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.


Available from: Jane Barlow
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    • "Here, child and youth care services need to find adequate answers to meet the needs of families in multi-problem situations. International literature suggests potential effectiveness of home-based, flexible, integrated and multicomponent services (MacLeod & Nelson, 2000; MacMillan et al., 2009; Mikton & Butchart, 2009; Thoburn et al., 2013). Even though a respectable number of studies point to the effectiveness of this form of care, a lack of effectiveness studies is, however, still concluded (Dunst, Boyd, Trivette, & Hamby, 2002; MacLeod & Nelson, 2000; Sweet & Appelbaum, 2004). "
    Full-text · Dataset · Feb 2016
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    • "In the event that any parent–infant dyad appears to have extreme difficulty, then this parent could be immediately encouraged to seek out more extensive therapeutic help (Weitzman and Wegner, 2015). As much developmental and clinical research has shown, the earlier such aid is provided, the better (Gilbert et al., 2009; MacMillan et al., 2009). However, finding such dyads, and motivating them to seek additional assistance, is only a secondary purpose for PC-VIT. "
    [Show abstract] [Hide abstract] ABSTRACT: This case series study evaluated the feasibility and acceptability of a behavioral/cognitive psychological intervention in a pediatric primary health care setting during standard well-baby visits. The aim of the intervention was to support caregivers’ sensitivity and mentalization in order to promote infant mental health. Four neonates from birth to eight months were consecutively enrolled to test a short video-feedback intervention (Primary Care - Video Intervention Therapy, an adaptation of George Downing's Video Intervention Therapy to primary care) conducted by a pediatrician. The five minute interaction recording and the video-feedback session were performed during the same well-baby visit and in the same pediatrician's office where the physical examination was conducted. During the study period, six video-feedback sessions were performed for each baby at different ages (1, 2, 3, 4, 6, 8 months). Filmed and discussed were a series of different interactional situations: touch, cry, affective matching, descriptive language, feeding, separation and autonomy. The intervention was easily accepted and much appreciated by all four families enrolled. This study aimed to answer a dilemma which pediatric providers generally face: if the provider wishes to respond to not only physical but also infant mental health issues, how on a practical level can this be done? This case series study indicates that Primary Care - Video Intervention Therapy deserves to be seen as a promising new tool for such a purpose.
    Full-text · Article · Feb 2016 · Frontiers in Physiology
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    • "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). "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Feb 2016 · Child abuse & neglect
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