Recurrence of child maltreatment is a major problem. In a study involving 163 Canadian families with confirmed child physical abuse or neglect, Harriet MacMillan (McMaster University, Hamilton, Ontario, Canada) and colleagues tested whether regular home visits by public-health nurses prevented recurrence of abuse when compared with standard services from child protection agencies (CPA). Standard services include routine follow-up by CPA caseworkers to assess risk of recurrence and provide education about parenting. However, investigators found after 3-years follow-up recurrence of physical child abuse and neglect did not differ between the groups. About half the intervention families (47%) and control families (51%) had a recurrence of neglect and 33% of the intervention group and 43% of the control group had a recurrence of physical abuse.
The authors state that there is a high risk of abuse and neglect recurring when a child remains in the home and there is currently no intervention proven to reduce the risk.
Dr MacMillan concludes: "The high rates of recurrence in this study suggest that substantive efforts must be invested in prevention of child abuse or neglect before a pattern is established."
In an accompanying comment Jane Barlow (University of Warwick, UK) states: "MacMillan and colleagues' study shows that more than 50% of abused children remaining in the home continued to be abused, and there is little evidence currently available about how to prevent this abuse from happening without removing the child from the home. The benefits of standard services are for the better part not known, but as MacMillan points out, most fall seriously short of the sort of service evaluated in their study. Whilst these findings might highlight the importance of the primary prevention of child abuse and neglect, primary prevention will not be effective in all cases, and there is an urgent need to identify an effective secondary preventive intervention to reduce the recurrence of abuse, and to limit the impact that such abuse has on children's health."
Contact: Dr Harriet L MacMillan, Offord Centre for Child Studies, McMaster Health Science Centre, Patterson Building Rm 410 - Chedoke Division, 1200 Main St W, Hamilton ON, L8N 3Z5, Canada. T) 905 521 2100 x 74287 macmilnh@mcmaster.ca
Comment: Dr Jane Barlow, Dept Public Health and Epidemiology, Div of Health in the Community, University of Warwick, Warwick Medical School, Medical School Building, Coventry, CV4 7AL, UK. T) 02476 574884 Jane.Barlow@warwick.ac.uk
Journal
The Lancet