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.