Maltreatment Prevention Intervention Research Articles

Family Partner: study protocol for a pilot randomised study of a home-visitation intervention in Norway.

Every year, about 5% of children in Norway experience severe child maltreatment and need support from the child welfare services. However, research-supported interventions for this group are lacking. The current study piloted an intensive home-visitation intervention, Family Partner, which aims to reduce child maltreatment among at-risk parents by improving parental skills, agency and trust in the welfare services, and children's well-being. The randomised controlled trial piloted in this study examines the acceptability of the Family Partner intervention for staff and families and evaluates its feasibility for a full-scale randomised controlled trial. This protocol outlines a prospective, parallel, pilot randomised trial of the Family Partner intervention in three Norwegian municipal child welfare services. The participants are families with children under 12 years of age, where the parents are identified as having challenges. Families in the treatment group receive the Family Partner intervention, while families in the control group receive ordinary child welfare services. Data are collected at baseline, and at 3, 6, 12 and 18 months after recruitment. The pilot study monitor retention and adherence to inform the feasibility of a future full-scale randomised study. To assess the acceptability of the trial and intervention, a subsample of the participating families, as well as the family partners and representatives of the child welfare services in each municipality, are invited to complete qualitative interviews. The results will guide the design of a fully powered randomised controlled trial of the Family Partner intervention compared with ordinary child welfare services. ClinicalTrials.gov identifier: NCT04957394; Pilot Trial of Family Partner: a Child Maltreatment Prevention Intervention (FAMPART); registered on 12 July 2021.

Child maltreatment prevention interventions for Latinx immigrant populations: a systematic review

ABSTRACT A growing population of immigrant children and families to the U.S. from Latin American countries requires consideration of their unique historical, sociocultural, and linguistic contexts in child abuse and neglect prevention. In light of the Family First Prevention Services Act’s focus on evidence-based child maltreatment prevention interventions, this systematic review analyzed interventions with relevance for use with immigrant populations coming from Latin American countries. Sixty-two interventions met inclusion criteria. This review revealed few gold standard interventions that address the unique needs of Latinx immigrant populations, highlighting a need for the development and study of interventions for these populations that are federally reimbursable.

A mixed-methods study to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings.

This mixed-methods study sought to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings. The study first asked case planners about their perceptions of practitioner and organizational factors related to fidelity through an online survey. This survey was connected to case-level fidelity scores to understand the relationship between perceptions and fidelity. The qualitative phase of this study involved further exploration with nine case planner interviews and two separate focus groups with supervisors and agency leadership. The results of this study suggest that supervision is a key contributor to a practitioner's ability to implement a maltreatment prevention intervention. Both methods of the study suggest that various aspects of supervision, including supervisors' perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of enhancing a practitioner's ability to learn and use the intervention. Additional components that influence the implementation for future research emerged from the qualitative phase related to system expectations and policies, individual practitioner attributes, and characteristics of the intervention.

A mixed-methods study to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings

A mixed-methods study to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings

The Nature, Logic, and Significance of Strong Communities for Children.

High levels of stress and low levels of support for parents have significant implications for child safety, particularly for families living in neighborhoods which are dangerous and disadvantaged. Building on this knowledge about the causes and correlates of child maltreatment, the U.S. Advisory Board on Child Abuse and Neglect (1993) recommended a neighborhood-based child protection strategy. This article describes Strong Communities for Children, a community-based child maltreatment prevention intervention designed to carry out the Board’s recommendations. During an initial period of development and evaluation (lasting more than 7 years) of the first such initiative (located in communities near Greenville, SC), Strong Communities added substantially to the knowledge base on the role of community factors in children’s safety. It also advanced understanding of ways to operationalize some of the ideas underlying the Board’s proposed strategy. This article (a) describes the conceptual foundation, the logic model, and the engagement strategies that comprise Strong Communities; (b) provides an overview of the results from the first comprehensive initiative; (c) discusses their significance; and (d) concludes with discussion of the possibilities for Strong Communities in the current context.

Child maltreatment prevention: a content analysis of European national policies.

