A Short-Term Evaluation of No-Hit-Zone Policy Training for Medical Professionals and Staff: An Innovative Strategy to Change Social Norms about Physical Punishment

Background: The majority of U.S. adults (i.e., 76% of men and 65% of women) believe that physical punishment, including spanking, popping or whooping is necessary for child discipline. However, extensive research has also shown that physical punishment has long-lasting negative impacts on children’s well-being, and can escalate to physical abuse. Therefore, it is necessary to change the norms and acceptance of physical punishment. No-Hit-Zones (NHZs) represent an innovative and promising public health approach that aims to change social norms around the acceptability and use of physical punishment of children and to promote positive parenting strategies. The core components of NHZs include:1) an organizational-level ban on physical punishment; 2) educational materials explaining the poor health outcomes of physical punishment and providing alternative, age-appropriate discipline techniques; and 3) bystander intervention training for staff with tools for how to intervene when witnessing parent-to-child hitting. There is a scarcity of literature on the effectiveness of NHZs, and this study is the first to assess the effectiveness of the staff training component.

Methods: All medical staff at Children’s Hospital of New Orleans were invited to complete surveys immediately before and after a mandatory NHZ training (N=607). Measures included: 1) Staff attitudes toward physical punishment; 2) support for staff intervention when witnessing parent-to-child hitting; and 3) knowledge about NHZ policy and how to intervene. Paired t-test and Ordinary Least Squares (OLS) regression were conducted to assess score differences (post-test to pre-test), and associations with participants’ demographics.

Results: Most participants identified as female (86%), White (69%), and religious (77%), and they provided direct care at the hospital (87%). From pre to post test, there was a significant decrease in support for physical punishment (MD=-3.74, p < .01), and increases in support for and knowledge about intervening when witnessing parent to child hitting (MD=3.79, p < .01; MD=4.71, p < .01, respectively). In particular, Black participants showed the greatest decrease in support for physical punishment (b = -1.64, SE = .50, p < .01) after NHZ intervention.

Implications: Our study findings suggest that after the NHZ training, staff were less likely to support spanking as a parenting strategy and more like to support intervention when witnessing parent-to-child hitting. Our results demonstrate the promise of NHZs in reducing support for physical punishment and changing social norms through an innovative multi-level approach. NHZs are rapidly expanding in medical centers, schools, and mental health agencies across the U.S., with 366 agencies registered to be NHZs in 46 states. Therefore, more research is needed to evaluate the overall impact of NHZs. Our study sheds light on the effectiveness of the staff training component of NHZ, and policymakers and practitioners should continue promoting the implementation of NHZs with the goal of shifting social norms around hitting children.