Shelley S. Selph, MD; Christina Bougatsos, MPH; Ian Blazina, MPH; Heidi D. Nelson, MD, MPH
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Tracy Dana, MLS, for conducting literature searches, and Peggy Nygren, MA, for providing additional contributions to the report.
Financial Support: By AHRQ under contract HHSA-290-2007-10057-I-EPC3, task order 3.
Potential Conflicts of Interest: Dr. Selph: Other (money to author and institution): This work was based on a report that was supported by AHRQ. Ms. Bougatsos: Other (money to author and institution): This work was based on a report that was supported by AHRQ. Mr. Blazina: Grant (money to institution): AHRQ; Support for travel to meetings for the study or other purposes (money to institution): AHRQ. Dr. Nelson: Grant (money to institution): AHRQ; Support for travel to meetings for the study or other purposes (money to institution): AHRQ; Payment for writing or reviewing the manuscript (money to institution): AHRQ.
Requests for Single Reprints: Heidi D. Nelson, MD, MPH, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mail Code BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Selph and Nelson, Ms. Bougatsos, and Mr. Blazina: Oregon Health & Science University, Mail Code BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098.
Author Contributions: Conception and design: S.S. Selph, H.D. Nelson.
Analysis and interpretation of the data: S.S. Selph, C. Bougatsos, I. Blazina, H.D. Nelson.
Drafting of the article: S.S. Selph, C. Bougatsos, I. Blazina, H.D. Nelson.
Critical revision of the article for important intellectual content: S.S. Selph, H.D. Nelson.
Final approval of the article: S.S. Selph, C. Bougatsos, I. Blazina, H.D. Nelson.
Provision of study materials or patients: H.D. Nelson.
Statistical expertise: H.D. Nelson.
Obtaining of funding: H.D. Nelson.
Administrative, technical, or logistic support: C. Bougatsos, I. Blazina, H.D. Nelson.
Collection and assembly of data: S.S. Selph, C. Bougatsos, I. Blazina, H.D. Nelson.
In 2004, the U.S. Preventive Services Task Force determined that evidence was insufficient to recommend behavioral interventions and counseling to prevent child abuse and neglect.
To review new evidence on the effectiveness of behavioral interventions and counseling in health care settings for reducing child abuse and neglect and related health outcomes, as well as adverse effects of interventions.
MEDLINE and PsycINFO (January 2002 to June 2012), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the second quarter of 2012), Scopus, and reference lists.
English-language trials of the effectiveness of behavioral interventions and counseling and studies of any design about adverse effects.
Investigators extracted data about study populations, designs, and outcomes and rated study quality using established criteria.
Eleven fair-quality randomized trials of interventions and no studies of adverse effects met inclusion criteria. A trial of risk assessment and interventions for abuse and neglect in pediatric clinics for families with children aged 5 years or younger indicated reduced physical assault, Child Protective Services (CPS) reports, nonadherence to medical care, and immunization delay among screened children. Ten trials of early childhood home visitation reported reduced CPS reports, emergency department visits, hospitalizations, and self-reports of abuse and improved adherence to immunizations and well-child care, although results were inconsistent.
Trials were limited by heterogeneity, low adherence, high loss to follow-up, and lack of standardized measures.
Risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. Additional research on interventions to prevent child abuse and neglect is needed.
Agency for Healthcare Research and Quality.
Analytic framework and key questions.
* Child Protective Services reports, removal of the child from the home, and reports of abuse or neglect.
† Physical injuries, mental health conditions, use of health care services, adherence to immunizations and well-child visits, and other relevant health measures.
Summary of evidence search and selection.
* Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews.
† For example, identified by reference lists and suggested by experts.
‡ Includes search results for child, adult, and elderly populations. Studies of adults and elderly populations are included in a separate report (6), as are studies of children that predate this update (37).
§ Studies that meet inclusion criteria for key questions.
Trials of Child Abuse and Neglect Prevention Interventions
Enrollment Criteria for Trials of Child Abuse and Neglect Prevention Interventions
Main Results of Trials With Greater Than 50% Adherence to the Intervention
Summary of Evidence
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Selph SS, Bougatsos C, Blazina I, Nelson HD. Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Ann Intern Med. 2013;158:179-190. doi: 10.7326/0003-4819-158-3-201302050-00590
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Published: Ann Intern Med. 2013;158(3):179-190.
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