Child Abuse

Scope of the Problem

The term "the battered child syndrome" was coined by Henry Kempe in 1961 to describe children who have been non-accidentally physically injured by caretakers. This is a worldwide problem, occurring in both industrialized and less industrialized countries. Children of all ages can be abused, and this abuse can take the form of physical injury, sexual abuse, neglect and emotional injury. This report will focus primarily on physical abuse.

Much attention has been given to attempting to identify children and families at risk of abuse, develop screening instruments, and intervene to prevent abuse, as well as to treat the abusers to prevent recurrence. This review will focus on primary prevention and second prevention. Primary prevention is defined as any maneuver that occurs to or around an individual the stated purpose of which is to prevent child abuse or neglect from ever occurring in an individual.¹ Secondary prevention is defined as any program or maneuver that is implemented to or for an individual or group of individuals, who have been identified as coming from a very high risk environment, which has as its intent the prevention of the abuse and/or neglect from occurring to that individual’s offspring. We will not review the literature on the effectiveness of treatment programs to prevent abuse recidivism (tertiary prevention). Child abuse prevention programs are aimed "primarily at improving or enhancing the interactional system between a parent and his or her child.¹

The studies which we included below are only those in which actual reported abuse is evaluated as an outcome. Many other studies have examined the effect of intervention programs on parenting skills, parent-child interactions, nature of the home environment, abuse potential and other proxies of abuse. However, in keeping with the rest of this review, we have elected not to include these studies because of the, at present, unknown reliability of the link between changes in these factors and actual changes in abuse. For the interested reader, systematic reviews are available which have examined these other outcomes: Guterman,² 1997; MacMillan³ et al., 1994; Wekerle and Wolfe,⁴ 1993; Fink and McCloskey,⁵ 1990; Dubowitz,⁶ 1990.

Prevention Interventions

• Home visitors
• Behavioral interventions
• Social support
• Interventions with children

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