The number of parent support programs aimed at preventing or reducing child maltreatment
\n has grown over the last decades. Some of these programs were found to have a positive
\n impact on various parenting domains in studies using randomized controlled designs
\n (RCTs; 1]). However, consistent findings about the effectiveness of such programs to prevent
\n or reduce child maltreatment are lacking 2], 3]. The current meta-analysis aims to fill this gap. We synthesized findings of all
\n randomized controlled trials (23 studies) that tested the effectiveness of 20 different
\n programs, aimed at the general population, at-risk, and maltreating groups, in order
\n to reveal the overall success of programs to prevent or reduce the occurrence of child
\n maltreatment and to uncover factors that influence the effectiveness of intervention
\n programs.\n <\/p>\n
A recent series of meta-analyses indicated that child maltreatment is a serious problem,
\n affecting children all over the world. Worldwide prevalence rates of different types
\n of maltreatment ranged from 0.3\u00c2\u00a0% based on studies with reports from professionals
\n to 36.3\u00c2\u00a0% based on self-report studies 4]. Risk factors for child maltreatment are low socio-economic status, parental mental
\n health problems, family isolation, and single parenthood 5]\u00e2\u20ac\u201c7]. Child maltreatment is associated with short-term and long-term negative consequences.
\n Victims have an increased risk for physical, behavioral, and psychological problems,
\n also up into adulthood (e.g., 8]\u00e2\u20ac\u201c11]), and benefit less from treatment compared to non-maltreated individuals 12], leading to high costs for individuals and society. Given the high prevalence rates
\n and serious consequences of maltreatment, effective prevention and reduction of child
\n maltreatment is essential.\n <\/p>\n
Over the last decades, the number of parent support programs has increased exponentially A well-known targeted prevention<\/em> program is the Nurse-Family Partnership developed by Olds and colleagues (e.g., 15], 16]). This program specifically targets pregnant adolescent women who are unmarried and\/or Parent\u00e2\u20ac\u201cchild Interaction Therapy (PCIT) is an example of a targeted program that aims A number of meta-analyses have synthesized results on the effectiveness of intervention The current meta-analysis aims to estimate the average effect of intervention programs An important characteristic of the intervention is the focus of the program. In some Further, the way of delivery is another intervention characteristic that can differ Intervention programs target different populations. Universal programs target the The rigor of the study design may also affect the effect size. Studies with poorer The number of parent support programs aimed at preventing or reducing child maltreatment has grown over the last decades. Some of these programs were found to have a positive impact on various parenting domains in studies using randomized controlled designs (RCTs; 1]). However, consistent findings about the effectiveness of such programs to prevent or reduce […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-26353","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/posts\/26353","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/comments?post=26353"}],"version-history":[{"count":0,"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/posts\/26353\/revisions"}],"wp:attachment":[{"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/media?parent=26353"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/categories?post=26353"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/healthmedicinet.com\/news\/wp-json\/wp\/v2\/tags?post=26353"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n 1]. Most of these programs are targeted and provide support to a clearly defined population
\n identified on the basis of risk factors for child maltreatment. However, some programs
\n are available for everyone or at least for a large proportion of the population. Examples
\n of such universal programs are Triple-P 13] and SOS! Help for Parents 14]. These programs aim to prevent the occurrence of child maltreatment in the general
\n population, for example by using the media to inform parents about effective parenting
\n strategies or by providing a short parent skill training to parents who visit a well-baby
\n clinic. Concerning programs that target a clearly defined population, programs that
prevent<\/em> the occurrence of child maltreatment in at-risk, but non-maltreating families, can
\n be distinguished from programs that reduce<\/em> the incidence of child maltreatment in maltreating families.\n <\/p>\n
\n have a low income, but women without any of these risk factors are also allowed to
\n participate in the program. It consists of nurse home visits in the prenatal period
\n and during the first two years of the child\u00e2\u20ac\u2122s life. The nurses promote improvement
