Evidence-based approaches to preventing child maltreatment

1. Evidence-based approaches to preventing child maltreatment Cathy Ward Department of Psychology and Safety and Violence Initiative University of Cape Town

2. Recent reviews • MacMillan, Wathen, Barlow, Fergusson, Leventhal, & Taussig (2008). Interventions to prevent child maltreatment and associated impairment. The Lancet. DOI:10.1016/S0140-6736(08)61708-0 • Mikton & Butchart (2009). Child maltreatment prevention: a systematic review of reviews. Bulletin of the World Health Organisation, 87, 353-361.

3. Five major subtypes of child maltreatment: • Physical abuse • Sexual abuse • Psychological abuse • Neglect • Exposure to intimate partner violence

4. Primary prevention Preventing the abuse from occurring in the first place

5. Physical abuse and neglect • Home visitation • Not uniformly effective • Effective programs include • Nurse-Family Partnership (reduced physical abuse, neglect, associated injuries in children of first-time, low-income mothers) http://www.nursefamilypartnership.org/ • Early Start programme (reduced injuries and hospitalizations but no difference in child protection reports; needs replication) http://www.earlystart.co.nz/index.html • Paraprofessional programs: no effect on child protection reports, conflicting evidence about maternal self-reported child abuse

6. Physical abuse and neglect • Parent-training programmes • No trials used child maltreatment as an outcome • Triple P: lower substantiated child maltreatment, lower out-of-home placement (population level) http://www.triplep.net/ • Abusive head trauma programmes: • Positive effects from one study suggest that hospital-based education programmes can reduce this http://www.wchob.org/shakenbaby/ • Enhanced paediatric care for families at risk: • Possible that enhancing doctors’ abilities to identify and help families may be effective http://www.umm.edu/pediatrics/seek_project.htm

7. Sexual abuse • Educating children: • Not known if they are effective in preventing reoccurrence of child sexual abuse; they may improve children’s knowledge and protective behaviours but could also have some adverse effects (such as increased anxiety)

8. Psychological abuse • Therapeutic counselling: • Attachment-based interventions may improve insensitive parenting and infant attachment security • No evidence that they prevent psychological abuse

9. Exposure to intimate partner violence • Emerging evidence: • IMAGE – a microfinance and HIV prevention intervention • Stepping Stones

10. Secondary & tertiary prevention Preventing re-occurrence and preventing adverse outcomes of maltreatment

11. Physical abuse and neglect • Parent-training programmes: • Limited evidence to support effectiveness • Parent-Child Interaction Therapy reduced recurrence of child protection services reports of physical abuse but not neglect http://pcit.phhp.ufl.edu/ • Some programmes (PCIT, IY) might be effective in improving some outcomes asscoiated with http://www.incredibleyears.com/ physically abusive parenting

12. Physical abuse and neglect • Home visitation programmes • Insufficient evidence for multifaced in-home programmes • Intensive nurse home visitation no evidence (one study) • Neglect-specific programmes • Insufficient evidence • Small studies for improving child outcomes: resilient-peer training, imaginative play training, therapeutic day training, MST

13. Sexual abuse • Therapeutic counselling for children and families: • CBT can improve specific mental health outcomes for sexually abused children (PTSD, anxiety, depression) • Conflicting evidence for CBT in reducing child behavioural problems

14. Emotional abuse • Therapeutic counselling for parents/families: • Limited evidence for interventions for caregivers • Group-based CBT might be effective with some parents

15. Exposure to intimate partner violence • Evidence for reducing children’s exposure by reducing recurrence of violence against women is limited • Restraining orders might prevent recurrent abuse • Batterer treatment programmes have mixed, generally negative, results • Psychological treatments: some evidence for mother-child therapy in reducing children’s internalising and externalising problems

16. Global interventions • Foster care: • Placement in foster care and not reunifying with biological parents can have benefits for maltreated children • Enhanced /multidimensional foster care can lead to better mental health outcomes for children than traditional foster care • Family preservation programmes: • No evidence that these are effective in reducing maltreatment impairment or recurrence

17. Initiatives from which evidence may emerge • Multi-component interventions (family support, preschool education, parenting skills training, child care) • Media campaigns to raise public awareness • Community-based initiatives: • System of care • Strong Communities for Children http://www.clemson.edu/public/ifnl/projects_grants/strong_communities/

18. Initiatives from which evidence may emerge • Mutual aid and support groups • Treating men