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Topic Editor: Harriet MacMillan, MD, McMaster University, Canada
Topic funded by: The Lawson Foundation
Prevention and intervention
The key to reduce child maltreatment is a strong focus on prevention. Strategies used to prevent the occurrence of maltreatment have been grouped into three major categories.
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Prevention before occurrence; these include universal and targeted programs. The best evidence is for the Nurse Family Partnership, an intensive program of nurse home visitation provided to first-time socially disadvantaged mothers. Another home visiting program – Early Start – and a parenting program – Triple P – are promising, but need further evaluation to determine their effectiveness. Hospital-based educational programs to prevent abusive head trauma are also promising, but need further study. Enhanced pediatric care for families of children at risk of physical abuse and neglect is also promising, but requires further assessment.
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Prevention of recurrence is much more challenging; one program - Parent-Child Interaction Therapy, has shown benefits in reducing the recurrence of physical abuse, but not neglect. It is considered promising and needs further study.
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Prevention of impairment programs, especially cognitive-behavioural therapy that focuses on reducing deficits in victims, can improve the well-being of sexually abused children who present with post-traumatic stress disorder symptoms. Interventions that target cognitive-emotional components have shown to yield better cognitive outcomes (e.g., memory) in children exposed to emotional maltreatment.
Transferring children to foster care can also enhance children’s mental and physical health, and provide better outcomes in the behavioural, social and academic realms. Transition from the home (e.g., quality preschool experiences, school entry) provides emotionally-abused children with opportunities to realign their emotions.
Given that financial difficulties put children at risk for maltreatment, fighting poverty can go a long way in promoting children’s safety. In addition, policies on employment flexibility can help parents establish a healthy balance between their home and job responsibilities. Strategies should also be implemented to encourage children and family members to disclose and report child maltreatment. Promoting coping and resilience in contexts of adversity is important.
Professionals working with children can contribute to making reduction of child maltreatment a priority. Abuse should always be considered in the assessment of children presenting with injuries or mental health problems. Trained workers should also become familiar with the cultural context in which children grow up to ensure that children’s needs for safety, nurturance and protection are met no matter what the cultural practices. Interventions to help maltreated children and neglectful families should also be guided by a common set of standards:
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Identify who and what contributes to the problems;
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Build a therapeutic alliance with the family;
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Set reasonable and concrete goals in collaboration with the family;
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Supervise the situation with care, and modify the plan as needed;
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Ensure that the needs of children are met;
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Collaborate with other professionals involved.
See also...
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