Effectiveness of Child Maltreatment Prevention Programs with High Risk Families

Background and Purpose: Child maltreatment remains a significant public health concern affecting millions of children each year with negative consequences persisting into adulthood. Despite scientific progress in identifying the key etiological factors associated with child abuse and neglect, relatively little is known about what helps prevent maltreatment in the first place. The study focuses on the effects of secondary prevention programs for families at risk for child physical abuse and neglect. Aims of this systematic review include to: (1) evaluate methodological rigor of physical abuse and neglect prevention programs targeting high-risk families; (2) examine the empirical support of the prevention programs to achieve the following outcomes: reduce child maltreatment, improve parenting attitudes and behaviors, reduce parental stress and depression, and improve child development and safety, while accounting for methodological rigor of the study; and (3) evaluate and compare intervention effectiveness to achieve the above outcomes by programmatic modalities.

Method: Electronic databases and manual searches were used to identify relevant studies. Studies published in peer review journals between 1998-2010 were selected if they met the following inclusion criteria: (1) focused on families that had custody of their children and were not involved in child welfare system at the time of recruitment; (2) targeted families that had risk factors associated with child maltreatment; and (3) studies that used experimental or quasi-experimental study designs to evaluate program effectiveness. Each study was evaluated for methodological rigor as described in the conference abstract. Program effectiveness was determined by examining significant improvements in the reported outcomes across different programmatic modalities (type of worker, population targeted, intensity, and duration), while accounting for the quality of studies.

Results: Eighteen studies met the selection criteria. All but two studies were home visiting programs and most employed randomized design. When overlooking study quality slightly over half of the studies had significant findings on reducing child maltreatment, improving parenting attitudes and behaviors and child cognitive skills while less favorable outcomes occurred in improving child safety. When study quality was taken into account, positive outcomes became stronger for child maltreatment, parenting behaviors, and child safety. Parental mental health did not seem to benefit from the programs. Programs served by professional staff had better outcomes on all but two measures. Teen and first time mothers benefited most from improving child safety, parenting attitudes and behaviors while child cognitive and behavioral outcomes were most improved for poverty and multiple stressor groups. Program frequency was associated with positive outcomes while program length did not matter.

Discussion and Implications: The results of this review indicate that child maltreatment prevention programs targeting high risk families can be effective in achieving positive parenting and child safety outcomes while outcomes aiming at improving child cognitive and socio-emotional development require further testing. On the other hand, little evidence exists to suggest that parental mental health is bettered. Program characteristics should be considered when designing interventions for specific populations. Finally, the results suggest that the study's findings can be enhanced by accounting for its methodological rigor.