Primary Care Interventions to Prevent Child Maltreatment: Updated Evidence Report and Systematic Review for the US...

Area of Science:

• Public Health
• Pediatrics
• Preventive Medicine

Background:

• Child maltreatment, encompassing abuse and neglect, has profound and lasting negative effects.
• Primary care settings offer opportunities for early intervention and prevention of child maltreatment.

Purpose of the Study:

• To evaluate the effectiveness of interventions delivered or referred through primary care for preventing child maltreatment.
• To update the evidence base for the US Preventive Services Task Force.

Main Methods:

• Systematic review and meta-analysis of English-language randomized clinical trials (RCTs) published up to July 2018.
• Included RCTs focused on children without prior maltreatment and assessed interventions feasible in primary care.
• Outcomes included direct measures of maltreatment (e.g., child protective services reports, removal from home) and proxy measures.

Main Results:

• Twenty-two trials (N=11,132) were analyzed.
• No significant association was found between interventions and reports to child protective services or child removal from home.
• Insufficient evidence exists for other outcomes, including emergency department visits, hospitalizations, child development, school performance, and prevention of death. No harms were identified.

Conclusions:

• Interventions provided or referred by primary care settings did not demonstrate consistent effectiveness in preventing child maltreatment.
• There is a lack of evidence regarding the harms associated with these interventions.
• Further research is necessary to identify effective primary care-based strategies for child maltreatment prevention.