Chapter 14: Preventing Child Maltreatment

Preventing Child Maltreatment

To reduce the likelihood of an occurrence. This is considered critical because maltreatment is highly prevalent, has serious lifelong consequences for victims, tends to be a chronic condition resistant to intervention once it starts, and carries astronomical financial costs for social welfare and medical care

Precursor

Any factor that occurs before the onset of child maltreatment and may function as a specific risk factor. i.e. Parental stress, substance abuse, or lack of parenting knowledge.

How Prevention Efforts Change

Historically, systems focused on protecting children after abuse. But now they are shifting towards early identification, risk reduction, and prevention at the population level.

Effectiveness of Prevention Efforts (1992–2010)

Prevention efforts have steadily increased since the 1970s, research indicates significant declines in maltreatment rates between 1992 and 2010:

• Physical Abuse: Decreased by 56%.

• Sexual Abuse: Decreased by 62%.

• Neglect: Decreased by only 10%.

Likely drivers: awareness, education, professional response, PSAs, professional training, federal grants & early reporting systems.

Physical and sexual abuse

Types of Maltreatment Easier to Reduce

Neglect

Types of Maltreatment Harder to Reduce

Family First Prevention Services Act

Federal legislation passed in 2018 that requires states to develop and implement community-based programs specifically designed to prevent child abuse and neglect

A Public Health Issue

Child maltreatment is viewed through this lens because intentional or accidental injury is a leading cause of death for children. Furthermore, childhood maltreatment increases risk factors for leading adult causes of death, such as heart disease and cancer

Centers for Disease Control and Prevention (CDC)

A division of the Department of Health and Human Services dedicated to promoting health and quality of life by preventing and controlling disease, injury, and disability

Division of Violence Prevention

A specific division of the CDC dedicated to preventing all forms of violence, including child maltreatment, intimate partner violence, and youth violence

At-Risk Individuals

A group of people who are predisposed to developing maladaptive behaviour patterns, such as child maltreatment

Attrition

The loss of participants during a research study for various reasons, such as relocation, death, or loss of interest. Prevention programs often face high abandonment rates between 30% and 50%.

Primary Prevention

Programs that universally target the general population (e.g., through public service announcements) to reduce the incidence of all new cases of a problem

Public Awareness Campaigns (PSA)

These programs use media—such as TV, radio, billboards, and the internet—to inform the public about child maltreatment and how to report it

Where’s the Baby? Look Before You Lock

A primary prevention program sponsored by the National Highway Traffic Safety Administration (NHTSA) to reduce vehicle-related heatstroke fatalities in children by urging caregivers to never leave children unattended in cars

Parental Education Campaigns

These are primary programs available to all parents through venues like schools or medical facilities, providing universal support without the stigma of being "targeted."

Detroit Family Project

A primary prevention program conducted in medical settings where parent facilitators engage in informal discussions about parenting with families in health clinic waiting rooms. Facilitators use mobile carts equipped with snacks, toys, and educational brochures to reach approximately 25,000 parents annually, providing them with resources and suggestions for further information where they are already located.

Don’t Shake the Baby

A primary prevention program designed to increase parental knowledge regarding the dangers of shaking infants and to reduce the incidence of shaken baby syndrome (or abusive head trauma). It is typically implemented in medical settings, such as maternity wards, where educational materials are distributed directly to new parents to intervene before any harm occurs.

The Period of PURPLE Crying

A primary prevention program that uses an acronym to educate parents that intense infant crying is developmentally normal, thereby reducing the frustration that leads to Shaken Baby Syndrome

• Peak of crying

• Unexpected

• Resists soothing

• Pain-like face

• Long lasting

• Evening

Child Sexual Abuse Programs

Educational prevention initiatives that primarily target potential victims (children) rather than perpetrators. These school- or community-based programs focus on empowering children by teaching them to recognize inappropriate touch, resist assault, and disclose abuse to a trusted adult. While traditionally child-focused, newer alternative models focus on educating adults and parents to take responsibility for child protection.

Effectiveness of CSA Prevention Programs

Generally demonstrates a slight increase in children's knowledge and disclosure rates. While these programs effectively improve children's understanding of appropriate boundaries and how to respond, research on their ability to prevent actual assaults is mixed; some studies show no necessarily lower the rates of completed victimizations, as children who fight back may be more likely to be injured

Gibson and Leitenberg (2000)

A retrospective study found that female college students who had participated in school-based prevention programs were half as likely to have experienced subsequent child sexual abuse compared to those who had not, they also disclosed it earlier and experienced for a shorter time

Stewards of Children Program

An adult-focused prevention initiative developed by the organization Darkness to Light. Unlike traditional programs that target potential child victims, this workshop educates adults, including parents and those in youth-serving organizations, on how to prevent, recognize, and react responsibly to child sexual abuse. The program provides concrete strategies for child protection and has been empirically shown to significantly increase participants' knowledge and improve their preventative behaviours over time.