\n of the women\u00e2\u20ac\u2122s health behavior during and after pregnancy, help building supportive
\n relationships with family and friends, and link them with other needed services. The
\n Elmira (New York) trial indicated a significant difference of 80\u00c2\u00a0% fewer child maltreatment
\n cases in the intervention group compared to the control group during the period of
\n intervention. However, these positive results disappeared in the two years after the
\n end of the program 17].\n <\/p>\n
\n to reduce<\/em> the incidence of child maltreatment in physically abusive parents. Families receive
\n 14 weekly one-hour live-coached sessions of parent\u00e2\u20ac\u201cchild interaction training. The
\n training consists of child-directed interaction, in which the parent is instructed
\n to follow the child\u00e2\u20ac\u2122s lead, and parent-directed interaction in which the parent is
\n taught to direct the child\u00e2\u20ac\u2122s behavior and use consistent disciplinary techniques 18]. Several studies have shown that PCIT indeed effectively reduces child behavior problems
\n 18], 19], and an RCT also indicated significantly fewer reports of physical abuse and improved
\n parenting skills in the PCIT condition compared to families who received community
\n services 20].\n <\/p>\nPrior meta-analytic findings<\/h4>\n
\n programs aimed at preventing or reducing child maltreatment. However, some meta-analyses
\n did not specifically include papers that measured the actual occurrence of child maltreatment
\n 21], 22], focused solely on non-maltreating families 23]\u00e2\u20ac\u201c25], included only home-visiting programs 23], 25], 26], and\/or included studies with less rigorous designs than RCTs 21], 23], 24]. For instance, Layzer and colleagues 21] combined abuse and neglect outcomes with child injuries, accidents, and removal from
\n the home into a single category \u00e2\u20ac\u02dcchild safety\u00e2\u20ac\u2122, which makes it impossible to estimate
\n the actual ability of programs to prevent or reduce child maltreatment. Geeraert and
\n colleagues 24] examined the effect of early prevention programs on actual abuse and neglect, but
\n they included mostly nonrandomized designs. A significant but small overall effect
\n on reported child maltreatment was found, but moderator analyses were not conducted.
\n Similarly, Filene and colleagues 23] examined the effect of home visiting programs on child maltreatment, but they also
\n included nonrandomized designs, and did not include maltreating families, thereby
\n only examining the preventive effect of interventions. In contrast to Geeraert and
\n colleagues, these authors did not find a significant effect on child maltreatment.
\n In another meta-analysis, only RCTs were included, but the focus of this meta-analysis
\n was solely on programs starting during pregnancy or within 6\u00c2\u00a0months after birth 22]. It revealed a small but significant effect for maltreatment outcomes at the end
\n of intervention, but no effect at follow-up. The only significant moderator that was
\n identified for child abuse and neglect measures was year of publication; more recent
\n studies yielded smaller effect sizes.\n <\/p>\nThe current study: Program effectiveness and moderators<\/h4>\n
\n that provide services to parents in order to prevent or reduce child maltreatment.
\n We only included RCTs, in which participants are fully randomly assigned to either
\n the intervention or the control condition. Because of the random assignment, it can
\n be assumed that the two groups do not differ systematically before the start of the
\n program. Clustered randomized trials were excluded, because participants are not fully
\n randomly assigned and therefore participants (or their contexts) in one cluster may
\n not be comparable to participants in other clusters. Further, we aimed to include
\n three types of programs: those targeting the general population, aimed at preventing<\/em> maltreatment, those for families at risk for child maltreatment, aimed at preventing<\/em> maltreatment, and those specifically developed for maltreating families, aimed at
reducing<\/em> maltreatment. We only included studies if they reported on actual maltreatment outcomes
\n and used this outcome in our meta-analysis. Child maltreatment was defined as \u00e2\u20ac\u0153any
\n act or series of acts of commission or omission by a parent or other caregiver that
\n results in harm, potential for harm, or threat of harm to a child\u00e2\u20ac\u009d (Centers for Disease
\n Control and Prevention (CDC)). In addition, we examined whether various intervention,
\n design, sample, and study characteristics were associated with program effects.\n <\/p>\nIntervention characteristics<\/h4>\n
\n programs, parents receive various sorts of support (e.g., social, emotional, material)
\n in order to build on strengths and improve overall family functioning, without actual
\n parenting skills training. For example, in Healthy Families America parents receive
\n support to reduce social isolation, access recourses such as food, housing, employment,
