Guide Early Prediction and Prevention of Child Abuse: A Handbook (Wiley Series in Child Care & Protection)

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By drawing upon the Surrey cohort data 5 it was possible for us to estimate how prevalent certain risk factors were within abusive families and the general population. The resulting figure expresses the percentage of true positive hits that could be expected when applying a particular risk factor to intervention, i. Combining this with figures on the national birth rate, estimation as to how many health visitors would be needed to implement a modified FNP using alternative risk factors to the ones outlined by the government can be calculated, together with the impact this may have on prevention.

On the other hand, targeting all of the young, first-time mothers with economic problems within the Surrey cohort would require health visitors. These figures clearly illustrate the potential to improve the cost-effectiveness of FNP whilst preventing more cases of CAN. It is recognized that FNP has the potential to be effective in promoting the positive development of children and protecting them from abuse and neglect.

However, this article has shown that currently, the FNP is only reaching around one-quarter of the families it is said to have the potential for benefiting. The relatively low prevalence of child maltreatment in the population as a whole implies that targeting this group based on the presence of risk factors would yield large numbers of false positives, even with the most optimistic estimates of sensitivity and specificity. Hence, the PPV of any one characteristic would be relatively low compared with using a combination of risk factors.

Nevertheless, it is proposed that targeting risk factors with a lower prevalence in the general population but with a higher prevalence amongst abusive families would be a more effective way of preventing abuse and neglect. Ideally, risk factors should also have a reasonable sensitivity to reduce the number of false negatives.


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China Baby Love Jane Hutcheon. Treatment of Complex Trauma Christine A. Beyond Belief Colm O'Gorman. I Miss Mummy Cathy Glass. The Hospital Barbara O'Hare. Secret Slave Anna Ruston. From Victim to Offender Freda Briggs. Daddy's Little Earner Maria Landon. Street Kid Judy Westwater. Who Will Love Me Now? Betrayal of Innocence Susan Forward. The Baby Snatchers Mary Creighton. Tiny Prisoners Maggie Hartley. Broken and Betrayed Jayne Senior. Child Protection - The essential guide Freda Briggs. Other books in this series. In the Firing Line Janet Stanley. Toward this end, it offers formal training in the Triple P model to direct service personnel working in a variety of clinical settings.

Standard Triple P offers a series of broadly focused eight- to ten-week parenting skill training sessions delivered in the home, or through group-based sessions, or self-directed using project material. Families whose parenting difficulties are complicated by other problems, such as domestic violence or mental health concerns, or who have not been adequately served by the standard services are offered Enhanced Triple P, a more intensive behavioral family intervention.

Although service provision at each level is supported by a variety of structured unique protocols, all of the direct services are framed by a set of common practice principles. These include ensuring a safe and engaging environment for children, creating a positive learning environment, using assertive discipline, having realistic expectations, and taking care of oneself as a parent.

As discussed in the article in this volume by Richard Barth, repeated randomized trials of specific Triple P interventions have consistently demonstrated positive effects on parenting skills and child behavior. Recently, with funding from the Centers for Disease Control and Prevention, Ronald Prinz and his colleagues randomly assigned eighteen counties in South Carolina to either the comprehensive Triple P program or a services-as-usual control group.

Staff also identified and contacted state and county stakeholders who provided such support services for parents of young children as education, school readiness, child care, mental health, social services, and health, in a variety of settings.

Child Abuse, Child Sexual Abuse, and Child Maltreatment

Direct service providers were offered the opportunity to participate in training on all of the Triple P interventions. The result was a mean of Effects were assessed by comparing trends between the intervention and comparison counties on three independently derived population indicators. These comparisons yielded statistically significant, large positive effects. Between the period just before implementation and twenty-four months later, intervention counties increased in substantiated child maltreatment rates by just 8 percent, compared with 35 percent for the control counties.

Out-of-home placements decreased in intervention counties by 12 percent but increased by 44 percent in control counties. Hospital admissions for child injuries decreased by 18 percent in intervention counties but increased by 20 percent in control counties. This study is the first to randomize geographical areas to intervention and control conditions and show preventive effects on child maltreatment at a population level. Although these findings are impressive, it remains unclear how the social marketing, universal service offers, and training in the Triple P model to direct service providers might have produced these results.

