The Empirical Development of an Early Child Maltreatment Prevention Program

Neil B. Guterman, PhD

Despite the ongoing struggle over the past several decades to stem the tide of child abuse and neglect in the U. S., all signs suggest that the problem continues to rise. As compared to the 1.2 million reports of suspected child abuse and neglect in 1982, 1992 saw more than double that figureó 2.9 million reports. More than three children each day die because of child maltreatment, and 87% of these are under five years of age (McCurdy Daro, 1993; Cohn Donnelly 1991).

The typical service path in child maltreatment begins after maltreatment has been suspected. However, by this point children frequently have suffered significant if not disastrous consequences. Family problems typically are entrenched and at a crisis point, and intervention, via the child protective services system, is usually involuntary, stigmatizing and often insufficient to overcome the depth of family problems associated with the maltreatment.

A host of clinical interventions aimed at ameliorating child maltreatment and its effects, after families have already been identified as maltreating, has shown questionable empirical efficacy (Shuerman, et al., 1993; Rossi, 1992; Cohn & Daro, 1987). All the more concerning are the great social and economic costs of such "after the fact" services, particularly when the need arises to place a child out of the home.

Preventive interventions, initiated before maltreatment occurs, offer the promise of servicing families proactively while at the same time alleviating the underlying conditions which appear to breed abuse and neglect. Early child maltreatment prevention programs typically service families in the home, targeting parenting skills and knowledge, and assisting families to link up with necessary resources and services, like health care for the young child or professional counseling for the parent(s). Early reports from Hawaii's "Healthy Start" program, currently considered the dominant program model in early child maltreatment prevention, have touted promising results: "Not a single case of abuse among the project's 241 high risk families (seen between 1985- 1988) had been reported since the demonstration began" (Breaky & Pratt, 1991).

Despite such reports and the intrinsic attractiveness of early child maltreatment programs in general, the existing empirical evidence raises many questions. For example, while parenting and formal supports are addressed in programs like Healthy Start, several risk factors remain largely untargeted by current intervention modelsómost particularly those associated with client powerlessness, such as poverty, social isolation, and minority group status (Garbarino, & Kostelny, 1992; Hampton, 1987; Spearly & Lauderdale, 1983; Cazenave & Straus, 1979; Pelton, 1979).

A more careful look at the most complete and recent (unpublished) data of the Healthy Start model provides a less sanguine picture than originally presented: Of 1,204 high- risk families serviced by the program (in 19871990), 10 were confirmed for abuse or neglect (99.2% nonabuse rate). In a comparison (uncontrolled) group of 337 high-risk families not receiving services, 9 were confirmed for abuse or neglect (97.3% nonabuse rate). In short, this initial nonexperimental data indicate a 1.9% difference in maltreatment rates between high-risk families receiving the Hawaii Healthy Start services and those that do not (State of Hawaii Department of Health, 1991).

Of the more controlled studies that utilize randomly assigned control groups and specific child maltreatment outcome measures (e.g., Brayden, et al., 1992; Barth, 1991; Siegel, et al., 1980; Olds, 1986), only one (Olds, et al., 1986) demonstrates clinical effectiveness. All controlled studies that reported nonsignificant findings had key inadequacies in the intervention designs employed.

No work has attempted to systematically and empirically ground the design and development of an optimal primary prevention model, prior to controlled evaluation. An approach that integrates both clinical research and practice methods can increase the likelihood of determining what optimally prevents maltreatment, and can significantly enhance the reliable transfer of effective services to a range of other sites.

Encouraged by earlier collaborative applications of a "developmental research" methodology (Rothman & Thomas, 1994) to other child welfare innovations (Guterman et al., 1989; Hodges, et al., 1989), CUSSW Assistant Professor Neil Guterman maintains that this approach has great potential to yield an effective innovation in early child maltreatment prevention. Developmental research methods draw upon empirical procedures to develop social work technologies which are clearly specified, clinically effective and transferable to a range of other sites.

In the past year, the Center and the JBFCS provided funding to initiate such a study. Using a developmental research methodology U?othman Thomas, 1994), the study seeks rigorous intervention knowledge to answer: How can we best prevent child maltreatment before it occurs? The study will examine the design and development of an early child maltreatment prevention program.

While not yet field tested, the intervention design draws from earlier program models such as the Healthy Start model, and includes support components that explicitly address parents' empowerment. Program components include a differential screening and assessment prior to or at birth of a first child, provision of home and group-based services, coordination with medical support for referral and services, parenting support, mutual support, and case management. In the "developmental" or field testing phase, the program will provide prototype services to families residing in the Upper West Side and Central Harlem areas of Manhattan, a cachement area that includes neighborhoods among the highest risk for child maltreatment and poor early childhood outcomes in the state of New York (New York State Department of Health, 1994). The JBFCS Preventive Services programs, directed by Rhona Triggs, CSW, will participate in this phase. The project is seeking larger scale funding to support full field testing and summative evaluation.

Principal Investigator: Neil B. Guterman, PhD (CUSSW)
Project Steering Committee Members: Robert Abramovitz, MD; Bruce Grellong, PhD; Jackie Miller, MSW, CSW; Alan Siskind, PhD (JBFCS)


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