BackgroundChild maltreatment is a major public health concern, which worsens inequalities and perpetuates social injustice through its far—reaching impacts on the health and development of children affected. The aim of this article was to provide a content analysis of the national policies presently used to address child maltreatment and provide an overview of prevention practices being employed in countries of the World Health Organization (WHO) European Region. This analysis will aid in identifying, which policy areas still require further work to prevent child maltreatment.MethodsThree search methods were employed to identify national policies on child maltreatment. A framework based on WHO guidelines for the development of policies was used to conduct a policy analysis of the identified national policies.ResultsTwo hundred and seventy-eight national policies were identified; of these, 68 met the inclusion criteria for further analysis representing 75% of the WHO Europe Region Member States. Whereas the majority of policies fulfilled most of the WHO criteria for effective policy-making, only 34% had a budget and 6% had quantified objectives. Plans to implement proven child maltreatment prevention interventions were high, with the exception of some countries where the health sector is in the lead.ConclusionsThe key policy areas requiring improvement were quantifiable objectives and allocated defined budgets. Hospital-based and home-based child maltreatment interventions were also not widely planned for implementation. Encouraging progress is being made on national policy development to prevent child maltreatment. There are as of yet, several key areas, which warrant increased attention in future policy-making.

The Costs of Child Maltreatment

Source: Florence C, Brown DS, Fang X, et al. Heath care costs associated with child maltreatment: impact on Medicaid. Pediatrics. 2013; 132(2): 312– 318; doi: 10.1542/peds.2012-2212Researchers from multiple institutions aimed to estimate the increased Medicaid expenditures associated with child maltreatment. The investigators used 2 databases: the National Survey of Child and Adolescent Well-Being (NSCAW) and Medicaid Analytic Extract (MAX). NSCAW contains data on children who were involved with Children’s Protective Services (CPS) agencies (denoting that the child was either maltreated or at risk for maltreatment) spanning portions of 1999 and 2000. MAX data were used to construct a matched control group of children on Medicaid with no CPS involvement. Health care expenditures and types of health service utilization for children with CPS involvement (cases) and those without (controls) were compared. Analyses were adjusted to account for skewing of means (ie, a few subjects with very large expenditures) often seen in health care expenditure data.A total of 972 cases were identified, comprising 2,465 children-years; an equal number of control children were included in the analyses. The case and control groups were similar across 6 demographic variables. Case children had considerably higher total Medicaid expenditures than those in the control group; adjusted costs were >$2,600 more per child-year compared to controls. Relative to the control group, cases were nearly twice as likely to have used psychiatric services and nearly 3 times as likely to have used targeted case management. Significant differences in utilization also existed in inpatient and outpatient care and prescription drug use.The authors conclude that Medicaid-enrolled children with investigated or substantiated cases of child maltreatment have substantially higher health care costs and utilization than non-maltreated children. The authors estimate that the cost of child maltreatment-related expenditures is 9% of all Medicaid expenditures for children.Dr Anderst has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.As the government faces tightening budget constraints and seeks to control health care costs, this study adds compelling data in support of child maltreatment prevention interventions. As some studies have shown a reduction in child maltreatment when using specific prevention interventions,1,2 the potential positive impact of these interventions on both the lives of the children and families involved and on the fiscal stability of health care must be considered. The estimated financial savings detailed in this study are clearly important; however, child maltreatment prevention programs are also known to reduce costs associated with juvenile detention, productivity, special education, and case management, among other social costs. These unaccounted savings further augment societal cost savings associated with effective child maltreatment prevention. Beyond cost savings, one may also argue that there is an ethical imperative to prevent child maltreatment. Hopefully, studies such as this will embolden efforts to prevent child maltreatment and increase the funding of child maltreatment prevention, not only for the betterment of children and families, but also for the betterment of society.Children with chronic health conditions are at greater risk of child abuse (odds ratio of 1.67 in one study3). Thus, some of the increase in Medicaid costs in these children may be due to their underlying chronic conditions, not considered in the current study. Although further prospective evaluation is needed to determine the costs specifically attributable to child maltreatment, we cannot afford to wait for these studies to initiate preventive strategies against the scourge of child abuse.