Additional analyses regarding potential variation across the intervention and comparison counties with respect to both implementation efforts and outcomes is needed to understand more fully the mechanisms through which Triple P might affect maltreatment rates. The Strengthening Families Initiative SFI —not to be confused with a selective individual-family program to prevent child abuse and child problem behavior started by Karol Kumpfer, also called Strengthening Families 32 —is designed to reduce child abuse by enhancing the capacity of child care centers and early intervention programs to offer families the support they need to avoid contact with the child welfare system.

Similar to the Triple P model, Strengthening Families also seeks to affect parent behavior by using an existing service delivery system. Specifically, SFI uses focused assessments, technical assistance, and collaborative ventures to enhance the capacity of child care centers to promote five core protective factors among their program participants—parental resilience, social connections, knowledge of parenting and child development, critical support in times of need, and social and emotional competence of children.

And if they are reported for suspected maltreatment, the family can count on the child care center to serve as their advocate with child welfare officials. In , with funding from the Doris Duke Charitable Foundation, the Center for the Study of Social Policy CSSP began studying the role that early care and education programs nationwide can play in strengthening families and preventing abuse and neglect. After developing the overall framework and related training materials, CSSP implemented the model in seven states on a pilot basis.

Importance of child psychology

In each state, officials enhanced their policies and practices through collaboration among their early childhood, child abuse prevention, and child protective services sectors. At present, twenty-three states are participating in the Strengthening Families National Network. Parents who have strong social connections, knowledge of child development, and a sense of personal efficacy are indeed among those who have the most rewarding relationships with their children, and these children are more likely to have strong self-perceptions and robust cognitive and social development.

The first is assumptions regarding the number of child care centers with the capacity and motivation to engage in the type of self-reflection and practice change required to adopt fully a focus on enhancing protective factors. The second is the belief that child care centers have contact with large numbers of families who need this type of assistance to avoid abuse. The third is the belief that the relationship of child care centers with families is sufficiently robust to meet the needs of the high-risk families they do encounter.

The fourth is the view that social networks built around child care centers can shape normative standards regarding how to care for a child, as opposed, for example, to merely reflecting existing standards that may or may not be appropriate. The fifth is the assumption that child care centers have access to the array and quantity of material support and mental health services that families may need or request.

Creating Community Responsibility for Child Protection: Possibilities and Challenges

And the sixth is the assumption that families have chosen a given child care center from an array of available options and therefore have a more personal relationship with their care provider than they do with other service providers. Although the program has anecdotal evidence to support all of these assumptions, the ability of the SFI to achieve normative change within local child care and early care networks and to provide families with sufficient support to reduce maltreatment rates remains untested.

There are no published reports of program efficacy using a rigorous design and no known trials under way. The Durham Family Initiative DFI is a population-wide effort to expand the consistency and scope of universal assessments designed to identify high-risk families or those needing prevention services and then to link them with appropriate community-based resources. One is to enhance community social and professional capital and improve community capacity to provide evidence-based resources to families. To reach these goals it focuses on universal assessment and referral.

Established with funding from the Duke Endowment in , the initiative posits that child abuse is best prevented by addressing the risk factors and barriers that affect the healthy development of parent-child relationships. Adopting an ecological perspective, DFI works to strengthen and expand the pool of available evidence-based direct services, to identify and secure meaningful public policy reforms, and to build local community capacity.

Its activities fall into four main areas. First, it fosters local interagency cooperation regarding adoption of a coordinated and consistent preventive system of care. Second, it increases social capital within a number of Durham city neighborhoods through the targeted use of outreach workers and community engagement activities. Third, it develops and tests innovative direct service models to improve outcomes with high-risk families or those already involved in abuse or neglect, while also increasing supports for high-risk new parents through early identification and service referrals.

Finally, it reforms county and state policies affecting the availability and quality of child welfare and child protection services. It is based on the view that key public and private health and human service agencies must share a consensus on how best to identify, engage, and meet the needs of troubled children and their families. This consensus has developed gradually, beginning in with initial meetings among key agency directors and their middle management.

Building on relationships established during these meetings, the effort has expanded to provide theory-to-practice training across a diverse set of local agencies and community professionals. Most recently, project staff members assisted the local system of care leadership team in writing a cross-agency manual, developing a quality improvement and evaluation plan, and expanding the system of care to include an adult focus. Project staff members also have used the lessons learned from their collaboration within Durham County to advocate and support statewide reforms.

