Developing an early intervention programme to prevent child maltreatment

This paper describes the development and implementation of a programme to prevent child maltreatment in a multicultural, inner city community setting with very high rates of physical abuse and neglect. The rationale and philosophy underpinning the prevention programme is outlined. It has a unique approach, combining several features present to varying degrees in other home visiting programmes within a well‐structured framework. This includes the identification of vulnerable parents during the antenatal period, the use of generic health professionals (health visitors) in identification and intervention with families, an ‘active engagement’ strategy, the development of specialist non‐stigmatizing clinics for parents and the creation of a consultation service for generic workers. A variety of interventions are briefly described which are used to support vulnerable families. These include antenatal parenting workshops; baby massage; dedicated crying, sleeping and feeding clinics; and clinics to help parents manage toddler behaviour.Evaluation over the first 5 years of these clinics shows almost 75% of cases have successful outcomes. Copyright © 2001 John Wiley & Sons, Ltd.     

Teachers' role in the primary prevention of child abuse dilemmas and problems

During the 1980s, many school-based primary prevention programmes were developed and adopted by schools. Much of the early enthusiasm which greeted these programmes dissipated in the light of often disappointing evaluations of the impact of the programmes on children. It is argued, however, that evaluating student outcomes should not occur before theextent of programme utilization is established. In this paper, an overview is given on the dilemmas and problems faced by teachers attempting to implement a primary prevention programme in South Australia. It is revealed that teachers selectively omit sections of the primary prevention programme as a way of resolving personal dilemmas presented by the programme. Some teachers are sensitive about teaching personal and controversial issues related to child abuse, while others deny the seriousness of child abuse in theirschool. The implications of the findings are that: (a) it cannot be assumed that primary prevention programmes are implemented by teachers in ways that are consistent with programme design; (b) teachers' personal beliefs, attitudes and feelings need to be addressed in any school-based primary prevention initiative; (c) training approaches and school support mechanisms need to focus on methods by which teachers can resolve the dilemmas raised by school-based primary prevention programmes in ways other than by radically dismembering the programme.     

Validity in an evaluation of Healthy Families Florida—A program to prevent child abuse and neglect

Evidence-based continuums have become a guide for identifying the level of evidence in evaluations of home visiting programs conducted to determine their effectiveness in preventing child abuse and neglect. While randomized controlled trials are required for the highest levels of evidence, quasi-experimental designs have also been specified as an appropriate alternative. Using a quasi-experimental evaluation of a home visiting program to prevent child abuse and neglect that adheres to the Healthy Families America model, this paper describes and illustrates how types of validity can be improved. More specifically, we address how threats to internal validity can be identified and reduced through statistical techniques; how construct validity may be strengthened using state records to measure the outcomes; and how external validity is affected by including or excluding study participants. After applying a variety of statistical adjustments to reduce selection bias, we found that the outcomes favored the home visiting program and increased after accounting for covariates that contributed to child abuse and neglect. This was true across the statistical techniques (traditional covariate and propensity score adjustment) used. For evaluations using quasi-experimental designs, recommendations relevant to the illustrations in the paper are also presented.     

Delinquency prevention using family-based interventions

This paper reviews 24 evaluations of prevention programmes including some kind of family-based intervention (usually parent training or parent education), an outcome measure of offending or disruptive child behaviour, a high quality experimental design and a minimum sample size of 100. Programmes are divided into seven categories according to the context of the intervention: home visiting, day care, pre-school, school, clinic, community or multi-systemic therapy. Most interventions were effective in reducing childhood antisocial behaviour and later delinquency, and in some cases their monetary benefits exceeded their monetary costs. General parent education and more formal parent training are both effective prevention techniques. Research is needed to identify the active ingredients of successful programmes, and to establish why some large-scale programmes were not successful. Copyright © 1999 John Wiley & Sons, Ltd.     

