The Pediatrician's Role in Child Maltreatment Prevention

To the Editor. –

It is a pleasure to see the increasing emphasis on child abuse prevention by the AAP and child abuse pediatricians as evidenced by the recent “Clinical Report: The Pediatricians Role in Child Maltreatment Prevention”, and for recognizing the unique opportunities pediatricians have to strengthen families and promote safe, stable, stimulating, and nurturing relationships that prevent child abuse and neglect1.

However, in the course of discussing prevention and intervention programs, the report states that Healthy Families America is a program that has not demonstrated effectiveness in preventing child maltreatment. The authors cite research in only two states related to the early implementation of the Healthy Families America program which revealed problems that have since been addressed. While earlier literature could best be described as “mixed”, the content of programs, fidelity of the programs over time to a consistent system of education and mentoring, and types of families served can make a critical difference to success. More recent research provides ample evidence of effectiveness.

In its 2005 evaluation report, Williams, Stern and Associates found that Healthy Families Florida had a positive impact on preventing child maltreatment. Children in the intervention group were less likely to be victims of maltreatment in the first two years of life than the comparison group (http://www.healthyfamiliesfla.org/pdfs/Final_Evaluation_1999- 2003.pdf ). Additional analyses completed in 2009-10 by Clark and Falconer, (Children and Youth Services Review - in press, and now available online Validity in an evaluation of Healthy Families Florida—A program to prevent child abuse and neglect) confirm a favorable outcome for Healthy Families Florida in preventing child maltreatment. After applying both multiple covariate logistic regression and propensity score adjustment statistical techniques to the evaluation data from the Williams, Stern and Associates report, Clark and Falconer found the additional set of results clarified and supported the findings in the original analysis. Statistical differences in the child maltreatment outcome between the treatment groups (high-fidelity group or completers group) and no-treatment or low dosage groups continued to be significant. These results provide further evidence that Healthy Families Florida is effective in preventing child maltreatment.

Healthy Families New York (HFNY) has also been found to have positive findings related to child maltreatment. A randomized controlled trial revealed that HFNY mothers reported committing fewer acts of serious physical abuse (e.g., hitting child with fist, slapping on face) at age 2 and fewer acts of very serious physical abuse (e.g., shaking, choking) at age 1 than mothers in the control group2. Confirming a finding from age 2, observational assessments at age 3 showed that first-time mothers under age 19 who were offered HFNY early in pregnancy were considerably less likely than similar mothers in the control group to engage in aggressive and harsh parenting behaviors while interacting with their children3. Upon a rigorous review of research related to HFNY, the Rand Corporation lists it as a proven program on its Promising Practices Network.

Recently, a study in Hawaii showed reduction of intimate violence with home visitation4.

It is important the pediatricians be aware that home visitation, long supported by the AAP, can show evidence of efficacy. Programs using the Healthy Families America model and adhering to key critical elements will prove helpful to national efforts to reduce child abuse.

References 1. Flaherty E, Stirling J, and the Committee on Child Abuse and Neglect. Clinical report – the pediatrician’s role in child maltreatment prevention. Pediatrics 2010, 126:833-841. 2. DuMont K, Mitchell-Herzfeld S, Greene R, Lee E, Lowenfels A, Rodriguez M, Dorabawila V. Healthy Families New York (HFNY) randomized trial: effects on early child abuse and neglect. Child Abuse & Neglect 2008, 32:295-315. 3. Rodriguez M, Dumont K, Mitchell-Herzfeld S, Walden N, Greene R. Effects of Healthy Families New York on the promotion of maternal parenting competencies and the prevention of harsh parenting. Child Abuse & Neglect 2010, 34:711-723. 4. Bair-Merritt M, Jennings J, Chen R, Burrell L, McFarlane E, Fuddy F, Duggan A. Reducing maternal intimate partner violence after the birth of a child: A randomized controlled trial of the Hawaii Healthy Start home visitation program. Archives of Pediatrics & Adolescent Medicine 2010; 164:16-23.

Conflict of Interest:

None declared