The process generated such neighborhood projects as community day activities, resource centers, language classes, neighborhood watch programs, and emergency food and clothing distribution centers. More recently, efforts to strengthen the informal systems of support among local residents in these communities have been fostered through a leadership training program developed in partnership with the Durham Housing Authority and DFI efforts to recruit, train, and link grandmothers in the community to women struggling with the care of young children.

Piloting began in July , when DFI began planning an aggressive campaign to provide an initial assessment and facilitate appropriate service linkages for the estimated 4, babies born each year in the county. Durham Connects will be grafted onto existing early-intervention services that now give approximately 85 percent of all infants access to a pediatric practice visit within forty-eight hours of their births. Its goal is to augment these services with a more comprehensive psychosocial assessment and to expand coverage to the families of newborns that are not now offered or do not accept these visits.

The assessment will be conducted by a nurse, most likely during a home visit. In addition to completing the standard risk assessment protocol, the home visitor will ensure that the family is linked to a medical provider and that any immediate needs identified through the risk assessment are addressed through an appropriate service referral. By building on the existing network of well-baby care within Durham County, DFI staff members believe they can provide universal coverage to all newborns and effectively link families to needed services.

Among children from birth to age seventeen, the rate of substantiated child maltreatment in Durham County fell 49 percent between —02, the year before the DFI began, and In contrast, the rate for the mean of five demographically matched comparison counties in North Carolina over the same period fell just 21 percent. Of particular interest is the recidivism rate, that is, the rate at which children who have been assessed for possible maltreatment by the Division of Social Services must be reassessed within six months.

A high rate would indicate a failure of the professional system to respond adequately. Among children from birth to age seventeen, the reassessment rate in Durham dropped 27 percent between —02 and In contrast, the rate for the mean of five demographically matched comparison counties over the same period dropped 15 percent. Independent sources provide additional information.

Anonymous sentinel surveys were completed with 1, family-serving professionals in Durham and one comparison county Guilford in and Estimates of the proportion of children who had been neglected decreased 18 percent in Durham but only 3 percent in Guilford. Witnesses who may be disturbed by cases in which adults punish children too severely usually hesitate to intervene Oldenburg, In one random survey, only 17 percent of observers acted to stop someone from hitting a child National Committee for Prevention of Child Abuse, Factors that affect the willingness of bystanders to intervene on behalf of children who are inappropriately disciplined by parents or caretakers have not been well studied although uncertainty about appropriate forms of response has been suggested as a significant factor.

The vague distinction between acceptable discipline and abuse also may discourage intervention. Social psychology literature on bystander behavior, which seeks to identify situational and individual factors that promote altruistic or prosocial intervention in public, may be useful in future studies of cases of child maltreatment Davis, ; Korbin, Prevention efforts in the exosystem show promise, especially in the design of multisystem approaches that can build on family-school-community approaches.

The community mental health approach, and examples of media and community-based interventions designed to reduce smoking and heart disease, represent much promise, but such efforts are only beginning to be developed and evaluated in the area of child maltreatment. Well-designed program evaluations that consider interactive effects of various types of individual, family, and community-based intervention are crucial for developing a knowledge base to guide future efforts. For example, we often do not know if current interventions produce long-term changes in knowledge, skills, and behavior.

We also do not know if prevention programs in selected areas of physical or sexual violence involving peers or adults can be generalized to incidents involving child maltreatment by trusted adult figures. Gaining such knowledge will require studies that follow cohorts of sample populations over time, to identify the strength of various program components and the requirements of special populations, such as children who have already experienced abusive behaviors, in designing effective prevention programs. As noted in Chapter 4, the macrosystem consists of fundamental values and cultural norms that affect public, private, and institutional behaviors.

In selected areas of public health interventions, cultural values are an important element in changing behavior that fosters adverse consequences. Examples that illustrate this point include the rapid change in American values on issues such as smoking, diet, and exercise. As a result, prevention programs increasingly focus on ways to foster social perceptions and cultural changes that would foster the well-being of children. One such approach is encouraging the use of ''time outs" to reduce the use of spanking and other forms of physical punishment in child discipline behaviors.

Several areas in the macrosystem have relevance for research on the prevention of child maltreatment. No research data have suggested that corporal punishment promotes child well-being. Despite the suggestion by several scholars that corporal punishment may be a major risk factor for physical abuse, the idea that spanking puts a parent at risk of going too far and engaging in physical abuse is not mentioned in publications issued by the National Center on Child Abuse and Neglect the major federal agency.