Linking child maltreatment retrospectively to birth and home visit records: an initial examination

The study reported here tested the feasibility of linking administrative datasets for evaluation of home visiting as a strategy to reduce the incidence of child abuse and neglect. It also examined associations between maternal and child attributes coded in the birth record, and subsequent child maltreatment. The results show that home visiting efforts in Vermont were, in general, targeted to the populations most at-risk for child maltreatment. Mother's educational attainment, in particular, was identified as a potent correlate of child maltreatment, a finding with implications for high school dropout prevention and recovery efforts.     

Preventing child abuse: a review of community-based projects II: Issues arising from reviews and future directions

Detailed examination of evaluated community programmes for the prevention of physical child abuse and neglect shows that success depends on matching the skills of the staff to the needs of the families. The relative inefficiency of risk screening and attrition from prevention programmes argues for comprehensive as well as focused aspects of programmes and variation in which is available. Sexual abuse prevention programmes have usually been implemented in schools but are more successful when the focus includes bullying and when children and parents are also actively involved. This is also true of bullying programmes. In establishing risk for abuse, more effective methods are required to assess aspects of family life that are not readily observable, including involved but non-resident adult males. It is important not only to approach abuse prevention by intervening in different ways and at different points in the network of processes within and around the family, but also to find cost-effective ways of sustaining preventative efforts. © 1998 John Wiley & Sons, Ltd.     

Ensuring an Abuse-Free Environment:

Abuse and neglect of nursing home residents are recognized as a major concern in the United States. The small amount of research conducted to date concerning the extent and correlates of the problem of abuse highlights the need for specialized staff training in abuse prevention. The residents' right to be free from abuse demands that facility staff be equipped with an awareness of the types of abuse, how to recognize the potentially abusive situations, and how to appropriately defuse conflict. This paper describes the development and test implementation of an eight module abuse prevention curriculum designed specifically for nurse aides in long term care facilities.     

The financial abuse of mentally incompetent older adults: a canadian study

ABSTRACT This article reports the results of a pilot study on the financial abuse of mentally incompetent seniors. The objectives of the study were to: (1) establish the incidence of suspected financial abuse among the clientele of the Office of Public Trustee, Province of Manitoba, (2) identify the characteristics of mentally incompetent older adults most at risk, and (3) identify indicators of financial abuse. Approximately 20% of the cases opened in a one year period were under suspicion of abuse. Findings were consistent with those of other research projects on elder abuse, in general, showing an over-representation of women over the age of eighty as victims of financial abuse. Unpaid personal care home bills when money should have been available was the most common indicator. In addition to providing a list of indicators of financial abuse that are of potential use to professionals, devising prevention programs, practical implications for service providers are presented.     

Preventing child abuse; a review of community-based projects 1. Intervening on processes and outcome of reviews

Recent theories advocating ecological and developmental perspectives on child abuse and neglect are summarized. Reviews of community prevention programmes underline the importance of focusing on processes and viewing the developing child and their family in a broad context. The conclusions of the reviews are reported. Although the reviews suggest that some programmes to prevent physical and sexual abuse and bullying are at least to some degree effective, their impact has been reduced by a failure to encompass adequately the various influences that operate across difference domains of the child's life at different stages of their development. © 1997 John Wiley & Sons, Ltd.     

Home Visiting Family Therapy for Children at Risk

Home visiting has a long history in the areas of health and welfare (Baldock, 1990: 121). Early intervention through home visiting programs has been found effective in preventing abuse and neglect in many countries including the USA (Olds, 1992), Ireland (Johnson, 1993) and Europe (Cox, 1993). The success of these programs lay in their effectiveness in reducing social isolation, improving parenting skills and enhancing self esteem. This paper reports on the role of family therapy in home-based early intervention for families with newborn infants.     

