Evidence-based approaches to preventing child maltreatment

1
Evidence-based approaches to preventing child
maltreatment

• Cathy Ward
• Department of Psychology and Safety and Violence
  Initiative
• University of Cape Town

2
Recent reviews

• MacMillan, Wathen, Barlow, Fergusson, Leventhal,
  Taussig (2008). Interventions to prevent child
  maltreatment and associated impairment. The
  Lancet. DOI10.1016/S0140-6736(08)61708-0
• Mikton Butchart (2009). Child maltreatment
  prevention a systematic review of reviews.
  Bulletin of the World Health Organisation, 87,
  353-361.

3
Five major subtypes of child maltreatment

• Physical abuse
• Sexual abuse
• Psychological abuse
• Neglect
• Exposure to intimate partner violence

4
Primary prevention

• Preventing the abuse from occurring in the first
  place

5
Physical abuse and neglect

• Home visitation
• Not uniformly effective
• Effective programs include
• Nurse-Family Partnership (reduced physical abuse,
  neglect, associated injuries in children of
  first-time, low-income mothers)
  http//www.nursefamilypartnership.org/
• Early Start programme (reduced injuries and
  hospitalizations but no difference in child
  protection reports needs replication)
  http//www.earlystart.co.nz/index.html
• Paraprofessional programs no effect on child
  protection reports, conflicting evidence about
  maternal self-reported child abuse

6
Physical abuse and neglect

• Parent-training programmes
• No trials used child maltreatment as an outcome
• Triple P lower substantiated child maltreatment,
  lower out-of-home placement (population level)
  http//www.triplep.net/
• Abusive head trauma programmes
• Positive effects from one study suggest that
  hospital-based education programmes can reduce
  this http//www.wchob.org/shakenbaby/
• Enhanced paediatric care for families at risk
• Possible that enhancing doctors abilities to
  identify and help families may be effective
  http//www.umm.edu/pediatrics/seek_project.htm

7
Sexual abuse

• Educating children
• Not known if they are effective in preventing
  reoccurrence of child sexual abuse they may
  improve childrens knowledge and protective
  behaviours but could also have some adverse
  effects (such as increased anxiety)

8
Psychological abuse

• Therapeutic counselling
• Attachment-based interventions may improve
  insensitive parenting and infant attachment
  security
• No evidence that they prevent psychological abuse

9
Exposure to intimate partner violence

• Emerging evidence
• IMAGE a microfinance and HIV prevention
  intervention
• Stepping Stones

10
Secondary tertiary prevention

• Preventing re-occurrence and preventing adverse
  outcomes of maltreatment

11
Physical abuse and neglect

• Parent-training programmes
• Limited evidence to support effectiveness
• Parent-Child Interaction Therapy reduced
  recurrence of child protection services reports
  of physical abuse but not neglect
  http//pcit.phhp.ufl.edu/
• Some programmes (PCIT, IY) might be effective in
  improving some outcomes asscoiated with
  http//www.incredibleyears.com/ physically
  abusive parenting

12
Physical abuse and neglect

• Home visitation programmes
• Insufficient evidence for multifaced in-home
  programmes
• Intensive nurse home visitation no evidence (one
  study)
• Neglect-specific programmes
• Insufficient evidence
• Small studies for improving child outcomes
  resilient-peer training, imaginative play
  training, therapeutic day training, MST

13
Sexual abuse

• Therapeutic counselling for children and
  families
• CBT can improve specific mental health outcomes
  for sexually abused children (PTSD, anxiety,
  depression)
• Conflicting evidence for CBT in reducing child
  behavioural problems

14
Emotional abuse

• Therapeutic counselling for parents/families
• Limited evidence for interventions for caregivers
• Group-based CBT might be effective with some
  parents

15
Exposure to intimate partner violence

• Evidence for reducing childrens exposure by
  reducing recurrence of violence against women is
  limited
• Restraining orders might prevent recurrent abuse
• Batterer treatment programmes have mixed,
  generally negative, results
• Psychological treatments some evidence for
  mother-child therapy in reducing childrens
  internalising and externalising problems

16
Global interventions

• Foster care
• Placement in foster care and not reunifying with
  biological parents can have benefits for
  maltreated children
• Enhanced /multidimensional foster care can lead
  to better mental health outcomes for children
  than traditional foster care
• Family preservation programmes
• No evidence that these are effective in reducing
  maltreatment impairment or recurrence

17
Initiatives from which evidence may emerge

• Multi-component interventions (family support,
  preschool education, parenting skills training,
  child care)
• Media campaigns to raise public awareness
• Community-based initiatives
• System of care
• Strong Communities for Children
  http//www.clemson.edu/public/ifnl/projects_grants
  /strong_communities/

18
Initiatives from which evidence may emerge

• Mutual aid and support groups
• Treating men