It’s not always easy to notice child abuse and neglect. Not every type of injury is visible to the naked eye. Once child abuse is spotted, how can interventions be most effective?
A recent review examined multiple studies to determine which methods were most effective in preventing child abuse and neglect. The review’s findings showed that interventions in a clinical setting by healthcare professionals were more effective than in-home visits by nurses and social workers.
Shelly Selph, MD, MPH, research associate, and Heidi Nelson, MD, MPH, research professor in the Departments of Medical Informatics and Clinical Epidemiology and Medicine, at the Oregon Health & Science University in Portland, worked with a team to update the US Preventive Services Task Force Recommendation on child abuse and neglect.
The authors said, “In 2004, the US Preventive Services Task Force determined that evidence was insufficient to recommend behavioral interventions and counseling to prevent child abuse and neglect.”
For this study, data from 2002 to 2012 was gathered and reviewed in order to design a new recommendation for the US Preventive Services Task Force in regard to behavioral interventions and counseling for child abuse and neglect.
In all, 11 studies were reviewed. These studies included a trial in a pediatric clinic that did risk assessment and interventions for families with children aged 5 and under, multiple reports from Child Protective Services (CPS) and studies on delayed immunizations and failure to follow medical instructions.
A total of 5,182 households were included in the 11 studies from the US, UK and New Zealand. Households were made up of white, Hispanic, Pacific Islander, black and low-income participants.
The clinic-based intervention study included 729 participants who were split into an intervention group and a no-intervention comparison group. Before the study, 12 percent of participants had been involved with CPS at some point.
For up to 44 months after the intervention, 13 percent of the intervention group had CPS reports, compared to 19 percent in the no-intervention group.
While 5 percent of the intervention group did not follow up with recommended medical care, 8 percent of the no-intervention group failed to follow up.
Participants in the intervention group reported no adverse effects due to the intervention of healthcare professionals.
Researchers determined the success of the interventions and counseling based on reductions in CPS reports, emergency room visits, hospitalizations, and self-reports of abuse, as well as better follow-up with immunizations and well-child care visits and instructions.
The authors concluded, “Risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. Early childhood home visitation also reduced abuse and neglect, but results were inconsistent”
The authors recommended further studies that also include intervention strategies and risk assessment for children over the age of 5.
Training healthcare professionals to assess risk and facilitate intervention strategies in a clinical setting could reduce child abuse and neglect.
This study was published in January in The Annals of Internal Medicine. The Agency for Healthcare Research and Quality provided the funding for this study. No conflicts of interest were found.