Child abuse prevention: Blending research and practice

For over two decades, child abuse interventions have been plagued by poor definitions of what (or who) exactly is being treated, what constitutes ‘success’, and how services can be delivered in such a way as to minimize the harm to the child and to his/her family. Most recently, intervention/prevention programmes reflect the growing recognition that child maltreatment is the product of the interaction between the parent's abilities and resources and the child's emerging behavioural and emotional characteristics (i.e. the parent–child relationship), and place less emphasis on individual psychopathology. Accordingly, ways to strengthen this relationship offer considerably more promise than those aimed at correcting only one component (i.e. the parent) or treating only the visible symptoms of conflict. In an attempt to focus greater effort on prevention and early intervention, this paper reviews prominent risk factors that have been linked to physical abuse and neglect of children and their consequences. Major intervention targets are identified from this literature and discussed in reference to: (a) problems related to the family context; (b) child treatment needs; and (c) parent/caregiver treatment needs. The paper concludes with a discussion of promising developments in early intervention that are beginning to address problems in the early formation of the parent–child relationship (i.e. the pre-natal and infancy periods of development) and problems associated with parental competency and family support. Most notably, preventive efforts have been associated with more positive parenting knowledge, attitudes, skills, and behaviour, as well as fewer child injuries, emergency room visits, and reports to protective agencies among at-risk parents and children. Further evaluation and expansion of these programmes appears to be warranted by these data.     

The characteristics and management of elder abuse: evidence and lessons from a UK case study

Despite older people representing a significant majority of victims of abuse in the UK and Europe, evidence about its characteristics and management is limited. This article reports on an analysis of adult protection referrals for older people over an eight year period in two English local authorities. It extends understanding of the characteristics of elder abuse and identifies lessons for its effective management. Findings suggest that older people are at particular risk of multiple and physical abuse. Those living alone are especially vulnerable to financial abuse and those living in a care home to multiple abuse. The most common sites of abuse were the person's own home or a care home. Just two fifths of abuse referrals were confirmed, with the vast majority involving multi-agency consultation and most resulting in ongoing monitoring. Findings also suggest that risk is a product of the intersection of dependency and setting and that information about user and carer need—especially the nature of disability—could enhance the quality of adult protection data and safeguarding responses. The study underscores the need for adult protection legislation and of committing professional resources to the prevention, identification, assessment and management of elder abuse across Europe.     

Partnering with parents to prevent childhood sexual abuse

Although research demonstrates that child‐focused sexual abuse prevention programmes can teach children personal safety knowledge and skills, childhood sexual abuse (CSA) prevention programmes that involve parents have a number of distinct advantages. The more knowledge parents have about CSA, the greater likelihood they can create safer environments for their children and thus prevent the occurrence of sexual exploitation. Research has demonstrated that parents lack crucial information about CSA and can benefit from even brief educational efforts. This paper will identify potential barriers to participation and offer practical suggestions for enhancing both recruitment and retention rates. Recommendations for parent education programmes are offered, including improving parents' confidence and skills in educating their children about CSA, providing them with parent‐friendly materials to use and developing Internet applications. Copyright © 2010 John Wiley & Sons, Ltd.     

Issues in the development of a computer-based safety programme for children with severe learning difficulties

In the last decade, professional interest in and awareness of the sexual abuse of children has increased dramatically and has led to the development of safety programmes which aim to teach children a range of personal safety skills (Tutty, 1992). These efforts have previously concentrated on children in mainstream schools, but there is growing recognition of the need for parallel concern for children in vulnerable groups such as those with learning difficulties. The present paper outlines the development of a personal safety prevention programme for children with severe learning difficulties. The programme has incorporated work by Tutty (1992, 1994) and others who argue for a more developmental view in designing such programmes. Concepts such as the child's understanding about authority figures and moral development have been integrated into the programme, which utilizes multi-media technology. As this is a computer-based programme, the reason for such a medium rather than previously implemented presentation (e.g. books, film) are discussed. Views of the participants evaluating the implementation of the teaching package are also described. © 1998 John Wiley & Sons, Ltd.     

