Abstract
Background: In 2004, the U.S. Preventive Services
Task Force determined that evidence was insufficient to recommend
behavioral interventions and counseling to prevent child abuse and
neglect.
Purpose: To review new evidence on the effectiveness
of behavioral interventions and counseling in health care settings for
reducing child abuse and neglect and related health outcomes, as well
as adverse effects of interventions.
Data Sources: MEDLINE and PsycINFO (January 2002 to
June 2012), Cochrane Central Register of Controlled Trials and Cochrane
Database of Systematic Reviews (through the second quarter of 2012),
Scopus, and reference lists.
Study Selection: English-language trials of the
effectiveness of behavioral interventions and counseling and studies of
any design about adverse effects.
Data Extraction: Investigators extracted data about
study populations, designs, and outcomes and rated study quality using
established criteria.
Data Synthesis: Eleven fair-quality randomized
trials of interventions and no studies of adverse effects met inclusion
criteria. A trial of risk assessment and interventions for abuse and
neglect in pediatric clinics for families with children aged 5 years or
younger indicated reduced physical assault, Child Protective Services
(CPS) reports, nonadherence to medical care, and immunization delay
among screened children. Ten trials of early childhood home visitation
reported reduced CPS reports, emergency department visits,
hospitalizations, and self-reports of abuse and improved adherence to
immunizations and well-child care, although results were inconsistent.
Limitations: Trials were limited by heterogeneity, low adherence, high loss to follow-up, and lack of standardized measures.
Conclusion: 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. Additional research on
interventions to prevent child abuse and neglect is needed.
Primary Funding Source: Agency for Healthcare Research and Quality.
Introduction
In 2004, the U.S. Preventive Services Task Force (USPSTF) found, on the basis of the results of a previous review (
1,
2),
insufficient evidence to recommend for or against routine screening of
parents or caregivers for abuse or neglect of children (
3,
4).
This systematic review is an update for the USPSTF that focuses on
studies published since the previous recommendation and addresses the
effectiveness and adverse effects of behavioral interventions and
counseling to prevent child abuse and neglect for children at
potentially increased risk. Separate reviews examine screening women for
intimate partner violence (
5,
6) and elderly and vulnerable adults for abuse (
6).
Approximately 695,000 children in the United States were victims of child abuse and neglect in 2010, and 1537 died (
7). Most of these deaths were in infants and toddlers (
7). Additional immediate health consequences of abuse and neglect include injuries and emotional and behavioral problems (
8,
9).
Associated long-term physical conditions include neurologic and
musculoskeletal disorders; gastrointestinal problems; metabolic
conditions, including diabetes; autoimmune disorders (
10,
11); obesity (
12,
13); chronic pain (
14,
15); teen pregnancy and pregnancy complications (
16); and others (
17).
Chronic mental health conditions include psychosis, anxiety and
posttraumatic stress disorder, alcohol and substance abuse, risky sexual
behaviors, depression and suicide, eating disorders, attention
problems, and personality disorders (
12,
18–25).
In the United States, child abuse and neglect have legal as well as
medical implications. Federal legislation defines child abuse and
neglect as any recent act or failure to act on the part of a parent or
caregiver that results in death, serious physical or emotional harm,
sexual abuse, or exploitation, or an act or failure to act that presents
an imminent risk for serious harm (
26–28). Although laws vary, states are required to include the minimum standards of the federal law (
29).
All states have laws that require physicians and other health care
workers, as well as other professionals who interact with children, to
report suspected child abuse and neglect to Child Protective Services
(CPS) (
30), part of the larger U.S. Department of Health and Human Services that specifically responds to child abuse reports (
28).
Physicians and other health care providers who care for children and
families are uniquely situated to identify children at risk for abuse
and neglect during well-child and other visits and to initiate
interventions to prevent harm. Although pediatricians consider screening
for abuse and neglect one of their important roles (
31), it is rarely done in practice (
32,
33). Barriers to screening include lack of experience, training, and confidence in handling abuse cases (
32,
34–36).
