Practice Profile: Preventive Child Maltreatment Programs

Practice Goals/Target Population

Preventive child maltreatment programs are designed to prevent physical child abuse or neglect by educating expectant and new parents in parenting skills, coping with stressors, and stimulating child development (Pinquart and Teubert 2010). Programs may be delivered to members of the general population or may target at-risk parents or parents with a history of maltreatment. Factors that may categorize a parent as “at-risk” include being a teenager or young parent, being a single parent, having substance use or mental health problems, experiencing intimate partner violence, having a low income, and having low educational attainment (Van der Put et al. 2017; CDC 2019). Parents with a history of maltreatment are those who have a substantiated (e.g., through official reports) or suspected history of child abuse or neglect (Vlahovicova et al. 2017).

Services Provided

Preventive child maltreatment programs may range significantly in duration, from 1 day to 5 years. The intervention typically starts during the first 6 months after birth, although some programs are initiated during pregnancy. The first 6 months after birth represent a challenging period of transition to parenthood, often marked by physical exhaustion and psychological distress (Cowan and Cowan 2000). Mothers are at higher risk for postnatal depression during this time (Miller et al. 2006). Additionally, these first few months are crucial for the child’s attachment development (McElwain and Booth-LaForce 2006).

Preventive programs are delivered individually, in groups, or both, and are fully or partially delivered in the home, in healthcare settings, or within the community. In general, programs include a variety of the following components: 1) teaching infant care, including ways to soothe the baby; 2) promoting parental sensitivity and responsiveness, including reading the baby’s signals and responding adequately; 3) promoting cognitive stimulation of the child, including teaching the use of stimulating materials, 4) counseling or cognitive behavioral therapy; 5) family planning; 6) health promotion, including providing information about immunization schedules; and 7) promotion of couple adjustment/marital adjustment, including through marriage counseling (Pinquart and Teubert 2010)

The following are different types of preventive interventions designed to address child maltreatment:

Home visitation interventions, in which parents are visited at home and provided with information, support, and/or training in regard to child health, development, and care
Parent training interventions, which are focused on learning specific parenting skills
Family-based/multisystem interventions, which are delivered to the whole family through collaboration between several social systems
Substance abuse interventions, which primarily target the substance use of parents and how this use relates to child abuse and neglect
General prevention interventions, which are designed to prevent the occurrence of child maltreatment in the general population
Crisis interventions, which are designed to solve acute problems, such as ongoing child maltreatment
Combined interventions, which include components present in multiple types of interventions, such as a parent training intervention that also targets substance use
Specific interventions, such as Triple P or The Incredible Years

Practice Theory

Programs for preventing child maltreatment are based on several theories, including social learning theory (Bandura 1971), which is related to the coercion hypothesis (Patterson 1982), and attachment theory (Bowlby 1969). Social learning theory suggests that behaviors are learned through the interaction with and observation of others. Therefore, children tend to learn and model behaviors demonstrated by their parents. Specifically, a child may incorporate their parents’ negative behaviors into development of their own behavioral patterns. The coercion hypothesis posits that abuse might result from a repeating pattern of coercive parent–child interactions in which the child responds by imitating the parent’s maladaptive behavior. Parents may continue to engage in coercive behavior because they believe that their children are deviant and unresponsive to less harsh forms of discipline. Thus, when a child responds to harsh discipline, parents may falsely assume that this strategy—and no other—works and continue to use it (Crouch and Behl 2001).

Child maltreatment prevention programs are also informed by attachment theory. Research on attachment theory shows that infants who are placed in an unfamiliar situation and separated from their caregivers will generally exhibit one of three types of attachment once they are reunited with their caregivers: 1) secure attachment, 2) anxious-resistant attachment, or 3) avoidant attachment. A child’s attachment style is largely affected by the caregiving he or she receives in the early years, especially in the first few months after birth. Children who are neglected or abused are more likely to develop an avoidant attachment style, which can cause relationship problems throughout childhood and adulthood. Interventions are therefore designed to 1) encourage secure attachment to promote the social development of the child, and 2) encourage parental sensitivity and responsiveness, which has been found to promote attachment security (DeWolff and van Ijzendoorn 1997).

