Child abuse prevention services have three primary goals: to reduce the overall incidence of abuse and neglect; to minimize the chance that abused children will be revictimized; and to “break the cycle” of abuse by providing victims therapeutic services to overcome the negative consequences of maltreatment. Efforts to do this can be provided on a universal basis (offered to all parents or all children); targeted basis (offered only to those who present one or more risk factors associated with an elevated risk for maltreatment); or indicated basis (offered to those who have already been abused in the hopes of preventing subsequent maltreatment and remediating the negative effects of abuse).
Evolution Of Prevention Services
Over the past 30 years, efforts to prevent child maltreatment in the United States have moved through three stages—public recognition of the problem, experimentation with a wide range of prevention programs that address one or more risk factors, and the evolution of systems designed to better integrate these diverse efforts.
Programmatic efforts to prevent child abuse and neglect have followed two distinct paths—interventions targeting reductions in physical abuse and neglect (including emotional neglect and attachment disorders) and interventions targeting reductions in child sexual abuse. Programs in the first group began with an emphasis on parental knowledge or parental behavior as the “cause” of maltreatment with services designed to address the cause (e.g., parent education workshops). Such programs have evolved in concert with the ecological paradigm to address the broader context in which the parent–child relationship develops. It is common for today’s prevention programs to focus on parental support networks, health care access, and parent–child interaction patterns, in addition to the more traditional emphasis on parental behavior or knowledge. Further, these programs tend to focus on new parents, offering assistance when a child is born or a woman is pregnant. Subsequent prevention services are then added to this universal base in response to the specific emerging needs presented by the growing child or the evolving parent–child relationship.
In contrast to these efforts, the target population for sexual abuse prevention has been potential victims, not potential perpetrators. Three factors contributed to this pattern: the social discomfort surrounding sexuality; the difficulty in developing voluntary treatment options for offenders; and the absence of clear risk factors identifying potential perpetrators or victims. Strategies within this framework include a number of educational-based efforts, provided on a universal basis, to children on the distinction between good, bad, and questionable touching and the concept of body ownership or the rights of children to control who touches their bodies and where they are touched. As children mature, these classes cover a broader range of concepts such as appropriate dating behavior, gender stereotypes, and nonaggressive conflict resolution strategies. These educational programs also offer children and youth service options or referrals if they have been abused or are involved in an abusive peer relationship.
Today, the concept of prevention is moving away from the notion of a single response agency or targeted intervention and more toward a communitywide system of shared responsibility and mutual support. The goal of altering both the individual and context provides a programmatic and policy response more reflective of the ecological theory often cited as the most appropriate in explaining the etiology of child maltreatment.
Evidence Of Success
Program evaluations and meta-analytic studies of child abuse prevention programs present a fairly positive picture. Early home visitation strategies, for example, are effective at reducing the likelihood that children will be reported as victims of child abuse and neglect or that they will need treatment for physical injuries or accidents. When the pool of relevant indicators is extended to include proximal indicators of a reduction in abuse potential or an increase in core protective factors, a number of additional strategies surface as promising. Interventions to enhance parental knowledge and skills, such as parent support groups, and strategies to protect children through child assault prevention programs also show positive results. It is important to note, however, that with this second group of strategies, a reduction in risk behaviors or change in attitude by the participants may enhance family functioning yet have little impact on aggregate rates of physical abuse and neglect.
Improving the quality and efficacy of prevention services requires new research in several areas. First, greater clarity is needed regarding the most accurate and appropriate way to measure prevention of child maltreatment. If maltreatment reports continue to be used as an indicator of prevention effectiveness, greater consistency is needed in how such reports are documented, including more careful identification and tracking of the type of maltreatment involved, the actual perpetrator, and the relative severity of the mistreatment.
Second, longitudinal research studies are needed that track the extent to which initial progress on various proximate outcomes is sufficiently robust to reduce subsequent maltreatment or involvement with child protective services. To the extent that prevention programs embrace the public health model and ecological theories of maltreatment, targeted outcomes for such interventions will include a dual focus on both risk and protective factors. Understanding how changes in various risk and protective factors can reduce subsequent maltreatment is essential for building better theory and enhancing program and policy effectiveness.
Finally, greater care needs to be taken to ensure that evaluative information is continuously collected and fed back into the decision-making process. Strengthening our knowledge base requires more consistent and rigorous attention to such issues as the characteristics of the target population, the rate at which programs successfully enroll and retain their population, the content of the services provided families, and the nature of the participant–provider relationship.
- Daro, D., & Cohn-Donnelly, A. (2002). Charting the waves of prevention: Two steps forward, one step back. Child Abuse & Neglect, 26, 731–742.
- Daro, D., & Cohn-Donnelly, A. (2002). Child abuse prevention: Accomplishments and challenges. In J. Myers, L. Berliner, J. Briere, T. Hendrix, C. Jenny, & T. Reid (Eds.), APSAC handbook on child maltreatment (2nd ed., pp. 431–448). Thousand Oaks, CA: Sage.
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