One content analysis by Straus and Yodanis of books on child abuse found that only 12 percent included an unambiguous recommendation that corporal punishment should not be used. Reliance on corporal punishment by American parents has been identified by some researchers as an important risk factor for physical abuse Gelles and Straus, ; Gil, ; Kadushin and Martin, ; Straus and Kaufman Kantor, ; Straus and Yodanis, ; Zigler and Hall, But corporal punishment is usually not dealt with in programs to prevent physical abuse, possibly a result of the absence of experimental evidence showing that reduction of corporal punishment reduces the risk of physical abuse as well as the existence of cultural norms in American society that support the use of corporal punishment Greven, Advisory Board on Child Abuse and Neglect has recommended that the use of corporal punishment should be eliminated in all activities and facilities which receive federal financial support.

However, corporal punishment is almost universally regarded by the general public as legally and morally correct and "sometimes necessary" Straus and Kaufman Kantor, It is almost a counterintuitive reversal of thinking about parental practices for parents to conclude that corporal punishment should not be practiced. Consequently, unless an explicit "no hitting of children" element is included in prevention programs including parent education,.

Research is needed on whether the inclusion of a no-hitting element in such programs reduces physical abuse. The use of criminal sanctions is an important aspect of prevention of child abuse because of the popular belief that strict legal standards and punitive measures will reduce the incidence of child maltreatment. In the area of sexual abuse, some offenders are so incapable of change that they must be incapacitated by incarceration. Nevertheless, the use of criminal penalties to deter offenders and the development of judicial and administrative procedures to remove children from abusing parents may be counterproductive in many cases, particularly in situations involving parental offenders and mild to moderate forms of child abuse or neglect.

We currently lack evidence that criminal penalties deter child abuse or neglect, and reliance on criminal penalties offers few resources to improve the abilities of parents in dealing with their children. In considering the effectiveness of criminal sanctions in the area of child maltreatment, it is important to recognize the multiproblem character of abusive and neglectful families.

Many of these families are already involved with the legal system because of other behaviors, including substance abuse, juvenile delinquency, and other crimes. Assessment of the impact of criminal sanctions solely in the area of child maltreatment is quite challenging, since the perpetrators may be removed from the home in a variety of other ways involving the court system. Despite its limitations, the current base of evaluative research offers preliminary guidelines for shaping programs and systems. The panel's primary conclusion from this review is that comprehensive and intensive programs that incorporate a theoretical framework, identifying critical pathways to child maltreatment, offer the greatest potential for future programmatic efforts.

Many community-based intervention programs have demonstrated some impact on knowledge and attitudes, but their impact on abusive behavior toward children remains uncertain. While such programs may offer many advantages, little evidence currently exists that such interventions directly reduce child maltreatment.

New theoretical models that incorporate ecological and developmental perspectives have complicated the development of prevention research, but these models hold much promise, for they suggest multiple opportunities. Prevention research needs to be guided by rigorous evaluation that can provide knowledge about the importance of different combinations of risk and protective factors, the developmental pathways of various forms of maltreatment, and the importance of replacing or supplementing risk behaviors with compensatory skills.

As our knowledge of the etiology of child maltreatment improves, prevention interventions can adapt new theoretical frameworks that will highlight promising interactions and theoretical insights. Evaluations of home visitation programs, school-based programs for the prevention of sexual abuse and violence, and community-based child maltreatment prevention programs are quite limited. The majority of these evaluations are not controlled experiments, many are compromised by serious methodological problems, and many promising preventive interventions do not systematically examine program outcomes for child maltreatment Azar, ; Daro, ; Howing et al.

Children and families who are most at risk for child maltreatment may not participate in prevention interventions, and those who do may not be sufficiently motivated to change or will have difficulty in implementing skills such as "anger management" techniques in their social context, especially if they live in neighborhoods characterized as violent. To this end, a greater understanding is needed regarding how high-risk individuals and families view formal support systems and how members of both formal and informal systems can best work together to provide a consistent and comprehensive network of prevention services for communities at risk of multiple problems, including child maltreatment.

Expanded research also is needed on those high-risk individuals and families who successfully engage in prevention programs. More descriptive information is needed to determine the staff characteristics, outreach efforts, and service delivery methods most successful in reaching families at high risk for maltreatment. Once these factors are identified, their impacts on client retention and client outcomes need to be formally tested through well-designed program evaluations.

