(see Poster Gallery) Child Maltreatment Prevention in Indigenous Families: A Systematic Review

Background and Purpose: American Indian/Alaska Native (AIAN) children in the United States are victims of child abuse and neglect at a rate of 14.8 per 1,000 children and hold the highest rate of victimization across all racial and ethnic groups according to the U.S. Department of Health and Human Services (2019). Child maltreatment refers to the many forms of abuse and neglect that have short- and long-term consequences on a child’s physical, mental, and behavioral development. Some potential consequences include stunted brain development, low self-esteem, high-risk behaviors, or poor school performance. To date, no systematic review has been conducted on existing child maltreatment interventions that include Indigenous children and caregivers. To address this knowledge gap, a review was conducted to examine the effectiveness of interventions designed for Indigenous children and caregivers. The review answered the following research questions: 1) What are the types of interventions delivered to Indigenous families and the outcomes used to measure their effectiveness? 2) What are the methodological strengths and weaknesses across the studies? 3) What types of interventions are most effective for what outcomes, considering the methodological rigor of the studies?

Methods: A systematic search of nine databases was conducted to identify empirical articles in peer-reviewed journals. Studies were included for review if they met the following criteria: 1) the sample included Indigenous children (ages 0-18 years old), and 2) parents or caregivers located in rural, urban, or reservation settings in the United States, Canada, New Zealand, or Australia. The methodological quality of the studies was measured by an adapted version of the Methodological Quality Rating Scale (MQRS) described by Auslander et al., (2012) consisting of ten items with a total possible score range of 0-13. A median split was used to determine high versus low study rigor. The effectiveness of outcomes (significant or non-significant) was compared across intervention types, taking into account the study’s rigor.

Results: Six studies met the inclusion criteria for the systematic review. The results of the MQRS ratings showed that the median score was 9 (M= 9.33). The scores ranged from seven to 11. Four of the studies fell at the median split and two were above the median. Two interventions were conducted in the home, three were group-based, and one was both in-home and group-based. The common outcomes were child psychosocial and behavioral functioning (n=6), parental competence (n=5), and parental mental health (n=4). All six interventions that assessed child psychosocial and behavioral functioning showed significant outcomes, with two showing strong evidence of effectiveness (33%) and four showing promising evidence (67%). Among the five studies that evaluated parental competence, two showed strong evidence (40%), two showed promising evidence of effectiveness (40%), and one showed weak evidence (20%). The four studies assessing parental mental health showed weak evidence of effectiveness.

Conclusions and Implications: Findings suggest that few interventions addressing the prevention of Indigenous child maltreatment exist. Because Indigenous children face high rates of child maltreatment, future studies with strong rigor and a deeper focus on child and parental outcomes are needed.