Prevention of child sexual abuse: implications of programme evaluation research

Thirty child abuse prevention programme evaluation studies were selected according to a set of methodological criteria following an extensive manual and computer literature search. Targets for intervention in 17 studies were children; in three parents; in four teachers; and in six studies multisystemic programmes were evaluated where some combination of children, parents and teachers was targeted for intervention. From a review of the 30 studies, it was concluded that child abuse prevention programmes can lead to significant gains in children's, parents' and teachers' safety knowledge and skills. Best practice guidelines arising from the review include the use of multisystemic programmes; child‐focused curricula which cover a wide range of safety skills and concepts; and the use of didactic instruction and discussion, video modelling and active behavioural skills training techniques in programme delivery. The curricula for parents' and teachers' programmes should cover child protection issues and local child protection procedures along with an overview of the children's programme lesson plans. Longer programmes conducted by trained staff are preferable and such staff may include teachers, parents, mental health professionals and law enforcement officers. Copyright © 2000 John Wiley & Sons, Ltd.     

Before the Welfare State: Public Health and Social Policy

Les changements apportés en matière de politique sociale de 1880 à 1920 ont joué un rôle déterminant dans l'établissement et la nature de l'État-providence. La santé publique était au premier rang de cette evolution. L'État a commencéà pénétrer dans les foyers par de nouveaux moyens, comme les programmes de visite à domicile lancés durant cette période. Dans notre étude, nous décrivons ces nouveaux programmes dans le contexte d'une transformation plus globale des politiques sociales, qui a amené l'État à assumer de nouvelles res-ponsabilités dans le domaine de la natalité.
Social policy developments in the period 1880–1920 played a crucial role in shaping the foundations of the welfare state. Public health was at the forefront of these developments, introducing new home visiting programmes that brought the state into the household in new ways. This paper sets these new programmes in the context of a broader transition in social policy in which the state began to assume new responsibilities in the reproduction of the population.     

Child sexual abuse: from prevention to self‐protection

There are a growing number of child abuse prevention and education programmes, including primarily group‐based parent and child education, which are taught by teachers within the school system. This article reviews some of the existing sexual abuse education and/or body safety programmes, as well as the research surrounding them. Advantages as well as criticisms of such programmes are reviewed. Issues such as target populations (i.e. children, teachers, parents), programme components and methodological limitations are addressed. Major findings include: children as young as three can be effectively taught self‐protection skills, parental and family involvement in training is important, and repeated exposure helps children maintain knowledge gains. The components of successful programmes include teaching children to identify and resist inappropriate touching, reassuring children that it is not their fault and learning the proper names of their genitals. Finally, future directions for programme development, research and policy are explored. Copyright © 2008 John Wiley & Sons, Ltd.     

The prevalence and nature of abuse and neglect in children under four: a national survey

This paper reports the results from a Danish national survey of child abuse and neglect. Data were obtained by a written questionnaire sent to all home health visitors. All newborn Danish children receive visits by a home health visitor several times during their first year of life. For children in need of special care for social reasons the visits may continue until school age (at 6 or 7 years). The questionnaire included four checklists of signs of abuse and neglect. The home health visitors were asked to record what they had actually observed visiting the children in their homes. Eighty‐three per cent (covering about 80% of all newborns) answered the questionnaire. The objective was to establish a scientific based framework that could be used to guide preventive efforts. Ten per cent of all children under 1 year of age may be characterized as children in need of special care for social reasons, the most frequent single reason being reliance on social assistance, alcohol abuse or violence against the mother. A minimum of 4% of infants are subjected to broadly defined abuse or neglect from one or more of the four categories: physical abuse, physical neglect, emotional abuse and emotional neglect, physical and emotional neglect being the most frequent and physical maltreatment the most rare. Copyright © 1999 John Wiley & Sons, Ltd.