How does child maltreatment prevention work?
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Transcript of How does child maltreatment prevention work?
How does child maltreatment prevention work?
An informed perspective for practitioners and providers
Jennie G. Noll, PhDProfessor, Human Development and Family StudiesDirector of Research & Education, Network on Child Protection & Well-being, The Pennsylvania State University
Stephanie Bradley, PhDManaging Director, Evidence-based Prevention and Intervention Support Center (EPISCenter), The Prevention Research Center, The Pennsylvania State University
What is child maltreatment prevention?
Primary – prevent maltreatment BEFORE it happens
Secondary – prevent another problem that stems from child maltreatment (Intervention)
Targeted – prevent child maltreatment from occurring in an at-risk group
Embedded – prevent other public health problems by embedding primary prevention programs within child welfare
Public awareness campaigns designed to educate entire populations
public service announcements TV, radio, billboards, mass distribution of
brochures or other educational material
working with professional groups to change the way they think about and react to
opportunities for prevention
Primary Prevention Efforts
Family home visiting programsbringing a well-planned intervention to families who need it
emphasize outreachfamilies who might be unwilling or unable to participate in more formally organized services
combination of educational, supportive, orempowering goals
Primary Prevention Efforts
Nurse Family Partnership (Olds et al, 2007)
First-time disadvantaged mothers received home visits by nurses
Begins prenatally and extends until child’s 2nd birthday
Nurses promoted 3 aspects of maternal functioning:–health-related behaviors–maternal life course development–parental care of children
Primary Prevention Efforts
Parent education programs organized in an “academic” way, with planned“lessons” delivered to individuals or small groups
Specific educational goals (e.g.,): -pregnancy and delivery-child growth and development-parenting skills-knowledge of add’l resources
Primary Prevention Efforts
Child education programsattempt to make children less vulnerable targets for abuse
Primarily focused on sexual abuse prevention
School-based or Physician-based
Teach children self-protective skills“Good touch, bad touch”
Primary Prevention Efforts
Physician administered Educates parents in pediatric or prenatal practice
“I will not shake my baby” contracts
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Home visitation (mixed results; Bell 2012 meta analysis)
Nurse Family Partnership (NFP) (best)Early Start (New Zealand) (promising)
Parent training programsTriple P Positive Parenting Program (promising)
Physician administeredAbusive head trauma education programs (promising)Enhanced pediatric care (promising)
Primary Prevention Efforts
Effective for Physical Abuse and Neglect? Nurse Family Partnership (Olds et al, 2007)Reduced child physical abuse and neglect as measured by official child protection reports
Reduced associated outcomes such as injuries in children
Nurse home visitation did not prevent recurrence of physical abuse or neglect (RCT) (MacMillan et al., 2005)
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Early Start (Fergusson et al., 2005, 2013)
Reduced associated outcomesinjuries and hospital admissions for child abuse and neglect
Rates of child protection reports did not differ between the intervention and control groups
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Paraprofessional home visitation e.g., Hawaii Healthy Start Program Healthy Families America
Have not been shown effective in reducing child protection reports
Primary Prevention Efforts
Home visiting programs are not uniformly effective in reducing child physical abuse and neglect (Rubin, 2013)
Any home visiting program should not be assumed to reduce child abuse and neglect
Every Child Succeeds (Ammerman, et al., 2013)Home-visiting maternal depression prevention program showed reduced effectiveness for mothers who were sexually abused as children
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Triple P – Positive Parenting Program
Population-level group-based supports for families
use of media/information strategiesconsultations with parents seminarsactive skills training
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Triple P – Positive Parenting Program
Positive effects on substantiated child protection services reports, out-of-home placements, and reports of injuries
Analysis is not clear and concerns about methods (Wilson et al., 2012)
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Physician Administered
Abusive head trauma education
Positive effects from one study suggest that hospital-based educational programs can reduce abusive head injuries (shaken impact syndrome) (Dias et al., 2005)
Primary Prevention Efforts
Effective for Physical Abuse and Neglect?
Physician AdministeredEnhanced pediatric care program for families at risk “Safe Environment for Every Kid” (SEEK) (Dubowitz et al., 2009, 2012)
Training physicians to identify family problems social worker is available
Promising effects in enhancing physicians’ abilities decrease risk factors and physical abuse rates
Primary Prevention Efforts
Effective for Sexual abuse?
Unknown if educational programs reduce occurrence of child sexual abuse
Some evidence that they improve children’s knowledge and protective behaviors
Could have some adverse effects(Zwi et al., 2007)
Primary Prevention Efforts
Emotional abuse?
Attachment-based interventions designed to improve insensitive parenting and infant attachment insecurity
No direct evidence that these interventions prevent emotional abuse (Bakersman-Kranenburg et al., 2003)
Primary Prevention Efforts
For Parents in the Child Welfare System
SafeCare (Chaffin et al., 2012)home-based, structured behavioral skills focused on caregiving, parenting, household management
SafeCare reduced recidivism compared with usual home-based services
Secondary Prevention Efforts
Recurrence of physical abuse and neglect
Parent-child interaction therapy (PCIT) behavioral approach to
skills training
PCIT reduced recurrence of child protection services reports of physical abuse but not neglect (Chaffin et al., 2004)
Intervention / Treatment
Impairment following sexual abuse
Trauma-focused cognitive-behavioral therapy (TF-CBT) (Cohen et al., 2004)
cognitive reframing positive imageryparent management training problem solving
Reduced internalizing and externalizing symptoms among children with PTSD symptoms
Intervention / Treatment
Out-of-home care
Placement in foster care and not reunifying with biological parents can lead to benefits for maltreated children
Enhanced foster care can lead to better mental health outcomes for children than traditional foster care
Conflicting evidence about kinship care compared with traditional foster care
Intervention / Treatment
Thinking about “Imbedded Prevention” within the child welfare system?