Research on child maltreatment prevention programs should be based on knowledge of the processes by which specific risk and protective factors lead to child maltreatment. As noted in Chapter 4, we do not yet know if the etiologies of the various forms of child maltreatment are similar or different. In the face of uncertainty, a diverse range of approaches to prevention research should be encouraged to explore promising initiatives. Recommendation Research on home visiting programs focused on the prenatal, postnatal, and toddler periods has great potential for.

The panel recommends that home visiting programs continue to be developed provided that they incorporate appropriate evaluation components. Such evaluations should include rigorous scientific measurements, appropriate measures of child abuse and neglect, and clarification of the theoretical assumptions that shaped the home visitation efforts. We currently lack knowledge about what programs work, for whom they work, and whether they influence child abuse and neglect directly via a reduction in child abuse and neglect or indirectly via changes in parental skills and parental characteristics such as depression, problem solving, fertility, or employment.

Both short-term and long-term benefits of programs need to be evaluated. Budgets for home visiting programs must be adequate to carry out such evaluations. Individuals with expertise in evaluation must be included in the program team. The panel makes the same recommendations for other early intervention service programs. The panel recommends that research on multiple models of home visiting and other early intervention services be funded, since no single model of home visiting has yet been shown to be the most effective.

Similarly, no single time period, length of programming, or intensity of program has been identified as the most effective although the literature suggests that the prenatal and postnatal periods are central, few programs have started home visiting service later; other research suggests that home visiting has to occur somewhat regularly to be effective.

The panel recommends that home visiting programs consider varying the time of onset and length of such programs. Programs could offer two or more different sets of service and evaluate the effectiveness of programs of varying lengths, following the scientific practices established in clinical trials. Other types of prevention programs often find that positive results are best maintained by offering either long-term, continuous services or, after a program ends, a short-term refresher or booster.

Such an approach should be considered for home visiting programs. Home visiting programs typically offer a number of services. Little is known about the mix of services that are necessary to enhance parenting and reduce child abuse and neglect although the current findings suggest that comprehensive services are most effective. Programs need to be initiated that vary on the type and number of services included; the efforts must be evaluated. Several approaches might be adopted, including direct comparisons of different arms of clinical trials, or from analyses of what program services individual families are actually receiving.

The panel recommends that evaluations of home visiting programs include descriptions of what goes on in visits, curriculum with clearly identified objectives the completion of which may be observed by the home visitor , and direct observation of home visitors in action.

Most home visiting programs have generally not been large enough to determine for whom the intervention is effective. Studies with sufficiently large and diverse samples to allow for subgroup analyses are strongly recommended. Of particular concern are mothers with a history of maltreatment of siblings, mothers of varying ages, and mothers with specific health habits smoking, alcohol use, etc.

Home visiting programs should also strive to involve immediate and extended family members who may have caretaking responsibilities for the child, including fathers, stepfathers, boyfriends, grandparents, and other relatives. Finally, evaluations of home visiting programs should examine results that link short-term outcomes for child maltreatment with other measures, such as maladaptive parenting.

Recommendation Research on child sexual abuse prevention needs to incorporate knowledge about appropriate risk factors as well as the relationship between cognitive and behavioral skills, particularly in situations involving known or trusted adults. Sexual abuse prevention research also needs to integrate knowledge of factors that support or impede disclosure of abuse in the natural setting, including factors that influence adult recognition of sexual abuse or situations at risk for child abuse. With a few notable exceptions, research on prevention of sexual abuse has been rare.

Very little is known about the psychometric properties e. Key research questions include the following:. To what extent do children's responses about the prevention of sexual abuse correspond to what they actually would do in the natural environment? What level of cognitive performance on prevention measures is associated with meaningful changes in the ability of children to modify their own abuse? Are there significant differences between children who have been abused and those at risk for abuse on their performance on prevention measures?

No records exist to determine the exact number or characteristics of children who have been exposed to sexual abuse prevention programs in the elementary schools, yet these children are in a unique position to inform us about preventive interventions. For example, some children may have been able to use prevention knowledge and skills to successfully prevent, avoid, or escape abuse; other children may have been unsuccessful in their efforts; some children may have been abused in situations or in ways that make prevention impossible; and many children may have reactions to or ideas about preventive intervention that could improve the delivery of these programs.

The field has generally ignored the criticisms, support, and ideas of children who are actual consumers of child abuse prevention programs, although a recent national survey of more than 1, children age 10 through 16 conducted by Finkelhor may provide new insights about the experiences of children who participate in victimization prevention programs Finkelhor, The tension in many prevention programs over the objectives of encouraging children to disclose abuse or helping children prevent future abuse has not been completely resolved.

