Child maltreatment interventions not shown to prevent abuse and neglect

1. In this systemic review, interventions from primary care were not found to reduce reports to child protective services or result in a lower likelihood of the child being removed from the home.

2. Insufficient evidence exists to associate primary care interventions with injuries, failure to thrive, and school attendance.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: Child maltreatment can result in negative physical and emotional health consequences that can persist throughout a lifetime. A review of the literature was conducted to inform the United States Preventive Services Task Force Evidence (USPSTF) of interventions for primary care to prevent child maltreatment. This review was used to update the 2013 USPSTF recommendations. This report suggests that there is no association between interventions to prevent maltreatment and reports to child protective services or removal of the child from their home. Furthermore, there were no associations found between interventions and outcomes for emergency department visits, hospitalization, developmental milestones, academic achievement, and mortality.

The conclusions from this review are limited in that they apply to children that do not have a history of abuse. Thus, results are not applicable to children who have experienced recurrent maltreatment. Additionally, results from the studies included in this review do not address the harms of primary care interventions, and as such, the consequences of these interventions are not fully known.

Click to read the study in JAMA

Relevant Reading: Primary care interventions to prevent child maltreatment: U.S. Preventive Services Task Force Recommendation Statement

In-Depth [systematic review and meta-analysis]: This study identified 33 publications for inclusion by searching PubMed, Cochrane Library, EMBASE, and trial libraries from November 1, 2011 to December 18, 2017. In all, these publications included 22 randomized control trials and 11,132 children. 95% (n= 21) of these studies included a home-visit component and 73% (n= 16) were conducted in the United States. The duration of the interventions from these studies ranged from 3 months to 3 years. Interventions were not found to significantly reduce reports to child protective services (pooled OR 0.94; CI₉₅ 0.72-1.23) or result in a lower likelihood of the child being removed from the home (pooled OR 1.09; CI₉₅ 0.16-7.28). Insufficient evidence exists to associate primary care interventions with injuries, failure to thrive, and school attendance. Inconsistent evidence is available to draw conclusions regarding long-term reports to child protective services and emergency department visits. No eligible trials on the harms of primary care interventions were identified.

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