Child maltreatment prevention: a systematic review of reviews

In the paper

“Three of them -home visiting, parent education and child sexual abuse prevention -appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on.”

In the paper

“An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low-and middle-income countries and make up only 0.6% of the total evidence base.”

• Also stated in: § Geographical distribution of the evidence · plain

  “Of the 298 publications on outcome evaluation studies included in the reviews, 296 (99.4%) were on studies in high-income countries (around 83% in the USA), two (0.6%) in middleincome countries -a study on a sex abuse prevention programme in China and another on kangaroo mother care and the mother-child bond in Colombia -and none in low-income countries”

In the paper

“Of the 3299 titles identified through the search strategy, 26 met the inclusion criteria (Table 1).”

In the paper

“Overall, these reviews suggest that early home visitation programmes are effective in reducing risk factors for child maltreatment, but whether they reduce direct measures is less clear-cut.”

In the paper

“Of the 26 reviews that satisfied the inclusion criteria, 17 summarized evidence on early childhood home visitation programmes (Table 1) based on 149 publications on individual outcome studies and several further reviews.This made it the most extensively evaluated type of intervention.”

In the paper

“The 26 reviews included summarized 298 publications on primarily single outcome evaluation studies and another 85 reviews and commentaries.”

In the paper

“Yet research on the effectiveness of universal and selective interventions appears to be almost exclusively the affair of English-speaking, highincome countries.”

In the paper

“The evidence, in relation to actual child mistreatment, on the three remaining types -child sexual abuse prevention, media-based interventions and social support and mutual aid groups -is either insufficient or mixed.”

In the paper

“Other reviews concluded, however, that while the evidence shows improvements in risk factors for child maltreatment, evidence of an effect on actual child maltreatment remains insufficient.”

In the paper

“These reviews are all but unanimous in the finding that, on the one hand, school-based interventions to prevent child sexual abuse are effective at strengthening protective factors against this type of abuse (e.g.knowledge of sexual abuse and protective behaviours) and, on the other, that evidence about whether such programmes reduce actual sexual abuse is lacking.”

In the paper

“Direct measures of child maltreatment were used in less than one-third of the publications on outcome evaluations (Table 4), and in around 64.4% of them, risk factors were used as an indicator of child maltreatment.The proportion of direct measures was highest (44.3%) for early home visiting programmes, considerably lower (17.4%) for parent education programmes, and exceedingly low for child”

In the paper

“Of the 298 publications on outcome evaluation studies included in the reviews, 296 (99.4%) were on studies in high-income countries (around 83% in the USA), two (0.6%) in middleincome countries -a study on a sex abuse prevention programme in China and another on kangaroo mother care and the mother-child bond in Colombia -and none in low-income countries (Fig. 1).Of all publications, 290 (almost 97”

In the paper

“Two methodological weaknesses of the outcome evaluation studies were repeatedly highlighted in the reviews themselves: weak internal validity and inappropriate outcome measures.”

In the paper

“The analysis of internal validity showed that some 15% of the publications included in the reviews failed to use a control group, and that for child sexual abuse prevention and parenting education the proportion increased to 18.9% and 23.9%, respectively.”

In the paper

“Cuatro de las siete (visitas a domicilio, educación de los padres, prevención de los traumatismos craneales por maltrato e intervenciones con múltiples componentes) fueron prometedoras para evitar que se produzca el maltrato infantil.”

In the paper

“Three reviews, which included a total of seven publications, discussed multi-component interventions”

• Also stated in: § Multi-component interventions · plain

  “A metaanalysis found the effect size of multicomponent interventions to be 0.58.14”

What the sources say

• Not checked yetcites [14]

In the paper

“Two reviews focused on social support and mutual aid groups aimed to strengthen parents' social network.MacLeod & Nelson found an effect size of 0.38 for interventions that used risk factors for child maltreatment as an outcome, 14 whereas Barlow et al. conclude that such interventions are not effective.9”

What the sources say

• Not checked yetcites [14]
• Not checked yetcites [9]

In the paper

“MacLeod & Nelson, based on two studies (only one of which was included in the two other reviews) found a large effect size (1.26) in the reduction of risk factors for child maltreatment for this type of intervention.14”

What the sources say

• Not checked yetcites [25]
• Not checked yetcites [33]
• Not checked yetcites [14]

In the paper

“Three of the reviews were of low quality (i.e.AMSTAR scores between 0-4), 10 were of moderate quality (5-8), and two, including the Cochrane Review by Zwi et al., were of high quality (9-11) 16 (Table 2).The overall mean AMSTAR score for the 15 systematic reviews included in this study was 6.3 (standard deviation, SD: 1.88).”

