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Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009

Progress toward a Prevention Perspective
Authors: Matthew W. Stagner Jiffy Lansing

Trade-offs and Challenges in Targeting

Proponents of targeting to specific subpopulations argue that public funds should be spent where they are most needed and can achieve the best results. Successful targeting thus requires accurate benefit-cost analysis. Which interventions, targeted on which families, are most likely to avoid the severe consequences of maltreatment? Researchers have yet to develop fully the rigorous intervention evaluations needed to inform such analysis. This volume outlines the progress made in making informed targeting decisions.

Demographic-based targeting strategies have been more successful than others, in part because they serve more or less as universal interventions for specific subpopulations, such as first-time parents or families of low socioeconomic status.56 As such, they lessen the likelihood of stigmatization and more easily facilitate peer networks. They also lessen the need to enforce eligibility criteria or provide alternatives to those who may benefit from some form of assistance but are not eligible for the particular program.

Demographic factors can be used to identify geographic areas where interventions can be targeted—for example, neighborhoods with inadequate social or human services capacity or areas that offer institutional structures on which to build, such as hospitals or community colleges. Demographic factors also may identify natural access points within an under-served community, such as a church, beauty shop, or shopping mall, which can be used to build existing informal networks into broader systems of support.

Unlike targeted interventions, universal prevention approaches educate the general public about the consequences of child maltreatment and provide information about and access to resources. One mass media universal approach uses everyday language and compelling images in television, radio, print, and billboard public service messages. First implemented during the 1970s, that approach continues to be considered a vital component of comprehensive maltreatment strategies.57 Yet Deborah Daro and Karen McCurdy find little evidence that it has positive effects on either maltreatment or related outcomes such as parental attitudes, knowledge, and behaviors, parent-child interactions, and child outcomes.58

Ascertaining whether programs are well-targeted is challenging as well. Targeting at levels other than universal sometimes requires assessing which families may be at risk. Researchers have developed tools to help identify parents and caregivers who are likely to maltreat again, but results suggest further refinement is needed to improve the accuracy of such assessment instruments.

Risk assessment tools are often highly inaccurate.59 Reviews of formalized risk-assessment methods call into serious question the use of such professionally administered checklists in child protection decision-making.60 One review of risk assessment instruments used by child protective services indicates that 13 percent to 25 percent of the families identified as likely to abuse their children again do not in fact repeat the abuse and that 14 percent to 86 percent identified as unlikely to abuse again later do repeat the abuse.61

Evaluations of programs that employ screening measures that include families with a low risk of maltreatment can show inflated rates of success. On the other hand, evaluations of programs accurately targeted to families with greater risk of maltreatment may show lower rates of overall success (though potentially greater benefit). This highlights the role of screening and assessment in targeting interventions. Because of the complexity of assessing child maltreatment prevention programs, recent efforts in program development, implementation, and evaluation have focused on determining “best practices” rather than on evaluating the impact of program models themselves.62