Journals > Journal: Preventing Child Maltreatment > Article: The Role of Home-Visiting Programs in Preventing Child Abuse and Neglect
Journal Issue: Preventing Child Maltreatment Volume 19 Number 2 Fall 2009
Kimberly S. Howard Jeanne Brooks-Gunn
Measuring Child Abuse and Neglect
Although home visiting is commonly thought of as a strategy to help prevent child abuse and neglect, few programs actually measure child maltreatment as an outcome and even fewer are able to document significant effects. This shortcoming is largely attributable to the difficulty of identifying substantiated cases of abuse and neglect as well as to questions about whether reported instances of abuse or neglect should be combined with substantiated cases. Furthermore, definitions of abuse and neglect vary by state, so that what is neglectful in one state may not be considered neglectful in another. The result is that national abuse and neglect data look dramatically different by state, further compounding the difficulty of accurately measuring a program’s effectiveness in reducing child maltreatment.
Even if abuse and neglect definitions were uniform across the country, it is still likely that the true prevalence rate of abuse and neglect is much higher than what is reported or substantiated by child protective services (CPS) agencies.9 In addition, researchers are still uncertain about the threshold at which certain parenting behaviors begin to compromise a child’s development. That is to say, behaviors that are not severe enough to be considered abusive or neglectful by legal definitions may nonetheless have detrimental effects on children’s development.10 In this way, improving parenting practices may be an important way to prevent child maltreatment.
Another complication in assessing rates of child maltreatment among families participating in clinical trials is that the frequent contact with home visitors makes it more likely that child abuse or neglect will be identified and reported among families in the intervention group, whereas it may go unnoticed among families in the control group. Indeed, the difference in surveillance between the treatment and control groups probably explains why so few home-visiting programs have measurable effects on rates of abuse and neglect. Because of these concerns, child abuse and neglect may not be the best outcome measure by which to assess the effectiveness of home visiting or similar types of programs. Instead, proxy measures such as child health and safety (for example, well-child and dental visits, number of injuries, and emergency room visits) may provide greater insight into the way that parenting practices directly bear on child well-being. In addition, programs that alter parenting behaviors such as responsivity, sensitivity, and harshness, as well as those that improve the quality of the home environment and maternal mental health, will likely also be associated with positive effects on children’s well-being.
Furthermore, from a theoretical standpoint, there is reason to believe that parenting, maternal stress (including maternal depression and anxiety symptoms), poor social support, and family conflict may be linked to child abuse and neglect. Indeed, Jay Belsky incorporated all of these risk factors into his process model of parenting,11 and data from multiple studies support links to child well-being.12 In an experiment on the effectiveness of a program for low-birth-weight infants, Lawrence Berger and Jeanne Brooks-Gunn examined the relative effect of both socioeconomic status and parenting on child abuse and neglect (as measured by ratings of health providers who saw children in the treatment and control groups six times over the first three years of life, not by review of administrative data) and found that both factors contributed significantly and uniquely to the likelihood that a family was perceived to engage in some form of child maltreatment.13 The link between parenting behaviors and child maltreatment suggests that interventions that promote positive parenting behaviors would also contribute to lower rates of child maltreatment among families served. That being the case, most intervention programs attempt to alter parenting, maternal stress, and maternal support. Some also try to reduce conflict in the home. The hypothesis is that so doing reduces child abuse and neglect, though difficulties in measuring the phenomenon preclude thorough testing.
We next review several major home-visiting programs, all of which have been evaluated using randomized controlled trials, and thus represent higher-quality evaluations than those using non-randomized trials. In addition, all programs recruited families either prenatally or around the time of the child’s birth, which is important because risk for child abuse and neglect is greatest among infants.14 We do not include programs beginning in preschool or later. Although our review is not meant to be exhaustive, it does represent the wide variation in types of home-visiting programs.