Small Changes Can Have Large Impacts: Health Care Overhaul Should Include Child Maltreatment Prevention in Primary Care

When we think of patient safety, we usually do not immediately think of child maltreatment prevention. Yet the incidence and prevalence of child maltreatment is a significant public health issue in the United States. As we begin to overhaul our health care system, it is a good time to think about child maltreatment prevention. Including child maltreatment prevention as a core component of pediatric care may be less complicated than understanding what child maltreatment is and how it affects children. Anonymous telephone surveys suggest that as many as 10% to 15% of children experience physical and emotional abuse. The abuse is most often long term, acting more like a chronic malady than an acute trauma. Children younger than 3 years of age experience the greatest risks for morbidity and mortality resulting from child abuse and neglect. Although we know that physical abuse is underrecognized and underreported, emotional abuse is even more difficult to identify. Research, such as the Adverse Childhood Experiences study, has shown that there is a direct association between the abuse and neglect suffered during childhood and use of drugs and alcohol, involvement in violence, depression and anxiety, and physical health in adulthood. This study of Kaiser adult enrollees shows dramatic increases in adult mental health and physical illness that are directly related to the number of adverse childhood experiences these enrollees suffered. These data are not new and yet there has been little momentum in health care to focus on prevention of childhood maltreatment. The actual prevention techniques are progressing through clinical trials and are still too early to be definitive, but a number of early studies show promise. Pediatricians see the majority of children younger than 3 years of age numerous times each year. Physicians have recognized that issues related to the child’s psychosocial health are a primary parental concern. This makes sense given that children’s physical health has improved beyond acute issues such as infectious diseases. The “new morbidities” of mental health and developmental issues have become of paramount importance to the pediatric visit. Although parents want pediatricians to help them with these topics, pediatricians often do not feel well equipped to answer questions related to psychosocial health, nor do they know what to do when they recognize family dysfunction. Several psychosocial topics related to maternal health, infancy, and toddlerhood are currently under study by researchers: maternal depression, infant crying, discipline, and toilet training (eg, Practicing Safety). Pediatric identification of and response to these issues can enhance parenting skills and behaviors and ultimately help raise a happy, healthier child and, thus, a healthier adult. Additionally, through its Bright Futures initiative, the American Academy of Pediatrics has assessment instruments and tools for pediatricians to use to identify other psychosocial issues related to the infant, child, and family. Lastly, it is essential that primary care provider sites provide medical homes for infants at risk for maltreatment or developmental delays. Interventions such as Practicing Safety, and perhaps Bright Futures, offer building blocks to primary care pediatrics to use in the development of medical homes for their infant and child patient populations. Incorporating such features into primary care requires a culture of change—a change in long-standing practice patterns. Quality improvement strategies, such as office-based coaching, learning collaboratives, and use of data to track changes, are critical to acceptance and sustainability. Rigorous studies to test child maltreatment prevention interventions are under way. The integration of risk identification, linkages and referral to community resources, and monitoring and follow-up to enhance parenting skills and behavior must undergo rigorous research to determine the treatment effect produced by such focused, proactive office-based approaches. Universal developmental screening has been suggested by the Commonwealth Fund and the American Academy of

Child maltreatment prevention: a systematic review of reviews

To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven - home-visiting, parent education, abusive head trauma prevention and multi-component interventions - show promise in preventing actual child maltreatment. Three of them - home visiting, parent education and child sexual abuse prevention - appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries.

Public health approaches to family maltreatment prevention: Resetting family psychology's sights from the home to the community.

The authors review recent trends within the family maltreatment research field toward a public health approach, discuss the rationale for community-level interventions for family maltreatment, and sketch the history and development of community-level prevention approaches. Next, to illustrate the both the logistic and the scientific challenges of such work, the authors discuss the development and testing of an empirically guided, research-community partnership for the prevention of family maltreatment, the United States Air Force's NORTH STAR initiative (New Orientation to Reduce Threats to Health From Secretive Problems That Affect Readiness). Finally, recommendations are made for effective and disseminable family maltreatment prevention interventions.