Since the 1993 National Research Council (NRC) report was issued (NRC, 1993), significant advances have occurred in the development and dissemination of model programs for treating and preventing various forms of child abuse and neglect (Daro and Benedetti, 2014). In addition to the public child protection and child welfare systems found in all communities, a variety of treatment programs targeting victims and perpetrators of child abuse and neglect are offered through various mental health and social service agencies. Many communities also have access to primary and secondary prevention services designed to reduce the risk for child abuse or neglect for families experiencing difficulties. Among this growing array of service options, an increasing number of interventions have strong evidence of efficacy with at least a portion of their target populations. Many others are aggressively building their evidence base and now operate with increased awareness of the need for and the value of robust evaluative data.
The current evidence base also suggests that the availability of these services is uneven across communities and populations, leaving many of the most vulnerable children and families without adequate services. Even when identified, children who are victims of child abuse or neglect may not receive the therapeutic services needed to address their serious developmental and behavioral problems. Families at significant risk of child abuse or neglect as a result of mental health issues, domestic violence, or substance abuse are among those least likely to be adequately served by the current array of preventive and family support services. And when services are offered, their quality and potential impacts vary greatly (Paxson and Haskins, 2009). On balance, however, much progress has been made in the ability to successfully identify, engage, and assist a growing proportion of children and families that have experienced or are at risk for child abuse and neglect.
The purpose of this chapter is to describe those program models and intervention strategies with the strongest evidence of success, identify approaches that have been found lacking, and highlight the importance of building an integrated system of care to enhance the capacity to successfully prevent child abuse and neglect and treat victims. In developing this conceptual framework, the committee intentionally considered the collective challenges facing all relevant interventions instead of segmenting the discussion into the traditional silos of treatment and prevention services. Also highlighted are the common challenges faced with all interventions in attempting to enhance their assessment, implementation, replication, and sustainability.
The child abuse and neglect interventions reviewed here are aimed in part at improving the capacity of parents and caretakers to cease certain harmful behaviors or to adopt behaviors commonly accepted as contributing to healthy child development. The behaviors targeted include those that are illegal and wrong, as well as those for which evidence demonstrates a link to negative or positive impacts on a child’s development or safety. Parental capacity and behaviors can be altered either directly by providing services to individual caretakers to improve their knowledge and skills, or indirectly by creating a context in which doing the “right thing” is easier, such as by reducing stress and increasing support within the immediate family and local community.
The child welfare system, as described in Chapter 5, provides a necessary public policy and service response but is insufficient to address the immediate and long-term consequences of child abuse and neglect or give families the support they need to prevent these outcomes. This chapter focuses on why it is important to develop, implement, assess, and sustain an array of strong interventions that address the consequences of child abuse and neglect (treatment) and offer promising pathways to improve parental capacity to support optimal child development by reducing risks and strengthening protective factors (prevention). The committee recognizes the wider range of interventions that address myriad issues associated with an elevated risk for child abuse and neglect, such as substance abuse treatment programs, domestic violence interventions, depression treatments, income support programs, child care, and community violence prevention programs. The discussion here, however, is limited to strategies whose core objectives include reducing child abuse and neglect, improving parental capacity, and ameliorating the consequences of child abuse and neglect.
The first two sections of the chapter identify an array of service strategies and program models that have demonstrated success in achieving their targeted outcomes, as well as those efforts that have failed to fulfill expectations. Because of variations in legal authority, target population, and scope across the various elements of the child abuse and neglect service continuum, this evidence is presented in two broad groupings: treatment programs designed to reduce reincidence and ameliorate the consequences of child abuse or neglect, and prevention efforts designed to enhance parental capacity, improve child outcomes, and reduce a child’s risk for experiencing abuse or neglect. The third section of the chapter examines a set of issues that have limited the replication and efficacy of interventions designed to address child abuse and neglect. Although the issues addressed are not exhaustive, they illustrate the challenges facing both public child welfare systems and the direct services provided to children and families. Improving outcomes for a greater proportion of victims and those at risk of child abuse and neglect will require new research on such issues as cultural relevance, replication fidelity, cost-effectiveness, service delivery reform, and service integration. In addition to offering guidance on how to structure and target specific interventions, such research can guide reforms in public child welfare and other public service delivery systems to improve overall service quality and create an institutional infrastructure capable of sustaining such reforms. The fourth section examines important aspects of building an integrated system of care, including organization culture and interagency networks. The final section presents conclusions.
Any intervention or reform strategy, regardless of its target population or primary outcomes, appears to benefit from a set of “core ingredients” (Barth et al., 2012). Although identifying the exact nature of these ingredients is a work in progress, they generally include building on a strong theoretical foundation that links intended outcomes to a clearly articulated theory of change, offering the program at a sufficient dosage and duration to make it possible to achieve the intended outcomes, staffing the program with individuals who have the knowledge and competencies to work with participants to achieve the desired outcomes, and operating within a system of quality assurance to ensure that the program is delivered properly and the desired outcomes are achieved (Chorpita et al., 2005; Duncan et al., 2010; Wulczyn et al., 2010). As noted in the following sections, these characteristics, among others, help distinguish successful efforts from those with less promise.