P3A160: Promising Population-level Interventions for Reducing Child Abuse and Neglect: A Review of the Literature

Background: Though proven to cause lifelong individual and intergenerational effects, child abuse and neglect remains a pervasive problem across all populations in the United States. Despite decades of efforts to reduce its incidence, rates of child abuse and neglect have not decreased substantially. In Cincinnati, OH, a multi-disciplinary, family-community-academic network is invested in decreasing the local incidence of child abuse and neglect. To ground our network’s efforts in current evidence, we examined the academic and gray literature to identify what is known about interventions that have attempted to reduce child abuse and neglect at a population level. Importantly, we sought to identify interventions that have been effective as well as ineffective in decreasing the incidence of child abuse and neglect.

Methods: We used the following search terms: child abuse; child welfare; maltreatment; physical abuse; neglect; inflicted trauma; county; neighborhood; state; community; policy; public benefits; public services; structural determinants; public health; population health. We searched PubMed, Google Scholar, and the Cincinnati Children’s Pratt Research Library. Inclusion criteria included: physical, emotional, and psychological abuse, neglect, primary prevention, studies that reviewed an intervention, studies based in the United States, and studies that reviewed interventions on a community level. Exclusion criteria included: studies on sexual abuse, study populations external to the United States, curative interventions studies without an intervention, and studies that reviewed impact on an individual level (Figure 1). From publications included in full review, we collected the following data: study type; type of child abuse or neglect; intervention; study population and/or location; age of children included in the study; effectiveness.

Results: Our search yielded 153 publications, with 105 included in full review (66 with single intervention, 39 with review or meta-analysis of multiple interventions). Interventions shown to be effective with a small effect size, included: decreasing use of corporal punishment, increasing economic stability, and increasing availability of and enrollment in early childhood education. Additional interventions that may be effective included: home visitation programs, parenting programs, built environment improvements, use of differential response systems, and creation of service homes. To date, public health campaigns were not shown to be effective. Of note, multi-modal approaches were shown to be essential.

Conclusion: Though small in statistical effect size, several population health interventions show promise in reducing the incidence of child abuse and neglect., Interventions that reduce corporal punishment, increase the resources of families to address needs, and provide readily available high quality early childhood education demonstrate benefit. Other interventions studied to date have mixed results when evaluated on a large scale. Family-centered, community-led, multi-level action research is needed.