Although a set of clinical ideas e. Research on the disclosure process in the natural environment of the child and evaluations of programs to increase disclosures of abuse might improve the development of new prevention and disclosure programs. The role of parents and other adults in the prevention of sexual abuse has also been a matter of current debate.

Critics have suggested that existing programs place too great a burden on children for the prevention of their own abuse, and that more effort should be directed toward learning how parents and other adults can become effective in preventing sexual abuse of children. Others in the prevention movement are suspicious of parents and have sought to introduce prevention programs in schools and elsewhere without prior parent permission. Few data exist to inform these concerns. Although parents with their own abuse histories may be less likely to recognize child abuse incidents or situations, no data has confirmed a parent's abuse history as a child risk factor for sexual abuse.

Factors such as the relationship between the adult and offender, the level of stress, attributional style, and a host of other factors may influence the ability of adults to identify and respond protectively to children around sexual abuse. Yet even when adults are well informed, it is not clear how much sexual. The identification of risk factors for sexual abuse is obviously useful in targeting prevention efforts toward those children in greatest need. Much of the research on risk factors for sexual abuse has been carried out with either clinical samples of sexually abused children or with college student samples, both of which have provided insufficient effort to determine whether certain factors e.

For example, clinical reports suggest that offenders do not abuse all children with whom they come in contact. Some children are selected over others, but it is not clear on what basis some children are selected and others are not. It is not currently known whether selection factors involve characteristics of the child, the offender, the environment in which the child is found, or other currently unknown factors. Research identifying such factors and the interplay among them may have clear implications for prevention interventions.

Recommendation Research evaluations are needed to identify the extent to which community-based prevention and intervention programs such as school-based violence or domestic violence prevention programs, Head Start, etc. Research is also needed on these programs to identify methodological elements such as designs that successfully engage the participation of at-risk communities that could be incorporated into child maltreatment prevention programs. If exposure to a greater number of risk factors increases the risk for violence and child abuse, then community-based prevention and intervention programs need to target multiple childhood risk factors in both the family and school domain as well as within the broader social context of the child e.

School-based programs are often limited because the child returns to the environment that contains many of the risk factors associated with violent behavior. Prevention and intervention programs targeted toward one or a few risk factors are not likely to have an impact on violent behavior and child abuse. Our recommendation is that prevention and intervention programs need to be comprehensive and intensive. In addition to recommending comprehensive and intensive programs that address multiple risk factors associated with violence and abuse, we recommend research evaluations of long-term interventions that involve home-school collaborations, supplemented by booster sessions at developmentally appropriate points in time.

Recommendation Evaluations of school-based programs designed to prevent violence and to improve parental skills are needed to identify the subpopulations most likely to benefit from such interventions and to examine the impact of school-based programs on the abusive behaviors of young parents.

Such evaluations should give particular consideration to the specific characteristics of participants who participate in school-based programs, including gender as well as social and cultural characteristics. School-based programs need to be designed for specific characteristics, risk factors, and the social context of the participants in order to determine who most benefits from selected programs.

Major prevention programs need to include a long-term follow-up as part of their evaluation. The evaluations of the school-based violence prevention programs described in this chapter were short term and basically assessed whether the intended skills and knowledge were acquired by the participant. None of the program evaluations included long-term assessments of outcomes. Evaluations of programs examine the characteristics of individuals who benefit from the programs. Most programs are evaluated by comparing the overall mean of the treatment and control groups. We recommend that the range of outcomes within the treatment group be examined in relation to specific characteristics of the participant.

Thus, in addition to asking "Does the program work? Programs need to be designed to take into account salient characteristics e. Perhaps the most important characteristic is the child's developmental level. Few of the programs we reviewed seem to take into account the participants' developmental level. For example, prevention programs for adolescents would need to be different from programs for preteens.

Adolescence is a period marked by a number of developmental issues, such as greater autonomy and shifting allegiance toward peers, emerging sexuality, and forming intimate relationships with members of the opposite sex, which need to be considered in developing prevention and intervention programs. Whenever possible, the development of prevention and intervention programs should be guided by theory and appropriate models and replicated in different schools.

Recognizing the current limitations of our understanding of the etiology of complex phenomena like child abuse, program devel-.

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One challenge facing prevention researchers is deciding which combinations of risk and protective factors, and which combinations of interactive systems, have the greatest potential to both influence outcomes and be effectively modified through intervention. Recommendation Research should be conducted on values and attitudes within the general public that contribute to, or could help discourage, child maltreatment.

The role of the media in reinforcing or questioning cultural norms in areas important to child maltreatment, such as corporal punishment, deserves particular attention. Important lessons can be learned from the role of the media in fostering healthy or unhealthy behaviors involving the use of alcohol, smoking, drug use, and condoms or safe sex practices. Research is needed that can identify significant pathways in addressing key factors and behaviors that affect child maltreatment, such as parental styles, the use of corporal punishment, alternatives to the use of violence in conflict resolution, and young children's relationships with strangers and abusive caretakers.

Rather than focusing solely on the sensational aspects of abusive cases, the media can play an important role in raising questions about the values that should be fostered in family relationships and the protection of children. Research is needed on whether specific advice to avoid corporal punishment and specific discussion of alternatives contribute to the effectiveness of prevention programs see Appendix B, Supplemental Views.

This includes home visitation programs, early childhood intervention programs, and violence prevention programs for schoolchildren. In connection with the latter, it should be noted that schoolchildren are much more likely to be victims of violence, such as slapping and hitting with objects, by parents than by peers. If school-based programs can teach children to voluntarily use time out to avoid violence, research is needed on whether the same can be done for parents. There is also a need for empirical research to determine the degrees to which criminal sanctions deter child abuse and the degree to which removal of children protects them from abuse, especially in cases of mild to moderate maltreatment.

Research involving case-control designs, which investigate the effect on families and children of mediation versus the use of criminal sanctions in cases of spouse abuse Sherman, shows that field experiments can be done within an ethically acceptable framework. Since the relative effectiveness of punitive compared with helping approaches could be different for physical abuse, sexual abuse, and neglect, each of these types of abuse may be analyzed distinctly. Sustained effects of early intervention programs are partly, but not primarily, due to alternations in cognitive functioning; for example, differences in intelligence and verbal ability test scores between children who did or did not receive early intervention services tend to dissipate by the middle of elementary school Lazar et al.

Later reductions in school failure and juvenile delinquency are hypothesized to be based on changes in parental commitment to and encouragement of their young children as well as familial functioning more generally Zigler, , as Bronfenbrenner predicted almost 15 years ago The four treatment groups are: 1 a control group that did not receive services but participated in the collection of evaluation data; 2 a minimal intervention group that received transportation assistance to attend medical appointments; 3 a group that received extensive nurse home visitors prenatally and transportation services; and 4 a group that received extensive nurse home visitors both prenatally and postnatally as well as transportation assistance.

The nurses provided parent education, made efforts to enhance family and other informal social supports, and initiated linkages with professional helpers in the community Olds et al. The evaluation is expected to be completed in Abrahams, N. Casey, and D. Daro Teachers' knowledge, attitudes, and beliefs about child abuse and its prevention.

Child Abuse and Neglect Azar, S. Hotaling, D. Finkelhor, J. Kirkpatrick, and M. Straus, eds. Barnard, K. Booth, S. Mitchell, and R. Telzrow Newborn nursing models: A test of early intervention to high-risk infants and families. Hibbs, ed. Baydar, N. Brooks-Gunn Effects of maternal employment and child-care arrangements on preschoolers' cognitive and behavioral outcomes: Evidence from the children of the National Longitudinal Survey of Youth. Developmental Psychology 27 6 Belsky, J.

Child Development 55 1 February Development and Psychopathology Benasich, A. Brooks-Gunn, and B. Clewell How do mothers benefit from early intervention programs? Journal of Applied Developmental Psychology Bennett, F. Guralnick and F. Bennett, eds. New York: Academic Press.

Berrick, J. Bierman, K. Coie, K. Dodge, M. Greenberg, J. Lochman, and R. Development and Psychopathology. Binder, R. McNiel Evaluation of a school-based sexual abuse prevention program: Cognitive and emotional effects. Child Abuse and Neglect 11 4 Boyer, R. Savageau Places Rated Almanac. New York: Rand McNally.

Table of Contents: Early prediction and prevention of child abuse :

Bradley, R. Casey, P. Barrett, B. Caldwell, and L. Whiteside in press Enhancing the home environment of low birthweight premature infants. Grors and D. Spiker, eds.


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