were identified. Ninety-one percent of the studies were conducted in developed countries. All the programs focused on the prevention of violence and maltreatment by promoting positive parenting practices. Only seven studies were randomized controlled trials. All studies that evaluated parenting strategies (n=18), reported after the interventions. The programs also effectively improved child behavior in 90% of the studies that assessed this outcome. In conclusion, parenting educational programs appear to be an important strategy for the universal prevention of violence and maltreatment against children. Future studies should assess the applicability and effectiveness of parenting programs for the prevention of violence against children in developing countries. Further randomized control trials are also required.
    Full-text · Article · Jan 2016
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    • "Using administrative data to evaluate child abuse prevention programs Efforts to implement and rigorously evaluate child maltreatment prevention programs have expanded considerably over the past three decades. While a number of these programs have shown promise in terms of promoting positive parenting and reducing risk factors for maltreatment , relatively few programs have examined the impact of services on rates of child maltreatment directly (Howard & Brooks-Gunn, 2009; MacMillan et al., 2009). One commonly cited reason for the absence of studies directly examining child maltreatment outcomes is the difficulty of obtaining reliable information about child abuse and neglect occurrence (Fallon, Trocmé, MacLaurin, Sinha, & Black, 2011). "

    Full-text · Dataset · Sep 2015
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