Child Abuse Prevention Task Force Report: What’s Working?
The U.S. Preventive Services Task Force just released an updated systemic review. This extensive review is an update of a 2004 report which found insufficient evidence to recommend routine screening of parents or caregivers for abuse or neglect of children. In 2010 about 700, 000 United States children were victims of abuse or neglect and about 1,500 died. Thus the problem is large and worth much effort. As discussed in a preceding post, the importance of intervening early to prevent child abuse/neglect is further bolstered by the increasing evidence that childhood trauma has lifelong consequences.
The primary question guiding this 2013 updated review for the U.S. Preventive Services Task Force, funded by the Agency for Healthcare Research and Quality, was, “For children without obvious signs and symptoms of abuse or neglect but potentially at increased risk, how well do interventions and counseling initiated in primary care settings reduce exposure to abuse or neglect, physical or mental harms, or mortality?” The reviewers found 11 randomized studies where the risk assessment identified the family through the primary care setting. One of the 11 studies conducted the intervention through the pediatric clinic, and showed efficacy in reducing child abuse and neglect. Although a promising result, little can be generalized from one study. The other 10 studies used the more common home visiting approach. Unfortunately, the reviewers found, “Trials were limited by heterogeneity, low adherence, high loss to follow-up, and lack of standardized measures.” Despite this, the reviewers did conclude that, “Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. Additional research on interventions to prevent child abuse and neglect is needed.” The review acknowledges that home visiting programs are widespread, yet vary widely in their services, intensity, length of intervention, staffing, and staff skill levels. Thus conclusions from one home visiting research study cannot be generalized to all others. However, the most effective interventions provided services for longer periods of two years or more.
U.S. Preventive Services Task Force Recommendations
“Efforts to improve identification of children at risk for abuse and neglect need to be coupled with development and evaluation of effective interventions to which they can be referred once identified. Additional research on the effectiveness of interventions is needed to support the results of current trials and expand their applicability. Standardization of interventions and outcomes would allow for quantitative meta-analysis. This research should also determine whether the interventions have unintended adverse effects.”
Implications for Prevention Programs
Though the results of research studies results were inconsistent, there are clearly promising signs. The magnitude and severity of child abuse and neglect in the U.S.demand continued efforts. The U.S. Preventive Services Task Force Report is a call for more effort into documenting outcomes, and the use of standardized measures. “Trials often lacked predefined identification of primary and secondary outcomes. Outcome measures also differed, limiting comparisons between trials, and often included self-reported outcomes that are subject to bias.” We have previously discussed the bias in self-report and clinical impression tools, and the value of more direct assessments. The existing studies focused on long-term outcomes such as child protective service reports, emergency room visits and deaths, which are important end points. However, quality interventions include improving parenting quality as a major focus in preventing the downward spiral of relationships that results in abuse and neglect. This important interim factor needs to be included in the studies. Variability in parenting quality outcomes might help explain some of the inconsistency found in studies.
The Role of Parenting Assessment in Documenting and Improving Results
Beyond the research results, it is these interim measures within program evaluations which can individualize preventive services, thereby generating better and less variable outcomes. Observational parenting assessments have yet to be included consistently in such evaluations. In a previous blog we compared intervening in parent-child relationships without an observational assessment to trying to build a watch in the dark. If prevention programs include assessments of parenting quality as part of their intervention, the results are likely to become stronger and more consistent. More than 300 family service programs in health, education, and social service settings are using the Keys to Interactive Parenting Scale (KIPS) observational parenting assessment to nurture insights and/or report parenting outcomes. One home visiting model, the Nurse Family Partnership, is in the process of disseminating the DANCE parenting assessment across their entire network. Using a reliable and valid observational parenting assessment tool can both guide intervention services and document parenting outcomes. Models employing parenting assessment routinely and thoughtfully in their services should more consistently show efficacy in preventing child abuse.