News Release

Interventions against child maltreatment and the impairment it causes -- what works?

Peer-Reviewed Publication

The Lancet_DELETED

Although a broad range of programmes for prevention of child maltreatment exist, there is still uncertainty about which programmes are effective. Unlike decades ago, there are now multiple disciplines involved in developing interventions to reduce child maltreatment including public health, social work, psychology, nursing, paediatrics, and psychiatry. A commitment across disciplines to apply evidence-based principles and link science with policy is essential. These are among the conclusions of Professor Jane Barlow, Warwick Medical School, University of Warwick, UK, and colleagues, authors of the third paper in The Lancet Series on Child Maltreatment.

The researchers look at interventions aimed at preventing the occurrence of abuse, and those aimed at preventing its recurrence and associated impairment in order to improve the long-term outcomes for the child. The paper examines all five major subtypes of child maltreatment — physical abuse, sexual abuse, psychological abuse, neglect, and exposure to intimate-partner violence.

In terms of preventing abuse, the authors say that home-visiting is not uniformly effective, but two programmes — Nurse Family Partnership (NFP), USA, and Early Start, New Zealand, have been shown to be effective. NFP involves home visitation by nurses to low-income first-time mothers beginning prenatally and continuing during infancy. One NFP trial in Elmira, NY, USA, showed a 32% reduction in emergency department visits overall during the second year after birth. Early Start is an intensive home-visiting programme targeted to New Zealand families facing stress and difficulties, and resulted in lowered hospital admission rates for abuse and neglect. The Triple P Parenting Programme (USA), which involved training the existing workforce and issuing messages via universal media, has shown promise but needs further evaluation. Hospital-based educational programmes about the dangers of infant shaking and how to handle persistent crying, are also promising interventions, as is enhanced paediatric care, where doctors are given special training to identify family problems and a social worker is available for families of children at risk of physical abuse and neglect. Less clear are the effects of school educational materials for children to protect them from sexual abuse, psychological abuse, or children's exposure to intimate partner violence. Sexual abuse programmes — involving combinations of film, video, and roleplay — can improve children's knowledge and self-protective behaviours, but it is not currently clear whether these actually protect children from sexual abuse.

Parent-Child Interaction Therapy (PCIT) has shown benefits in preventing recurrence of physical abuse of children. This programme aims to improve parent-child interaction through the use of direct coaching and practicing of skills in interactive parent-child sessions (USA). However, no interventions have been shown effective in preventing recurrence of neglect, emphasising the way in which neglect is often overlooked, as has been highlighted elsewhere in the Series. Preventing future child impairment requires a thorough assessment of the child and his or her family. Cognitive-behavioural therapy shows benefits for sexually abused children with post-traumatic stress symptoms. There is some evidence for child-focused therapy for neglected children and for mother–child psychotherapy in families with intimate-partner violence.

The research also suggests that placing children in foster care and not reunifying them with their biological parents can lead to benefits for maltreated children. Furthermore, enhanced foster care including better trained caseworkers and greater access to services and support for youth and foster families, can lead to better mental health outcomes for children than traditional foster care.

The authors conclude: "Despite the lack of evidence for effective interventions in the area of child maltreatment compared with other paediatric public-health problems, there have been some important gains over the past 30 years in approaches to prevention of maltreatment and its associated impairment."

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Professor Jane Barlow, Warwick Medical School, University of Warwick, UK T) +44 (0) 2476 574884 E) Jane.Barlow@warwick.ac.uk

Kelly Parkes-Harrison, Communications Officer, University of Warwick, +44 (0) 24 7615 0483, +44 (0) 7824 540863, K.E.Parkes@warwick.ac.uk

Full paper: http://press.thelancet.com/childmaltreatment3.pdf


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