Child Maltreatment Research, Policy, and Practice for the Next Decade Workshop Summary (2012) / Chapter Skim
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6 Preventing Child Maltreatment
6 Preventing Child Maltreatment
Pages 55-68
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From page 55... ...
Speakers at the workshop session on prevention discussed primary interventions for all families, secondary interventions for targeted families (e.g., those that experience mental health disorders or substance use problems) , and tertiary interventions to prevent recurrence of child maltreatment and chronic neglect.
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From page 56... ...
In addition, recent efforts have concentrated awareness programs on very specific behaviors. Daro listed several well-known programs, including the Central Massachusetts Shaken Baby Syndrome Campaign, a web-based community engagement program, and a hospital-based initiative at Pennsylvania State University's Hershey Medical Center.
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From page 57... ...
. Person-to-person change is a way to generate normative change in a much quicker way than if you rely solely on a formal intervention." Shaken babies make up a small percentage of the overall child abuse problem, Daro continued, but focusing on the behavior has merit given its fatal consequences in many cases and the high costs associated with head trauma.
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From page 58... ...
Some research on community initiatives has found measurable reductions in child abuse reports, substantiated cases, hospital emergency room use, and out-of-home placements at the population level, though other initiatives have not demonstrated measurable population-level change. "It is not uniform, but there is certainly some evidence that under certain circumstances the strategy can work." Research also shows changes in parent self-reporting that suggest fewer adverse parenting practices and other normative changes.
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From page 59... ...
"We don't know how to get that something to the parent at the point at which they need it, and that is what we are really struggling with." Future Opportunities to Strengthen Universal Prevention Programs The outcomes of programs could be strengthened through an intentional focus on the contexts of intervention programs and individual families, Daro said. Additional research also will be necessary on the sustainability of reform and population-level change.
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From page 60... ...
.3 Putnam pointed out that population studies see a higher frequency of parent-reported abuse (including sexual abuse, physical abuse, and shaken baby syndrome) than substantiated abuse reports, so he thinks it is important not to discount those data.
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From page 61... ...
In particular, a Beck Depression Inventory of 800 mothers over the course of 9 months had 44 percent scoring in a clinical range split into three groups: one group that scored high and then improved, one that remained chronically depressed, and one that first scored low and then became depressed. In the literature, Putnam said, the rate of maternal depression in home visiting populations is 30 percent, and the majority of those mothers do not get treatment (Ammerman et al., 2011)
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From page 62... ...
These trials compare well with randomized controlled trials in clinical settings, as well as with medication trials, Putnam observed. Other studies, he added, show that depressed subjects with a history of maltreatment respond poorly to medication but well to cognitive behavioral therapy.
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From page 63... ...
Most services are locally derived and delivered by communitybased agencies that may invent their own model without strong guidelines. An informal search of the Child Family Services Reviews, which evaluate child welfare systems, resulted in no matches for the term "evidence based." "Typically, services in this area have been ideology driven, not evidence driven, and that is still the case," Chaffin said.
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From page 64... ...
In 2012, for example, the California Evidence-Based Clearinghouse for Child Welfare (CEBC) , which reviews evidence on interventions for families in child welfare, rated as well supported four parent training models, one foster care stabilization model for children, two foster care stabilization models for adolescents, and four models for children with internalizing anxiety, depression, or PTS.
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From page 65... ...
At the end of his presentation, Chaffin noted that neglect is more stable and recurrent than other types of maltreatment, which results in a flood of chronic cases in the child welfare system. In Oklahoma, for example, more than 40 percent of cases have been seen four or more times in the past, typically for chronic neglect.
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From page 66... ...
In contrast to randomized controlled trials, continuous quality improvement is nimble, cheap, and data-driven. It embraces variation as a way of improving a system and depends on quick feedback to foster continual improvements.
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From page 67... ...
Barth brought up the challenge of reengaging families in chronic neglect situations without a child abuse report as a mechanism. He said that this could be made more difficult because of the expansion of multiple response programs that do not collect or keep complete information from child abuse reports.
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