Abused children are at high risk for a host of conditions of grave public health concern:
-teen pregnancy (Noll & Shenk, 2013)-obesity (Noll, et al, 2007)-substance use (Fergusson, 2010)-high-school drop out (Noll, et al,
2010)
Children already in the child welfare system are prime targets for primary prevention of these problems
Next Steps for Sexual Abuse
Sexual abuse prevention needs more attention:-understanding perpetrator-community awareness-increased resources for increased
awareness-training professionals to spot outward signs
Sexual-specific modules added to:-SafeCare-Adult treatments shown to be less
effective for sexual abuse survivors
Maltreatment
HPA axisdysregulation
Brainmaldevelopment
Neurocognitiveimpairment
High-risk Social/Emotionalfunctioning
Outcomes: Alcohol, tobacco substance use
Neurocognitive mechanisms for Alcohol and Substance Abuse
Psychological Mechanisms for Alcohol and Substance Use
Trauma
PTSD
Re-experiencing
symptoms
Avoidantsymptoms
Arousalsymptoms
Numbingsymptoms
Alcohol and Substance Abuse
Specifics for substance usetreatment
Trauma-focused therapies not as effective for SUD patients
SUD treatments not as effective for trauma victims
Other examples????
Break Out Session
• how does child maltreatment or child trauma affect your efforts?
• in what ways has maltreatment or trauma been apparent in youth you serve?
• what resources to address maltreatment or trauma do you have access to?
• what types of trauma-informed care are you/your organization using?
Brain Storming
Resources
Training for TF-CBThttp://tfcbt.musc.edu/
https://www.childwelfare.gov/preventing/
SafeCarehttp://safecare.publichealth.gsu.edu/
Next Steps:
Data integration to implore public health investment
Distribution of Total Medicaid Beneficiaries and Spending
63%
37%
90%
10%
Under ACA70% of children in
protective services are Medicaid eligible
Ferris, et al., 2010
Putnam-Hornstein, 2013
The Power of Linked-data to show that children in protective services should be
targeted for a host of public health problems
Putnam-Hornstein, 2013
Death From Unintentional Injury
Putnam-Hornstein, 2013
Death From Intentional Injury
Integrated data systems to identify high-risk kids for coordinated care
Electronic Med Records: 1. Hospitalizations 2. ER visits 3. Vitals / Dx -T1D -BMI 95th% 4. STI
Criminal Justice:1. Self
2. Parent
Census Data: 1. high risk zip code 2. crime stats 3. poor schools 4. few parks 5. other
Public Schools: 1. missed days 2. poor grades/test scores 3. dropouts 4. truancy 5. other
Program A Program B Program C
CPS:sexual abuse
physical abuseneglect
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Partnerships for Prevention
Prevention Research Center (PRC)
Penn State University
College of Health & Human Development
EPISCenter
The Network on Child Protection and Well-Being
Social Science Research Institute
Foundational Center
Affiliate Center
The EPISCenter is a project of the Prevention Research Center, College of Health and Human Development, Penn State University, and is funded by the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare.
Multi-Agency Steering Committee(Justice, Welfare, Education, Health)
Support to Community Prevention
Coalitions
Improve Quality of Local Innovative Programs and
Practices
Support to Evidence-based
Prevention & Intervention Programs
Intermediary and State-level Prevention Support System
Evidence-based Prevention and Intervention Support Center (EPISCenter)
Evidence-based Prevention and Intervention Support Center (EPISCenter)
public health model:- use data- to identify and prioritize risk & protective factors- to select and implement evidence-based
programs- sustain and evaluate programs
- achieve public health impact
Evidence-based Prevention and Intervention Support Center (EPISCenter)
objectives:- connecting policymakers, researchers, program developers, and
communities
- promoting use of the public health model
- achieving public health impact in reducing youth violence, delinquency,
substance use
The EPISCenter is a project of the Prevention Research Center, College of Health and Human Development, Penn State University, and is funded by the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare.
Evidence-based Prevention and Intervention Support Center (EPISCenter)
Key objectives:- connecting policymakers, researchers, program developers, and
communities- achieving public health impact in
reducing youth violence, delinquency, substance use
Data Collaborationsintegrating systems data (proposition*):PA Commission Crime & Delinquency (planning agency)Dept. of Public Welfare (OCYF, OMHSAS, BJJS)Juvenile Court Judges Commission- how much “overlap” in youth served by each system?- if we prevent trauma, do we prevent juv. justice involvement?
research in progress:Bumbarger & Frank – investigating adult criminal justice population and preventable issues in adolescence
Integrated data systems to identify high-risk kids for coordinated care
Electronic Med Records: 1. Hospitalizations 2. ER visits 3. Vitals / Dx -T1D -BMI 95th% 4. STI
Criminal Justice:1. Self
2. Parent
Census Data: 1. high risk zip code 2. crime stats 3. poor schools 4. few parks 5. other
Public Schools: 1. missed days 2. poor grades/test scores 3. dropouts 4. truancy 5. other
Program A Program B Program C
CPS:sexual abuse
physical abuseneglect
1 2 3 4 5 6 7 8