Meta-Analysis Snapshot
	Literature Coverage Dates	Number of Studies
Meta Analysis 1	1981-2014	14
Meta Analysis 2	1977-2017	91
Meta Analysis 3	1981-2014	14

Meta Analysis 1

Vlahovicova and colleagues (2017) conducted a meta-analysis to evaluate the effectiveness of preventive programming in reducing re-abuse in families with a history of child maltreatment. Databases were searched for studies conducted prior to 2015. To be eligible for inclusion, studies had to 1) be randomized controlled trials or quasi-experimental designs; and 2) have parents as the participants (i.e., mothers, fathers, or other primary caregivers of children ages 0 to18), for whom there was a suspected or substantiated report of child physical abuse. Maltreatment history had to be supported by a police report, child protection referral, or other official agency report; the self-report of an abusive parent or abused child; or an above-threshold score in standardized instruments used for detection of child physical abuse.

A total of 14 studies were included in the review. All 14 studies that met the inclusion criteria used randomized controlled trials to evaluate eight different behavioral, parent-training programs that were based on social learning theory. The number of participants in the study ranged from 26 to 2,176. Seven of the studies included only physically abusive parents, and the others ranged from between 23 and 63 percent of parents who were physically abusive. In seven of the studies, data were collected from official reports to child protective services or similar agencies. The other seven studies used data collected through parent and child self-reports.

The researchers used a random effects model to analyze the data, which was presented as Cohen’s d effect sizes.

Meta Analysis 2

Van der Put and colleagues (2017) conducted a meta-analysis to examine the effectiveness of interventions designed to prevent child maltreatment. The authors searched electronic databases and conducted a manual search of reference sections of retrieved articles, reviews, and book chapters for studies published in 2013 or earlier. The authors also contacted fellow researchers to request studies and unpublished manuscripts that may have been relevant for inclusion. Studies were eligible if they 1) were preventive programs that targeted the general population, 2) were randomized controlled trials or quasi-experimental design studies, and 3) reported at least one effect size or provided sufficient information to calculate at least one effect size.

A total of 91 studies published between 1977 and 2017, comprising 63 randomized controlled trials and 29 quasi-experimental designs, were eligible for inclusion. Sixty-two of the studies collected outcome data based on self-report measures completed by the parent(s), 41 used official reports, and 7 percent used another collection method. Of the 91 studies, 83 focused on at-risk families, and the remaining 8 delivered the preventive programming to parents who were representative of the general population. At-risk families were identified using risk factors that included teenage parents, parents with substance use problems, or multi-problem families; however, “at-risk” did not refer to families with a history of child maltreatment.

The authors used a random effects model and estimated the overall effects using Cohen’s d in separate three-level, intercept-only models, consisting of 1) a random sampling variation of observed effect sizes, 2) variance within studies, and 3) variance between studies. Effect sizes were weighted by the inverse of their variance (i.e., sampling error).

Meta Analysis 3

Vlahovicova and colleagues (2017) conducted a meta-analysis to evaluate the effectiveness of preventive programming in reducing re-abuse in families with a history of child maltreatment. Databases were searched for studies conducted prior to 2015. To be eligible for inclusion, studies had to 1) be randomized controlled trials or quasi-experimental designs; and 2) have parents as the participants (i.e., mothers, fathers, or other primary caregivers of children ages 0 to18), for whom there was a suspected or substantiated report of child physical abuse. Maltreatment history had to be supported by a police report, child protection referral, or other official agency report; the self-report of an abusive parent or abused child; or an above-threshold score in standardized instruments used for detection of child physical abuse.

A total of 14 studies were included in the review. All 14 studies that met the inclusion criteria used randomized controlled trials to evaluate eight different behavioral, parent-training programs that were based on social learning theory. The number of participants in the study ranged from 26 to 2,176. Seven of the studies included only physically abusive parents, and the others ranged from between 23 and 63 percent of parents who were physically abusive. In seven of the studies, data were collected from official reports to child protective services or similar agencies. The other seven studies used data collected through parent and child self-reports.

The researchers used a random effects model to analyze the data, which was presented as Cohen’s d effect sizes.