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Practice Profile

Preventive Child Maltreatment Programs

Evidence Ratings for Outcomes:

Effective - More than one Meta-Analysis Victimization - Child abuse/neglect/maltreatment

Practice Description

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 Outcomes

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Effective - More than one Meta-Analysis Victimization - Child abuse/neglect/maltreatment
A meta-analysis of 142 studies by Piquart and Teubert (2010) found that preventive child maltreatment programs did not have a statistically significant effect on measures of child abuse or neglect. In contrast, Van der Put and colleagues (2017) found a small, statistically significant effect size of 0.26 across 91 preventive programs designed to reduce child maltreatment, meaning that intervention parents had a 26-percent lower likelihood for child abuse or neglect, compared with control group parents. Across 14 studies, Vlahovicova and colleagues (2017) also found a small, statistically significant effect size of 0.11 for preventive programs, meaning that intervention parents had an 11-percent lower likelihood for child abuse or neglect, compared with control group parents.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11973 - 20091420
Meta-Analysis 21977 - 2017910
Meta-Analysis 31981 - 2014140

Meta-Analysis 1
Pinquart and Teubert (2010) conducted a meta-analysis to examine the effects of interventions for new and expectant parents that are designed to prevent child maltreatment. The researchers searched electronic databases for all studies available up until 2009. Studies were eligible for inclusion if 1) they used a randomized controlled design, with the control group receiving no intervention or only minimal intervention; 2) they included a parenting education component; 3) the intervention was initiated during pregnancy or in the first 6 months after childbirth; and 4) effect sizes were reported or could be computed from the available information, such as from means and standard deviations. Studies were excluded if they 1) were not targeted at improving parenting (e.g., programs that limited their focus to improving the couple relationship), 2) did not provide enough information for extracting effect sizes, and 3) focused exclusively on treatment or prevention of recurrence of psychological disorders, such as postnatal depression in parents (usually mothers), or were programs designed solely for parents of chronically ill or disabled children.

The search yielded 142 eligible studies from 1973 to 2009. All studies were randomized controlled trials. Of the eligible studies, 137 were published in a peer-reviewed journal. The average number of participants per intervention was 108. More than half (N = 82) of the interventions worked with families at risk, and 107 included only mothers. Most interventions began after the baby was born, 38 were conducted during both pregnancy and post-pregnancy, and 10 were held only during pregnancy. The average length of the intervention was 15 months, but could range from 1 day to 60 months, with participants attending an average of 29 meetings. Most interventions (N = 84) were delivered at home, 16 interventions were held in hospitals, 6 were held in the community, and a further 26 combined home visits with other locations (e.g., support group meetings in the community). The participating parents were, on average, 24.3 years old; approximately 79 percent were expecting or had just given birth to their first child. About 58 percent were married, and 21 percent were cohabiting. In addition, 59 percent were ethnic minorities, and 56 percent had completed high school education. Eighty-nine percent of the participants were mothers, and 51 percent of the infants were girls.

Outcome data were analyzed using random effects models and iterative maximum-likelihood estimations. Effect sizes were calculated using Cohen’s d, in which the differences in the posttreatment measures between the intervention and control conditions were divided by the pooled standard deviation (Lipsey and Wilson 2001). The authors averaged effect sizes for studies that reported results from one dataset for different outcome variables (e.g., for different parenting behaviors). They also averaged results on couples’ interventions in which separate results were reported for mothers and fathers. Weighted mean effect sizes were also computed.

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.
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Cost

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There is no cost information available for this practice.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Piquart, Martin, and Daniela Teubert. 2010. “Effects of Parenting Education with Expectant and New Parents: A Meta-Analysis.” Journal of Family Psychology 24(3):316–27.

Meta-Analysis 2
Van der Put, Claudia E., Mark Assink, Jeanne Gubbels, and Noelle F. Boekhout van Solinge. 2017. “Identifying Effective Components of Child Maltreatment Interventions: A Meta-Analysis.” Clinical Child and Family Psychology Review 21(2):171–202.

Meta-Analysis 3
Vlahovicova, Kristina, G. J. Melendez-Torres, Patty Leijten, Wendy Knerr, and Frances Gardner. 2017. “Parenting Programs for the Prevention of Child Physical Abuse Recurrence: A Systematic Review and Meta-Analysis.” Clinical Children and Family Psychology Review 20:351–65.
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Additional References

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These sources were used in the development of the practice profile:

Bandura, Albert. 1971. Psychological Modeling: Conflicting Theories. Chicago, Ill.: Aldine.

Bowlby, J. 1969. Attachment and Loss: Vol. 1. Attachment. New York, N.Y.: Basic Books.

CDC [Centers for Disease Control and Prevention]. 2019. “Risk Factors.”
https://www.cdc.gov/violenceprevention/childabuseandneglect/riskprotectivefactors.html

Cohen, John. 1992. “A Power Primer.” Psychological Bulletin 112:155–59.

Cowan, Carolyn P., and Philip A. Cowan. 2000. When Partners Become Parents: The Big Life Change For Couples. Mahwah, N.J.: Erlbaum.

Crouch, Julie L., and Leah E. Behl. 2001. “Relationships Among Parental Beliefs in Corporal Punishment, Reported Stress, and Physical Child Abuse Potential.” Child Abuse and Neglect 25(3):413–19.

De Wolff, Marianne. S., and Marinus H. van IJzendoorn. 1997. “Sensitivity and Attachment: A Meta-Analysis on Parental Antecedents of Infant Attachment.” Child Development 68:571–591.

Lipsey, Mark W., and David B. Wilson. 2001. Practical Meta-Analysis. Thousand Oaks, Calif.: Sage

McElwain, Nancy L., and Cathryn Booth-LaForce. 2006. “Maternal Sensitivity to Infant Distress and Nondistress as Predictors of Infant-Mother Attachment Security.” Journal of Family Psychology 20:247–55.

Miller, Renee. L., Julie F. Pallant, and Lisa M. Negri. 2006. “Anxiety and Stress in the Postpartum: Is There More to Postnatal Distress than Depression?” BMC Psychiatry 6:12.
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Triple P – Positive Parenting Program Effective - One study
This is a comprehensive parent-training program designed to enhance parental competence and prevent or alter dysfunctional parenting practices. By enhancing parenting practices, the program seeks to reduce family risk factors for child maltreatment and children’s behavioral and emotional problems. The program is rated Effective. There were statistically significant reductions in substantiated child maltreatment cases, out-of-home placements, and child maltreatment injuries.

Infant–Parent Psychotherapy Promising - One study
A relationship-based treatment for parents and infants designed to improve the parent–child relationship, by examining the insecurities that have developed in parents from negative experiences during their own childhoods. The program is rated Promising. The Infant-Parent Psychotherapy group significantly improved on measurements of attachment when compared with the community standard condition. Intent-to-treat analyses confirmed the treatment effects of the interventions.

Alternatives for Families: Cognitive Behavioral Therapy Promising - One study
This is a family therapy program designed to reduce the effects of child abuse. The program is rated Promising. There were statistically significant reductions in family conflict, parent-child violence, physical punishment, and child abuse risk, and improvements in discipline, cohesion, and child acceptance. There were also statistically significant reductions in child internalizing and externalizing symptoms. However, there were no significant differences between groups in re-abuse rates.

Parent–Child Interaction Therapy (PCIT) Effective - More than one study
The program teaches parents new interaction and discipline skills to reduce child problem behaviors and child abuse by improving relationships and responses to difficult behavior. The program is rated Effective. Program children were more compliant with less behavior problems than the wait list group. The treatment group parents gave more praise and fewer criticisms and improved negative aspects of their parenting. There were fewer re-reports of physical abuse.

Multisystemic Therapy for Child Abuse and Neglect (MST–CAN) Promising - One study
This program addresses family functioning and parental behavior to reduce child abuse, neglect, and external placement. The program is rated Promising. Compared with the control group, treatment parents and children showed statistically significant improvements in functioning, treatment parents showed significant improvements in social support, and treatment children had a lower likelihood of receiving external placement. However, there were no significant differences between groups on abuse.

Nurse–Family Partnership Effective - More than one study
A home visitation program for low-income, first-time mothers to improve family functioning. The program is rated Effective. Program children had less substance use, reported fewer internalizing problems, and had higher child academic achievement. At the 15-year follow-up, less child abuse and neglect involving the mother as the perpetrator or involving the study child for families receiving home visitations during pregnancy and infancy.

The Incredible Years Effective - More than one study
A parent, teacher and child social skills training approach to reduce challenging behaviors in children and increase their social and self-control skills. The program is rated Effective. The evaluation reviewed multiple outcomes. Findings revealed that negative parenting practices decreased in the intervention group; there was greater improvement in school readiness measures; classroom atmosphere; child social competence; and stimulation for learning in the treatment group.

Healthy Families America Promising - One study
A home visitation program targeting expecting and new parents, with children up to age 5, who are at risk of abusing or neglecting their children. The program is rated Promising. The study showed parenting behaviors improved and some evidence of a reduction in precursors to delinquency. There were no effects on the prevalence or number of confirmed child Protective Services reports of child maltreatment for the sample as a whole.

Parents as Teachers No Effects - More than one study
An early childhood parent education and family support program serving families from pregnancy until their children enter kindergarten. The program is rated No Effects. The preponderance of evidence suggests that the program had no effect on improving child or parent outcomes.

Adults and Children Together (ACT) Raising Safe Kids Program Promising - One study
A national anti-violence intervention designed to prevent child maltreatment by providing education, resources, and support to parents. The program is rated Promising. Program parents reported a statistically significant decline in harsh discipline as measured by the Parent Behavior Checklist (PBC) from the pretest to 3-month follow-up period. There was no statistical difference between the comparison groups for PBC in nurturing, expectation, or parent stress measures.

Period of PURPLE Crying No Effects - More than one study
This is a preventative approach that uses educational materials to inform caregivers about the frustration caused by an infant’s prolonged crying and about behaviors that reduce the risk of shaking and abuse. The program is rated No Effects. There were no significant differences between the intervention and comparison groups on measures of crying generally, unsoothable crying, and caregiver self-talk.
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Practice Snapshot

Gender: Both

Targeted Population: Children Exposed to Violence, Families

Settings: Home, Inpatient/Outpatient, Other Community Setting

Practice Type: Children Exposed to Violence, Cognitive Behavioral Treatment, Conflict Resolution/Interpersonal Skills, Crisis Intervention/Response, Family Therapy, Group Therapy, Individual Therapy, Parent Training, Violence Prevention

Unit of Analysis: Persons