Secondary Prevention

Programs that target a specific group of individuals (such as young parents, single parents, substance abusers, a history of abuse & poverty) to reduce the incidence of new cases among those at an identified risk

Disease Model

A medical term applied to behavioural patterns like maltreatment, viewing them as lifelong illnesses requiring "inoculation" of susceptible families through prevention services

Hawaii’s Healthy Start Program

A secondary prevention program that provides home visitation services for families identified as being at risk for maltreating their newborn children. Enrolled during the mother’s pregnancy, families receive services for the first three years of the child’s life, starting with weekly visits from trained paraprofessionals shortly after childbirth.

Although it spearheaded home visitation efforts, later evaluations found the program had no significant impact on preventing physical abuse, leading researchers to conclude that the use of paraprofessionals may not be appropriate for high-risk families with complex psychosocial needs.

Healthy Families America

A secondary prevention home visitation program initiated by Prevent Child Abuse America in 1992. Modelled after Hawaii’s Healthy Start Program, it uses paraprofessionals to provide weekly home visits starting shortly after childbirth for up to the first five years of a child's life. While research indicates the program has positive impacts on parenting skills, its direct effect on reducing substantiated child maltreatment rates is limited.

Nurse Home Visitation Program (now Nurse–Family Partnership)

A secondary prevention program that targets pregnant women whose fetuses are at risk for later health and developmental problems due to factors such as maternal age, single parenthood, and low socioeconomic status.

Consists of weekly home visits conducted by nurses that typically begin during the second trimester of pregnancy and continue until the child's second birthday. It is widely regarded as the "gold standard" for child maltreatment prevention because research has shown it significantly reduces substantiated reports of abuse and neglect, particularly among poor, unmarried teenage mothers.

Triple P – Positive Parenting Program

A parent education and training program designed to provide caregivers with the tools and resources they need to be effective in their parenting roles. Originally developed in the early 1980s in Australia, it is now an evidence-based program available in over 25 countries for parents of children ranging from infancy to adolescence.

The program offers various levels, including online modules, brief individual sessions, group discussions, and intensive training. It has been shown to have a positive impact on children's behaviour, parental well-being, and overall rates of child abuse

Parental Discipline Styles Program (Peterson et al., 2003)

A secondary prevention intervention designed to reduce harsh physical discipline (a big risk factor for child maltreatment). This 16-week program targets low-income mothers with children aged 18 months to four years and utilizes a combination of weekly group therapy sessions and weekly home visits.

While the study did not directly measure reports to child protective services, it demonstrated a significant reduction in harsh discipline, like shouting, threatening, shoving, and slapping (a good example of using proxy measures)

Child Parent Enrichment Project

A secondary prevention program that provides six months of home visitation beginning during pregnancy. It specifically targets high-risk mothers, including those with a history of maternal abuse, mental illness, or a low IQ. While the program received high consumer satisfaction scores, evaluations showed no evidence that it effectively prevented child abuse or neglect

Family Connections Program (DePanfilis and Dubowitz, 2005)

A secondary prevention program specifically designed to prevent child neglect among high-risk families in impoverished urban areas. Targeting families with children between the ages of 5 and 11. While the program has demonstrated success in improving certain risk and protective factors, it has shown limited impact on reducing substantiated child maltreatment reports.

This may be because the chronic and complex nature of neglect requires a longer intervention period than the short 3 to 9 months provided by the program

Prevention Efforts in Schools

An early, universal primary prevention setting that utilizes the educational environment to intervene before risk escalates into harm. These programs equip students with life skills (stress management, decision-making), parenthood preparation (child development, parenting), and self-protection training to improve recognition and disclosure of abuse. Additionally, schools provide the community with educational resources and direct assistance for at-risk families

Tertiary Prevention

These programs target affected individuals to minimize the negative effects of an already existing problem and prevent recidivism (recurrence). Examples include parent training for families already in the CPS system

“Fuzzy” boundary between this prevention and intervention

Major Problems with Prevention Programs

• Measurement issues: No clear definition of maltreatment = hard to measure outcomes.

• Lack of long-term data: Many programs only studied short-term.

• Participants drop out (attrition)

• Limited effectiveness: Some programs improve knowledge but do not reduce abuse rates.

• Proxy measures

Methodological Issues with Researching Prevention Programs

• Need more Empirical/scientific studies

• Sleeper Effect: An outcome that emerges some time after a program has been completed, rather than immediately

• Mediator: A factor that may explain the relationship between two other variables (e.g., socioeconomic status may explain the relationship between race and parenting style)

Proxy Measures

Variables used in place of the actual variable of interest (like using "harsh discipline" as a proxy for "abuse") when the actual variable is difficult or rare to measure directly

Mindset Shift

Successful prevention requires moving from a "child-saving" approach to a strength-based perspective that normalizes participation in programs so they are less stigmatizing for families. Extend the promise of equal opportunity to all children by offering universal support to all parents

Canadian Initiatives

• The Community Action Program for Children

• First Nations Child and Family Services Program

• Canada Prenatal Nutrition Program

• Save The Children

• Canadian Centre for Child Protection, and

• Project Arachnid strategies specifically targeting sexual exploitation on the internet