Understanding Child Abuse and Neglect (1993) / Chapter Skim
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5 PREVENTION
5 PREVENTION
Pages 161-207
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From page 161... ...
In recent years, some researchers have begun to examine variables that foster healthy relationships or reduce risk for child maltreatment (Cicchetti and Rizley, 1981; Rosenberg, 1987~. The developmental perspective of the panel encourages consideration of significant research areas from the field of child development, such as attachment, autonomy and social relationships, peer competency, parental styles, and so forth, in the evaluation of preventive efforts for child 161
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From page 162... ...
The panel examined evidence of what appear to be promising prevention programs, such as home visitation, parental education, and child sexual abuse prevention curriculums. We also examined research on interventions not designed specifically for child maltreatment prevention but that may reduce such behavior by improving the welfare of families that are characterized by multiple problems or by reducing the use of violence in general.
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From page 163... ...
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From page 164... ...
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From page 165... ...
First, although most child maltreatment prevention programs (with the exception of child sexual abuse programs) fall into the category of secondary prevention, the programs vary significantly by the type of maltreatment and interactional processes that are the focus of the program, the context of the prevention effort, the nature of the risk assessment process, and the developmental stage of the child.
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From page 166... ...
To be effective, prevention research needs to establish a clear link between a reduction in selected risk factors and an ultimate decrease in abuse. Until recently, the primary or even sole focus in designing preventive interventions was the identification and modification of problematic or damaging parental practices associated with child maltreatment, such as excessive physical discipline, failure to provide children with basic necessities and care, and mismatches between a parent's expectations and a child's ability (Daro, 19921.
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From page 167... ...
, the use of violence against children may be linked to other types of violent behavior, and efforts to reduce the use of violence in resolving individual conflicts may lead to a reduction of child maltreatment. Summary Most studies of prevention of risks for maltreatment have sought to isolate the relative significance of risk factors within the family, including poverty, social isolation, age and education of the mother, unrealistic parental expectations, and prior history of child maltreatment.
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From page 168... ...
Not surprisingly, then, the majority of primary prevention programs for child abuse and neglect focus on this transition, beginning either prenatally or just after the child's birth and continuing through part or all of the first year of life or even through the second and third years. Pathways to Parental Practices Prevention strategies have built on individual, familial, and communitylevel risk and protective factors that contribute directly to both parental practices and to child well-being.
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From page 169... ...
But here again, uncertainty remains as to whether such measures are correct proxies for child abuse and whether a parent's improved knowledge of childrearing skills is a sufficient measure of effectiveness given the multiple pathways that may result in child maltreatment. While many child maltreatment prevention programs have the reduction of abuse and neglect as a goal, most programs focus on intermediate or surrogate outcomes, such as parenting behavior, childrearing attitudes, maternal mental health, maternal problem-solving and use of health and social services, subsequent fertility, maternal employment, job training, and school completion (Benasich et al., 1992; Clewell et al., 1989; Olds, 19903.
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From page 170... ...
Most of these programs have focused on multiple risk factors, and the evaluations of program outcomes focus primarily on child health measures. Only a few have been evaluated in terms of their impact on child maltreatment.
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From page 171... ...
The Prenatal/Early Infancy Project is characterized by the use of professionally trained nurses as home visitors as well as a rigorous evaluation methodology that includes random assignment of subjects to four treatment groups.2 The project evaluated prenatal, birth, and postnatal outcome variables, including length of gestation, infant birthweight, quality of maternal interactions with the child, disciplinary behaviors, child maltreatment reports, and postnatal emergency room visits. The major finding of the project was that nurse home visitation services significantly reduced the number of subsequent child maltreatment reports, compared with the control population.
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From page 172... ...
, evaluations have assessed risk factors for child maltreatment such as unstable relationships, social isolation, maternal education, personal adjustment and mental health of parents, limited childrearing skills, lack of knowledge about child development, unrealistic expectations and attributions, the quality of the relationship between parent and child, and harsh or punitive parenting. One frequently cited study compared reported (state-verified)
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From page 173... ...
Family support programs may be effective in reducing the prevalence of child maltreatment by addressing multiple risk factors associated with abuse and neglect, including disabilities, poverty, family violence, and poor health. However, the comparative effectiveness of general family support programs and center-based programs that target families based on psychosocial factors associated with poverty, child abuse, punitive parenting, and child failure, such as stressful life events, maternal depression, and low social support, has not been evaluated.
