Secondary prevention--serving families at risk

Secondary prevention of child abuse and neglect aims at protecting children who live in high-risk environments when overt abuse has not yet occurred, but is likely to occur in the future. Several screening strategies to identify families at high risk for child maltreatment have been reported in the literature, none of which has been translated into practice so far. For practical but foremost ethical reasons, general screening programs to identify vulnerable children and families cannot be recommended. Traditional welfare and health-care agencies have encountered difficulties in reaching out to population groups believed to be at higher risk for child maltreatment. The system of care or services often contributes to isolation, defensiveness, and noncompliance of families. The concept for the Child Protection Center in Lübeck focused on a nonpunitive, self-help approach to reach out to families and encourage them to determine their own needs. There is a significant guarantee not to involve law enforcing agencies or to initiate court proceedings without the families' consent. Over half of all the families seen in the Center over a 2-year period were self-reported, almost a fifth of all families received help to prevent violence against children before child abuse or neglect had yet occurred. We conclude that nonpunitive concepts that avoid labeling and stigmatizing, and offer free, easy accessible, family oriented services will help prevent child maltreatment.