\n and health care, and improve their knowledge about child development 27]. Other programs do provide actual training for parents to improve their parenting
\n skills, such as SOS! Help for parents 14], in which parents are instructed about (the role of) parenting skills and common
\n mistakes in parenting, or Parent Child Interaction Therapy 20], in which parents receive (among other things) live parent\u00e2\u20ac\u201cchild coaching sessions
\n to improve parent\u00e2\u20ac\u201cchild interaction skills. Finally, some intervention programs combine
\n parent training and support. For example, in the Project Support intervention 28], mothers are taught skills for child behavioral management by instruction, practice,
\n and feedback, and they are provided with instrumental and emotional support, such
\n as training in how to evaluate a child care provider.\n <\/p>\n
\n substantially between programs. Some programs use support-groups in a center-based
\n setting 29], others consist of personal home visits 15] or combine center-based and home-based sessions 30]. The number of sessions and the duration varies from program to program. For instance,
\n in the Nurse-Family Partnership Program 15], parents receive 45 home visits during the first two years of the their child\u00e2\u20ac\u2122s life,
\n while the SOS! Help for parents program (SOS) described by Oveisi and colleagues 14] consists of only two 2-h weekly sessions. A meta-analysis on the effectiveness of
\n interventions aimed at improving parental sensitivity and parent\u00e2\u20ac\u201cchild attachment
\n revealed that programs with fewer contacts were more effective in improving sensitivity
\n and attachment 31], but it is unclear if this is also true for programs aimed at preventing or reducing
\n child maltreatment. Last, and more specific for programs aimed at preventing child
\n maltreatment, the moment of onset of the program, and thus the age of the child at
\n the start of the program, has been discussed as an important moderator of a program\u00e2\u20ac\u2122s
\n effectiveness. Although it has been suggested that programs for the prevention of
\n child maltreatment would be most effective if starting before birth 1], meta-analytic evidence showed that programs focusing on parental sensitivity or
\n parent\u00e2\u20ac\u201cchild attachment that started 6\u00c2\u00a0months after birth were at least as effective
\n as programs with an earlier onset 31].\n <\/p>\nSample characteristics<\/h4>\n
\n general population, while targeted programs focus on a clearly defined group of families
\n at risk for child maltreatment or maltreating families. Some have suggested that programs
\n with a clear target population would be more effective 32]. This may be especially true for programs that target maltreating families, because
\n those families show the behaviors that are targeted for change, and therefore they
\n may have the greatest potential for demonstrating change.\n <\/p>\nDesign characteristics<\/h4>\n
\n methodological designs likely yield larger effect sizes 3]. The use of intent-to-treat analyses is an example of a methodological strength,
\n as selective refusals after randomization or selective attrition during the intervention
\n may affect the randomization. In intent-to-treat analyses, group differences are analyzed
\n based on the original random assignment. Other design characteristics are sample size,
\n whether assessment was blind for group assignment and whether a pretest was included.
\n Moreover, the type and amount of services received in the control condition differs
\n between programs. Largest effect sizes may be expected when the control group received
\n few or even no services. In addition, there may be differences in effect sizes for
\n short-term and long-term effects. On the one hand, it may be expected that intervention
\n effects decrease or even disappear over time. On the other hand, there may be sleeper
\n effects, meaning that intervention effects increase over time, because parents would
\n need some more time to practice new skills 33]. Finally, the method of assessment of child maltreatment may influence effect sizes.
\n Although self-report measures may be informative since participants may know their
\n own experiences best, self-reports have several disadvantages. Participants may interpret
\n definitions of maltreatment or parenting practices differently than researchers and
\n it may be difficult for participants to remember the exact frequency of specific events
\n in the past. In addition, self-report of maltreatment experience is not possible in
\n early childhood. In contrast, reports from professionals who work with children do
\n cover all ages and these reports are generally coded by expert coders who use the
\n same set of definitions. The downside of this method is that professionals may not
\n be aware of all cases of maltreatment; they may only see the tip-of-the-iceberg 34].\n <\/p>\n","protected":false},"excerpt":{"rendered":"