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Child Abuse Interventions
Social Support
Background
Social support can take many forms in addition to home visits: day
care, transfer payments, other social service payments, etc. Child abuse and neglect
occurs with a higher incidence in poor families and families with limited social
support. Thus, the provision of appropriate social support may have an impact on
the risk of subsequent abuse and neglect.
Review of social support programs:
Author | Brayden et al., 1993 |
Study design and target population | Nashville, TN, USA
Low income pregnant women were screened for risk of abuse,
neglect or failure to thrive. 314 high risk women were randomized to comprehensive
intervention (N=160) vs. standard care (N=154). Both compared to 295 low risk
control women. |
Intervention | Intervention was care until age 2
by multi-disciplinary team, psychosocial support for mother, education about
self care, health promotion; assignment to "main support person" who
contact pt monthly to assist with social services |
Outcomes | Reports of CAN to CPS during first
36 months of child’s life.
Outcome data available for 141 high risk intervention, 122 high risk
control, 264 low risk control. |
Results | Physical abuse reports made on 9.2%
o f the intervention group, 6.6% of high risk controls. RR=1.45 (0.58-3.62) |
Study quality and conclusions | Program was an ambitious intervention
beginning during the prenatal period. Intervention did not appear to decrease
the risk of physical abuse |
Author | Armstrong, 1986 |
Study design and target population | Intervention, comparing families who
received 1, 2 or all 3 components
US
46 families and 74 children at high risk for abuse |
Intervention | Family support center consisting of
home visiting, school for children, parent education, parent support groups |
Outcomes | Reports of child abuse and neglect |
Results | No difference in reported abuse of
neglect between families who received 1, 2 or 3 components. |
Study quality and conclusions | Essentially uncontrolled study; families
by default selected what they would do.
Thus, unknown whether the program had an impact. |
Author | Caruso, 1989 |
Study design and target population | Post-test only with comparison group
of families from adjacent cities
Public Health Department families
171 intervention families and 91 comparison families |
Intervention | (A) Infant stimulation instruction.
(B) General counseling and support.
(C) Referral information.
(D) Children’s and parents groups |
Outcomes | Reported child abuse and neglect by
age 6 years |
Results | 0% of intervention group and 14% of
control families had reported abuse and neglect. |
Study quality and conclusions | By age 6 years, 47% of intervention
and 45% of comparison families dropped out precluding any conclusions which
can be drawn form this study. |
Author | Burks, 1990 |
Study design and target population | Controlled study, pre-test, post-test
35 primiparous teen age mothers attending a health department
prenatal clinic in Oklahoma City who agreed to be in the intervention group.
Control group were 37 women attending the same clinic who
refused to be in the intervention group |
Intervention | Intervention group: Home visits pre-
and post-natal, educational information, car seats, routine health care, WIC
Control group: routine health care |
Outcomes | Reports to CPS of abuse or neglect
9 months after the intervention ended |
Results | No reports of child abuse for either
group. |
Study quality and conclusions | The small sample size, and poorly
chosen control group preclude any conclusions about the effectiveness of the
intervention. |
Summary of social support interventions
The lack of well designed studies in this area is very problematic.
At present, one cannot conclude that these programs work or do not work to prevent
subsequent abuse.
Recommendations on social support interventions
These programs cannot be recommended at the present time because
of the lack of any appropriate outcome data.
Recommendations for future research
There is a need for prospective, RCTs testing the effectiveness
if social support intervention trials, and determining the magnitude of any effect.
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