What the sources say

• Not checked yetcites [16]

In the paper

“The minimum standards for the research designs of the studies included were specified in 17 of the 24 reviews (excluding the reviews of reviews).In six of the 11 reviews that included studies with no control group, the latter comprised 20% or more of the total, and in one case, as much as 50%, In 11 of 24 reviews, the proportion of outcome evaluations in which risk factors for child abuse were the”

In the paper

“Non-randomized controlled designs were used in about 27.5% of the publications overall and in 21.5%, 39.1% and 31.1% of the publications on home visiting, parent education and child sexual abuse prevention, respectively.”

In the paper

“retrospective and prospective studies have established that child maltreatment has strong, long-lasting effects on brain architecture, psychological functioning, mental health, health risk behaviours, social functioning, life expectancy and health-care costs.”

What the sources say

• Not checked yetcites [1]
• Not checked yetcites [2]

In the paper

“Both reviewers assessed the full text of all reviews in light of the inclusion criteria.Uncertainties were discussed and consensus was reached in all cases.”

In the paper

“epidemiological data on and policies and programmes against child maltreatment are conspicuously lacking in most low-and middle-income countries”

What the sources say

• Not checked yetcites [8]

In the paper

“epidemiological studies have clearly established that child maltreatment is not peculiar to the West but a truly global phenomenon that occurs in some lowand middle-income countries at higher rates than in wealthier countries.”

What the sources say

• Not checked yetcites [5]
• Not checked yetcites [6]

In the paper

“A second reviewer independently screened 25% of the studies identified and previously screened by the first reviewer.”

In the paper

“evidence strongly suggests that treating and later trying to remedy the effects of child maltreatment are both less effective and more costly than preventing it in the first place.”

What the sources say

• Not checked yetcites [7]

In the paper

“AMSTAR, a measurement tool for the assessment of multiple systematic reviews that has good reliability and validity.36,37”

What the sources say

• Not checked yetcites [36]
• Not checked yetcites [37]

In the paper

“Evidence for the effectiveness of each main type of intervention was graded independently by two reviewers (Table 1) with an adaptation of a pre-existing system, 35 and there were no disagreements.”

What the sources say

• Not checked yetcites [35]

In the paper

“The empirical examination of surveillance bias, a problem affecting outcome measures in home visiting evaluations, suggests that its importance is often exaggerated and that it rarely substantially alters findings.45”

What the sources say

• Not checked yetcites [45]

In the paper

“Furthermore, the mean number of times individual publications were included in the reviews was 1.68, which suggests that searches were less than comprehensive.”

In the paper

“It is important to emphasize that when a particular type of intervention is judged to be promising, it may mean that only a single programme has been unambiguously shown to be effective, as is the case for home-visiting programmes.”

In the paper

“The programme was found to reduce the in-cidence of abusive head trauma by 47%”

What the sources say

• Not checked yetcites [41]

In the paper

“Lastly, only the most easily accessible grey literature was searched.”

In the paper

“Third, in the case of four reviews it was not possible to separate the conclusions derived from the small number of”

In the paper

“Methods and standards for developing sound and effective child maltreatment Special theme -Childhood injuries and violence Review on child maltreatment prevention Christopher Mikton & Alexander Butchart prevention interventions are available and have been successfully applied.”

In the paper

“This study has revealed a woeful imbalance in the geographic distribution of child maltreatment prevention research: over 99% of the publications were on studies conducted in highincome countries, a parallel of the 10/90 gap in other areas of health research.”

In the paper

“Fourth, three other methodological quality dimensions of outcome evaluation studies -namely, treatment fidelity, statistical conclusion validity and descriptive validity -were not assessed.”

What the sources say

• Not checked yetcites [50]

In the paper

“However, its main conclusions -e.g. that more controlled trials using actual outcomes of maltreatment are needed -reinforce the main messages of this review.”

What the sources say

• Not checked yetcites [49]

In the paper

“Second, a recent review published in the Lancet was not included, since it appeared after this review was completed.”

What the sources say

• Not checked yetcites [49]

In the paper

“Although the quality of the non-randomized controlled studies was not assessed here, the internal validity of the research designs of most of these studies is generally considered to be weak.43,44”

What the sources say

• Not checked yetcites [43]
• Not checked yetcites [44]