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Child Maltreatment: Prevention Strategies

Child maltreatment is a serious problem that can have lasting harmful effects on its victims. The goal for child maltreatment prevention is clear—to stop child abuse and neglect from happening in the first place. Child abuse is a complex problem rooted in unhealthy relationships and environments. Safe, stable, and nurturing relationships and environments for all children and families can prevent child abuse. However, the solutions are as complex as the problem.

Increasing factors that protect children can reduce the occurrence of abuse. Preventing child maltreatment means influencing individual behaviors, relationships among families and neighbors, community involvement, and the culture of a society. Prevention strategies include effective programs that focus on attitude change and on modifying policies and societal norms to create safe, stable, and nurturing environments. We need to implement effective prevention strategies to stop child abuse and neglect before it happens and to foster commitment to social change.

Evidence-based Programs to Stop Child Maltreatment

  • Child-Parent Centers
    Child-Parent Centers (CPCs) provide comprehensive educational and family support to economically disadvantaged children (beginning at age 3 and thru the third grade) and their parents. CPCs require parental participation and emphasize a child-centered, individualized approach to social and cognitive development. Results from a matched control trial showed a 52% reduction in child maltreatment among participants.1
  • Durham Family Initiative
    The Durham Family Initiative works to improve family well-being and to reduce child maltreatment by coordinating services for high-risk families. Children who are at risk for maltreatment are identified through home visits after birth or through referrals from pre-kindergarten, schools, and clinics. The initiative also includes collaboration with community leaders and agencies to implement a shared information system, a standardized data collection system, cross-training, and integrating services across organizations. A randomized controlled trial showed that child maltreatment was reduced by 57% in Durham County, compared to control counties.2
  • Nurse-family Partnership
    Nurse-Family Partnership is a nurse home visitation program for low-income, first-time parents and their children beginning before birth and continuing up to the child’s second birthday. Nurses in the program encourage healthy behaviors during and after pregnancy, teach appropriate parenting skills, and link parents to community services. Results from a randomized controlled trial showed a 48% reduction among participants in child maltreatment at the 15-year follow-up.3
  • Parent-Child Interaction Therapy
    Parent-Child Interaction Therapy (PCIT) teaches parents specific skills to build a nurturing and secure relationship with their children, increase their children’s desirable behaviors, and decrease negative behaviors. An examination of PCIT delivered to physically abusive parents in the child welfare system found participants had significantly fewer re-reports of physical abuse (19%) than parents who participated in services as usual (49%).4 In a study of families with chronic and severe neglect or physical abuse histories, PCIT plus a motivational enhancement reduced the number of future child welfare reports.5
  • Triple P
    Triple P is a multi-level system of parenting interventions based on need and is usually delivered through health care systems. In the Triple P System Trial, funded by CDC, researchers found a slowed growth of confirmed child abuse cases (22% lower), fewer child out-of-home placements (16% lower), and fewer hospitalizations and emergency room visits for child injuries (17% lower) in nine counties in South Carolina where parenting interventions were implemented when compared to control counties.6
  • The Safe Environment for Every Kid
    The Safe Environment for Every Kid (SEEK) program screens parents of children ages 0–5 in pediatric primary care settings to identify parental exposure to partner violence, mental illness, or substance abuse and provides appropriate referrals. Randomized controlled trials showed significantly lower rates of child maltreatment among SEEK participants relative to non-participants.7,8

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Guidelines and Planning Tools

  • Essentials for Childhood [PDF 5.5MB]  proposes strategies communities can consider to promote the types of relationships and environments that help children grow up to be healthy and productive citizens so that they, in turn, can build stronger and safer families and communities for their children.
  • Essentials for Parenting Toddlers and Preschoolers is a free, online resource developed by CDC’s Division of Violence Prevention. It provides information about what parents can do to build a positive, healthy relationship with their child.
  • Understanding Evidence is an interactive Web resource that CDC's Division of Violence Prevention developed to support public health practitioners in making evidence-informed decisions around violence prevention.
  • Developing and Sustaining Prevention Programs
    The Child Welfare Information Gateway provides resources on developing a prevention program, conducting a community needs assessment, funding, collaborating, and evaluating program effectiveness, and building community support.

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Community and Societal Level Examples

Essentials for Childhood offers various examples of organizational or internal policy. Primary health care organizations can make it their policy to deliver components of evidence-based programs such as Triple P as their standard of care. More specifically, community health centers or private pediatric practices can make anticipatory guidance and brief consultation on common developmental issues part of their standard protocol during well-baby visits. They can also coordinate with other specialized services to provide more intensive approaches to address problems with parenting and child behavior.

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Reviews of Effective and Promising Programs

  • California Evidence-based Clearinghouse for Child Welfare
    This organization provides online access to information about evidence-based child welfare practices in a simple, straightforward format. The effectiveness of these practices is supported by empirical research.
  • Community Guide
    This guide provides systematic reviews of interventions, including home visitation programs like Nurse-Family Partnerships.
  • Child Welfare Information Gateway
    This site connects child welfare and related professionals to comprehensive information and resources to help protect children and strengthen families.
  • Promising Practices Network
    This network provides summaries of effective programs and issue briefs summarizing current research related to child well-being, including their physical and mental health, academic success, and economic security.
  • Violence Prevention Evidence Base
    The Centre for Public Health at Liverpool John Moores University developed this database that provides access to abstracts from published studies that have measured the effectiveness of interventions to prevent violence. The abstracts can be searched by violence type, keywords, and geographical area of implementation. Studies included must have directly measured the impact of interventions on violence and are selected through a systematic review of published academic literature.
  • World Report on Violence and Health
    This report is the first comprehensive review of violence on a global scale. Chapter 3 [PDF 176KB] provides detailed information about child maltreatment, including prevention strategies.

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References
  1. Reynolds AJ, Robertson DL. School-based early intervention and later child maltreatment in the Chicago Longitudinal Study. Child Dev. 2003;74(1):3–26.
  2. Daro D, Dodge KA. Creating community responsibility for child protection: possibilities and challenges. Future Child. 2009;19:67–93.
  3. Olds DL, Eckenrode J, Henderson CR, Kitzman H, Powers J, Cole R, et al. Long-term effects of home visitation on maternal life course and child abuse and neglect: fifteen-year follow-up of a randomized trial. JAMA. 1997;278(8):637–43.
  4. Chaffin M, Silovsky JF, Funderburk B, et al. Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. J Consult Clin Psychol. 2004;72(3):500–10.
  5. Chaffin M, Funderburk B, Bard D, Valle LA, Gurwitch R. A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial. J Consult Clin Psychol. 2011;79(1):84–95.
  6. Prinz RJ, Sanders MR, Shapiro CJ, Whitaker DJ, Lutzker JR. Population-based prevention of child maltreatment: the U.S. Triple P System Population Trial. Prev Sci. 2009;10(1):1–12.
  7. Dubowitz H, Feigelman S, Lane W, Kim J. Pediatric primary care to help prevent child maltreatment: the safe environment for every kid (SEEK) model. Pediatrics. 2009;123(3):858–64.
  8. Dubowitz H, Lane WG, Semiatin JN, Magder LS. . The SEEK model of pediatric primary care: can child maltreatment be prevented in a low-risk population? Acad Pediatr. 2012;12(4):259–68.

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