Interventions to prevent or ameliorate child physical abuse and neglect: findings from a systematic review of reviews
| Date | 01 November 2006 |
| Pages | 6-28 |
| Published date | 01 November 2006 |
| DOI | https://doi.org/10.1108/17466660200600020 |
| Author | Jane Barlow,Doug Simkiss,Sarah Stewart‐Brown |
| Subject Matter | Education,Health & social care,Sociology |
6
1Reader in
Public Health,
University of Warwick
2Senior Lecturer in
Child Health,
University of Warwick
3Professor of
Public Health,
University of Warwick
Journal of Children’s Services
Volume 1 Issue 3 November 2006
©Pavilion Journals (Brighton) Ltd
Abstract
The aim of this article is to summarise the available evidence from systematic reviews about the
effectiveness of interventions to prevent or treat child physical abuse and neglect. A computerised search
was undertaken of major electronic databases up to December 2005 using key search terms. Only
systematic reviews were included in which the primary studies evaluated the effectiveness of targeted or
indicated interventions for child physical abuse or neglect. A total of 31 systematic reviews were
identified and 15 met all the inclusion criteria. They covered a range of interventions/services, including
home visiting, parenting programmes, multi-component interventions, intensivefamily preservation
services, family-focused casework and multi-systemic family therapy. There was limited evidence of the
effectiveness of services in improving objectivemeasures of abuse and neglect, due in partto
methodological issues involved in their measurement, but good evidence of modest benefits in improving
a range of outcomes that are associated with physical abuse and neglect, including parental and family
functioning and child development. The results also showed some interventions (eg. media-based and
perinatal coaching) to be ineffectivewith high-risk families. The evidence provided by these reviews has
clear implications for children’s services in the UK and other western developed countries.
Key words
prevention; treatment; child physical abuse; neglect; services; child protection
Introduction
Services that can prevent abuse and neglect, reduce
occurrences, or ameliorate the impact are critical in
reducing the profound effects of such parenting on
children’s development. During the 1990s research
commissioned by the Department of Health showed
that on the whole, the UK child protection system
intervened too late and did not offer parents
sufficient support or preventive services (DoH,
1995), and a National Commission highlighted the
need for moresupport to families, including the
teaching of parenting skills (National Commission of
Inquiry into the Prevention of Child Abuse, 1997).
Although objective measures suggest that rates of
abuse are low, recent evidence from a survey of
adults living in the UK suggests much higher levels
of all types of abuse than previously recognised
(Cawson et al,2000).
The death of Victoria Climbié and the subsequent
Laming Report (2003) resulted in recommendations
for major changes with regard to the ways in which
services and professionals work together to reduce
abuse in the UK. Some of these recommendations
havebeen enshrined in recent policy documents,
including Every Child Matters (DfES, 2003), the
Interventions to prevent or
ameliorate child physical abuse
and neglect: findings from a
systematic review of reviews
Jane Barlow1,Doug Simkiss2and Sarah Stewart-Brown3
National Service Framework for Children, Young
People, and Maternity Services (DoH, 2004), and the
Children Act 2004, which created the legislative
framework for whole system reform.
These changes represent an important shift in
government policy with regard to children’s services,
from a focus on child protection to family support and
improved parenting (DfES, 2004). They also recognise
the need to locate targeted services within universal
services, to intervene early and to work ‘in
partnership’ with parents (DoH, 1997; Nursing and
Midwifery Council, 2002). They have resulted in
extended early years provision, better integration of
health, education and social care via Sure Start
children’s centres, ‘parenting support embedded at
each life stage’,and ‘multidisciplinary teams based
in universal services such as clusters of schools or
early years settings’ (DfES, 2004, p3). Other changes
aimed specifically at better protecting children have
included the development of a shared database of
children containing information relevant to their
welfare, local authorities leading on multi-agency
working via children’s trusts (DoH, 2004), the
development of statutory Local Safeguarding Children
Boards (LSCBs) to replace non-statutory Area Child
Protection Committees (ACPCs), and the development
of an integrated inspection framework.
Despite these policy developments there remains
some confusion about the best ways to intervene to
prevent or ameliorate abuse, due in partto the
diverse range of preventive and therapeutic
interventions available. This diversity reflects the
various aetiological models that havebeen developed
since the 1970s, the most recent of which highlights
the importance of increasing protective and reducing
risk factors at the level of the child, the family, the
family’s support system and the wider community
(Bronfenbrenner, 1979).
Anumber of systematic reviews1have been
undertaken to identify which of these interventions
and services work best; some have been limited to
one type of intervention or service (eg. home visiting
programmes), while others have been broad ranging
and included diverse types of provision. The aim of
this article, therefore, is to collate this review level
data in order to clarify the evidence about ‘what
works’ and to identify the implications for future
policy and practice.
We have restricted our searches to reviews of
physical abuse and neglect and havenot aimed to
cover interventions for sexual or emotional abuse;
while these are as important as physical abuse and
neglect, they havebeen excluded because they are
the focus of very different sorts of intervention or are
less well studied (in the case of emotional abuse). We
have included reviews of interventions that target ‘at
risk’ families, defined in a variety of ways, as well as
services for families where abuse has already
occurred (indicated services). Although many of the
former (targeted services) are provided around the
time of a child’s birth, and therefore by definition aim
to prevent (as opposed to treat) abuse, the distinction
between prevention and treatment may not be as
clear-cut for services provided later in the child’s life.
The evidence suggests that much abuse remains
undetected and it is therefore likely to be occurring in
asignificant proportion of families included in studies
of targeted services. Due to problems with the
identification of abuse and the value of making
changes to parenting which may not be abusive but is
nevertheless detrimental to children’s development,
we have included reviews of studies examining the
impact of services on factors associated with abuse
(eg. maternal mental health problems and poverty),
as well as on documented abuse. We have used the
terminology ‘targeted’ and ‘indicated’ (rather than
‘prevention’ and ‘treatment’) as both approaches aim
to prevent poor outcomes in the child.
Objective
The objectiveof this review was to identify existing
systematic reviews of studies of the effectiveness
of targeted or indicated interventions for parents
that aimed to prevent, reduce or ameliorate incidents
of physical abuse or neglect, in order to identify
‘what works’.
Methods
Acomputerised search was undertaken of key
electronic databases: Medline, Psych Info, CINAHL
and Social Science Citation Index. Reference lists
were also searched. Key search terms included ‘Child
abuse’, ‘maltreatment’, ‘neglect’ and ‘injuries’. These
were combined with a range of terms to identify
systematic reviews.
The following inclusion criteria were used:
1. Study type: Reviews showing evidence of a
systematic and comprehensive search of the
literature and presenting quantitative data from
the primarystudies.
2. Intervention type: Any targeted or indicated
intervention aimed at parents and designed to
prevent, reduce or ameliorate child physical
abuse and neglect.
Interventions to prevent or ameliorate child physical abuse and neglect:
findings from a systematic review of reviews
7
Journal of Children’s Services
Volume 1 Issue 3 November 2006
©Pavilion Journals (Brighton) Ltd
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