ArticlesEffectiveness of home visitation by public-health nurses in prevention of the recurrence of child physical abuse and neglect: a randomised controlled trial
Introduction
During the past two decades, interventions to prevent child abuse and neglect have been assessed increasingly in high-risk community samples in randomised controlled trials.1, 2, 3 Although recurrence of child abuse and neglect is common4, 5, 6 and is associated with negative health outcomes for children, most programmes aimed at preventing recidivism in families have not undergone such rigorous investigation.7 Wolfe and Wekerle7 have reviewed studies of interventions provided to families in which child maltreatment has occurred, but they draw attention to the “relative paucity of carefully designed studies”. They emphasise that the measure of success in home-based interventions is usually avoidance of alternative placement. Although important, this outcome is distinct from recurrence of maltreatment. Services provided to families associated with the child protection system are sometimes implemented without determining whether they prevent child abuse and neglect from happening again.8
Rates of recurrence in child protection system populations vary because of differences in methods and definitions.5 Some studies examined rates of reabuse by the perpetrator,4 whereas others examined revictimisation of children6, 9 or recurrence within families.5 In a review, DePanfilis and Zuravin10 concluded that there is no standard method for assessing recidivism of child maltreatment. Reported recurrence rates of child abuse and neglect in published work range from 9% to 67%.4, 5, 6, 8, 9, 11, 12 Clearly there is a need to develop interventions that prevent recurrence of child abuse and neglect. Since the best evidence for prevention of physical abuse and neglect in high-risk groups before it occurs comes from the nurse home visitation programme developed by Olds and colleagues,13, 14 we investigated whether a programme of home visiting by nurses would be effective in preventing recurrence of physical abuse or neglect in families in which it had already occurred.
Section snippets
Setting and participants
The study was done in Hamilton, Canada, a city in the south-central region of Ontario with a population of about 300 000 at the time of the study. We invited consecutive eligible families who were referred to the two local child protection agencies (CPAs) between Mar 24, 1995, and Oct 30, 1996, to participate in the study. Families were eligible if they met the following criteria: (1) the index child was younger than 13 years, (2) the reported episode of physical abuse or neglect occurred
Results
Figure 1 shows the trial profile. Table 2 summarises the characteristics of the 163 families randomised. CPA records were available for 72 of 74 (97%) control families and 88 of 89 (99%) intervention families. For other measures, figure 1 shows the proportion of families who completed follow-up. Losses were small and similar between the two groups. Parent non-completers were similar to completers for age, marital status, work status, education, spouse's work status and education, but not for
Discussion
On the basis of CPA records, the intensive 2-year programme of home visitation by nurses was not more effective than standard services in preventing recurrence. The incident severity findings and the proxy measures are consistent with this finding. We were surprised by the hospital data that showed a higher rate of physical abuse or neglect in the intervention group. This finding could have been the result of nurses identifying the need for medical care in children in the visited families,
References (30)
- et al.
Identifying correlates of reabuse in maltreating parents
Child Abuse Negl
(1988) - et al.
A survival analysis of the revictimization of children: the case of Colorado
Child Abuse Negl
(1994) - et al.
Treatment strategies for child physical abuse and neglect: a critical progress report
Clin Psychol Rev
(1993) - et al.
The effect of services on the recurrence of child maltreatment
Child Abuse Negl
(2002) - et al.
Reabuse rates in a sample of children followed for 5 years after discharge from a child abuse inpatient assessment program
Child Abuse Negl
(1995) - et al.
The repetition of child abuse: how frequently does it occur?
Child Abuse Negl
(1979) - et al.
What happens after the care and protection petition? Reabuse in a court sample
Child Abuse Negl
(1992) - et al.
Primary prevention of child physical abuse and neglect: a critical review—part I
J Child Psychol Psychiatry
(1994) Preventive health care, 2000 update: prevention of child maltreatment
CMAJ
(2000)- et al.
A review of programs to promote family wellness and prevent the maltreatment of children
Can J Behav Sci
(2001)
Survival analysis of risk factors for recidivism in child abuse and neglect
Child Maltreat
Rates, patterns and frequency of child maltreatment recurrences among families known to CPS
Child Maltreat
Preventing child abuse and neglect: a randomized trial of nurse home visitation
Pediatrics
Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial
JAMA
Factors predicting severity of physical child abuse injury: a review of the literature
J Interpers Violence
Cited by (134)
Desistance from physical abuse in a national study of Nepal: Protective informal social control and self-compassion
2023, Child Abuse and NeglectEffect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial
2020, Preventive MedicineCitation Excerpt :State child protection systems (CPS) respond to maltreatment reports and provide services to promote child safety. However, those services often lack scientific support, with large-scale trials documenting little impact on critical outcomes such recidivism, family reunification, and out of home placements (Littell, 1997; MacMillan et al., 2005; Chaffin et al., 2001; Westat, 2002; Schuerman et al., 1994). States have begun to adopt evidence-based interventions with documented improvements in these target outcomes, and recent federal child welfare legislation – the Families First Prevention and Services Act of 2017 – will accelerate the adoption of such programs.
A Systematic Review of Trials to Improve Child Outcomes Associated With Adverse Childhood Experiences
2019, American Journal of Preventive MedicineReducing maltreatment recurrence through home visitation: A promising intervention for child welfare involved families
2018, Child Abuse and NeglectCitation Excerpt :Nor is it clear to what extent families with child protective services involvement and prior substantiated maltreatment do participate in early childhood home visiting programs when parity is not a consideration for eligibility (Jonson-Reid et al., 2018). Consequently, research on the impact of home visiting programs for these families is underdeveloped as only a few trials have been conducted, with mixed results (Chaffin et al., 2012; Jonson-Reid et al., 2018; MacMillan et al., 2005). In this study, we investigate the long-term maltreatment outcomes from Healthy Families New York (HFNY)’s randomized controlled trial.