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From page 174... ...
if they are seen as benefiting the entire community. Neighborhood or community-level interventions allow for an examination of differential effects of programs for various groups of families or families with a particular pattern of risk factors (see the Elmira Prenatal/Early Infancy Project, targeted toward families at risk of child health problems, and the Infant Health and Development Program, targeted for low birthweight and premature infants and their parents, as examples; Olds et al., 1986a,b, 1988; BrooksGunn et al., 1992, in press a,b)
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From page 175... ...
And do such benefits lead to a reduction in the frequency or severity of child maltreatment? Not all center-based programs for young children report their effects on maternal or familial outcomes, or their effect on reported cases of child abuse and neglect, even though all pay lip service to the relevance of their programs for families.
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From page 176... ...
Domestic violence treatment programs may offer some promise in preventing child maltreatment as well. However, the scientific literature regarding the impacts of domestic violence treatment programs on the children who witness spousal assaults, or who may be subject to violence themselves, is too limited at this stage to provide a basis for inferences by the panel.
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From page 177... ...
Although quite promising, no investigation to date has evaluated the effects of newborn demonstration projects on subsequent rates of child maltreatment (Holder et al., 1992~. Drotar (1992)
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From page 178... ...
Child maltreatment prevention programs are usually found in the schools: they are primarily child sexual abuse prevention programs designed for children in elementary and high schools. In addition to major efforts in child sexual abuse prevention, two other efforts were reviewed by the panel that may have implications for the prevention of child abuse and neglect.
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From page 179... ...
School-Based Sexual Abuse Prevention Programs Current preventive interventions rest on several core assumptions that influence many programs and materials designed to help children prevent or escape sexual abuse: many children do not know what sexual abuse is, that sexual touch need not be tolerated, that adults want to know about children who experience sexual touches by older persons, and that disclosure of sexual abuse will help stop it (Conte and Fogarty, 1990; Kolko, 1988; Tharinger et al., 1988~. Most prevention materials also incorporate several key concepts outlined by Conte et al.
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From page 180... ...
, stressing concepts such as good and bad touches and discussions of bullies or relatives who forcefully try to kiss a child (Reppucci and Herman, 1991~. The development of sexual abuse prevention programs for children under the age of 10 has been controversial because of criticisms about the appropriateness of teaching young children concepts and actions for understanding and repelling sexual abuse, the absence of consideration of children's developmental capacities in the design and implementation of such programs, the fairness of focusing prevention programs exclusively on potential victims rather than perpetrators, and uncertainties about long-term or unanticipated consequences of such programs on sexual and intimate behaviors (Come, 1992; Leventhal, 1987; Melton, 1992; Reppucci and Herman, 1991~.
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From page 181... ...
Although sexual abuse prevention education programs have generally achieved the goals of teaching prevention knowledge and skill acquisition, it is not clear that these gains will be retained over time or would be useful to a child in an assault situation, especially if the offender was a relative or trusted adult. Less is known about the efficacy of child sexual abuse prevention programs compared with prevention efforts (such as parental enhancement programs)
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From page 182... ...
The use of role playing and in vivo assessment situations is a promising new technique in the formation of effective prevention programs, but such approaches raise important ethical issues that need to be considered carefully before exposing children to them (see discussion in Chapter 9~. Other Community-based Prevention Programs Preventive interventions focused on various aspects of community life have been proposed as part of an interactive systems approach to reducing child maltreatment.
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From page 183... ...
Educator and Child Care Staff Training Day care providers, teachers, principals, and others who have ongoing and long-term contact with children are in a position to identify suspected victims of maltreatment and report them to child protective services. Such interventions can be a source of reduced incidence for the recurrence of child maltreatment and may prevent incidents when the offenders become aware that they can be reported for abusive or neglectful actions.
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From page 184... ...
Despite the interest in violence prevention efforts, most school-based programs have not been evaluated. This review will focus on violence prevention programs that have been evaluated for effectiveness of their goals, recognizing that these programs were not designed to deal specifically with child abuse prevention, but rather the prevention of violence in general or in social or peer relationships.
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From page 185... ...
These two programs are examples of promising interventions in the area of violence prevention that may have implications for child maltreatment, although they were not designed with the prevention of child maltreatment as a specific objective. In addition to the school-based programs discussed above, several organizations have designed comprehensive multisystem approaches to address the interaction of family and school factors that foster violence.
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From page 186... ...
Given the increasing number of youth involved in violence, surprisingly few well-designed, rigorously evaluated, and effective prevention programs exist, and the association between violence prevention programs and child maltreatment is largely unknown. The lack of consistent positive results in the evaluation of school-based violence prevention programs may be due to the relatively narrow scope of the interventions.
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From page 187... ...
Survey data from the National Committee for Prevention of Child Abuse involving various forms of print and broadcast media suggest that public awareness of child maltreatment has increased dramatically over the past decade. Media efforts to prevent child maltreatment may benefit from lessons derived from the role of the media in addressing public health issues.
