Interventions to prevent child maltreatment and associated impairment

• Published in: The Lancet (British edition) Vol. 373; no. 9659; pp. 250 - 266
• Main Authors: MacMillan, Harriet L, Prof, Wathen, C Nadine, PhD, Barlow, Jane, Prof, Fergusson, David M, Prof, Leventhal, John M, Prof, Taussig, Heather N, PhD
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 17.01.2009; Elsevier Limited
• Subjects: Behavior; Child; Child abuse & neglect; Child Abuse - prevention & control; Child Abuse - psychology; Child, Preschool; Education - organization & administration; House Calls; Humans; Internal Medicine; Medical research; Nurse-Patient Relations; Parent-Child Relations; Parents & parenting; Post traumatic stress disorder; Sexual assault; Sexual behavior; Studies
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(08)61708-0

Summary Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes—the Nurse–Family Partnership (best evidence) and Early Start—have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother–child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures.