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Limited success for child abuse prevention programs

By Genevra Pittman

NEW YORK (Reuters Health) - Evidence is mixed on whether home visits and doctor's office interventions can help prevent child abuse, according to a new analysis - leading a government-backed panel to decide the data isn't convincing enough to recommend those programs.

Just as in 2004, on Monday the U.S. Preventive Services Task Force (USPSTF) said current evidence is "insufficient" to weigh the benefits and harms of screening for and trying to prevent abuse and neglect. Its draft statement is available for public comment here: http://bit.ly/aF5NPd.

"There have been quite a few studies done… (but) there's inconsistency in the results across these trials," said Dr. David Grossman, a member of the panel from Group Health Research Institute in Seattle. "I wish we could be more definitive on this."

In a review conducted for the USPSTF, researchers from Oregon Health & Science University in Portland analyzed 10 studies of child abuse prevention programs involving home visitors in the U.S., UK and New Zealand and one intervention done in a Baltimore clinic.

Those studies included families at higher risk of child abuse based on responses to questionnaires or referrals from midwives and nurses.

For the one intervention that didn't involve regular home visits, at-risk families were given materials about child abuse and referred to social workers.

Some of the programs were tied to a drop in Child Protective Services (CPS) family reports and kids' emergency room visits, according to findings published this week in the Annals of Internal Medicine.

But others found no link to the proportion of kids hospitalized - in general or specifically because of abuse or neglect - or to CPS contact with families.

"It looks like some progress is being made in terms of evaluating early childhood abuse prevention programs," said Elizabeth Letourneau, who studies child sexual abuse at the Johns Hopkins Bloomberg School of Public Health and didn't participate in the new review.

"The country is rightly concerned by reducing any type of abuse, and particularly by programs that address child abuse and neglect across the board," she added.

There's a need for more of those evidence-backed programs, Letourneau told Reuters Health, but also to focus on sexual abuse in particular - an area that is especially lacking when it comes to research, she said.

ALMOST ONE PERCENT ABUSED

According to the U.S. Department of Health & Human Services, about 675,000 kids were reported as victims of child abuse or neglect in 2011 - just under one percent of children nationwide. About nine percent of those kids were sexually abused.

Jane Barlow, a child abuse researcher at Warwick Medical School in Coventry, UK, said there's good evidence that at least one program, focused on teen moms, can help prevent child abuse.

It's more difficult, she added, when there are other issues in the home - for example, an older child who has already been abused or a mother who is a victim of domestic violence.

The best time to act to prevent abuse and neglect, Barlow told Reuters Health, seems to be while at-risk women are pregnant, using "intensive support from a range of practitioners."

Grossman told Reuters Health investigating the potential harms of child abuse prevention programs will also be important for future recommendations.

"We frequently think of removing (abused and neglected) children from the home as being a potential solution," he said - and often, it is. But, "Removing children from the home and placement in foster care carries its own harms associated with it."

While it's unclear how kids and their families should be treated when abuse is not occurring, Grossman said the draft recommendations don't change the need to act when there are signs of maltreatment already going on.

"We want to emphasize that child health care providers know well to look for signs and symptoms of abuse, and of course that doesn't change," he said.

SOURCE: http://bit.ly/Tg9N56 Annals of Internal Medicine, online January 21, 2013.

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