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From page 188... ...
We also do not know if prevention programs in selected areas of physical or sexual violence involving peers or adults can be generalized to incidents involving child maltreatment by trusted adult figures. Gaining such knowledge will require studies that follow cohorts of sample populations over time, to identify the strength of various program components and the requirements of special populations, such as children who have already experienced abusive behaviors, in designing ef fective prevention programs.
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From page 189... ...
Several areas in the macrosystem have relevance for research on the prevention of child maltreatment. Although these issues are relatively untested in intervention strategies or research evaluations, the panel includes them here because of our belief that they warrant attention in a research agenda for the future.
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From page 190... ...
Research is needed on whether the inclusion of a no-hitting element in such programs reduces physical abuse. Use of Criminal Sanctions The use of criminal sanctions is an important aspect of prevention of child abuse because of the popular belief that strict legal standards and punitive measures will reduce the incidence of child maltreatment.
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From page 191... ...
As our knowledge of the etiology of child maltreatment improves, prevention interventions can adapt new theoretical frameworks that will highlight promising interactions and theoretical insights. Evaluations of home visitation programs, school-based programs for the prevention of sexual abuse and violence, and community-based child maltreatment prevention programs are quite limited.
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From page 192... ...
Programs could offer two or more different sets of service and evaluate the effectiveness of programs of varying lengths, following the scientific practices established in clinical trials. Other types of prevention programs often find that positive results are best maintained by offering either long-term, continuous services or, after a program ends, a short-term refresher or booster.
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From page 193... ...
Recommendation 5-2: Research on child sexual abuse prevention needs to incorporate knowledge about appropriate risk factors as well as the relationship between cognitive and behavioral skills, particularly in situations involving known or trusted adults. Sexual abuse prevention research also needs to integrate knowledge of factors that support or impede disclosure of abuse in the natural setting, including factors that influence adult recognition of sexual abuse or situations at risk for child abuse.
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From page 194... ...
For example, some children may have been able to use prevention knowledge and skills to successfully prevent, avoid, or escape abuse; other children may have been unsuccessful in their efforts; some children may have been abused in situations or in ways that make prevention impossible; and many children may have reactions to or ideas about preventive intervention that could improve the delivery of these programs. The field has generally ignored the criticisms, support, and ideas of children who are actual consumers of child abuse prevention programs, although a recent national survey of more than 1,400 children (age 10 through 16)
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From page 195... ...
Recommendation 5-3: Research evaluations are needed to identify the extent to which community-based prevention and intervention programs (such as school-based violence or domestic violence prevention programs, Head Start, etc.) focused on families at risk of multiple problems may affect the likelihood of child maltreatment.
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From page 196... ...
Schoolbased programs need to be designed for specific characteristics, risk factors, and the social context of the participants in order to determine who most benefits from selected programs. Major prevention programs need to include a long-term follow-up as part of their evaluation.
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From page 197... ...
. This includes home visitation programs, early childhood intervention programs, and violence prevention programs for schoolchildren.
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From page 198... ...
4. These curricula included Child Assault Prevention, Children's Self-Help, Talking About Touching, Touch Safety, Child Abuse Prevention Intervention and Education, the Youth Safety Awareness Project, and SAFE Stop Abuse Through Family Education.
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From page 199... ...
Binder, R.L., and D.E. McNiel 1987 Evaluation of a school-based sexual abuse prevention program: Cognitive and emotional effects.
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From page 200... ...
Conte, J.R. 1992 School-Based Sexual Abuse Prevention Programs.
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From page 201... ...
Rosenberg, eds., Prevention of Child Maltreatment. New York: John Wiley and Sons.
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From page 202... ...
1988 Child Sexual Abuse Prevention: Evaluation of Educational Materials for Pre school Programs. Unpublished manuscript, Family Welfare Research Group, School of Social Welfare, University of California, Berkeley.
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From page 203... ...
1989 Child sexual abuse prevention programs: What makes them effective in protecting children? Children Today (September/October)
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From page 204... ...
Wurtele 1988 The child sexual abuse prevention movement: A critical analysis of primary and secondary approaches. Clinical Psychology Review 8:313-329 Mueller, D.P., and P.S.
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From page 205... ...
Herman 1991 Sexuality education and child sexual abuse prevention programs in the schools.
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From page 206... ...
Briggs 1985 Child sexual abuse prevention: Does it work? Child Welfare 64:667-674.
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From page 207... ...
Miller-Perrin 1987 Practice makes perfect? The role of participant modeling in sexual abuse prevention programs.
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