An experimental evaluation of in-home child abuse prevention services

Perinatal child abuse prevention projects are rarely rigorously evaluated. Women were referred to the Child Parent Enrichment Project (CPEP) project during or just after pregnancy if identified as at-risk of engaging in child abuse by community professionals. Clients were randomly assigned to CPEP services (n = 97) or traditional community services (n = 94). CPEP services are based on ecological theory and involve six months of home visiting by paraprofessional women and linkage to other formal and informal community resources. No advantages on self-report measures for the CPEP group were measured at posttest, and follow-up reports of child abuse were similar for both groups. Consumer satisfaction indicates that clients highly valued the program. Some indication of greater success with families with less serious problems was observed. The results argue for caution regarding the capacities of perinatal child abuse prevention services to serve the high-risk clientele they often receive.     

A treatment and education program for parents and children who are at-risk of abuse and neglect

A treatment program for families at-risk of abusive or neglectful parenting was described and evaluated. The program combined intervention strategies and concepts based on research on abuse, early intervention, education and social service. Treatment and education for the parent and child were provided in the three services of the program: Home-Based, Family School, and Neighborhood Peer Support Groups. At-risk families were identified by a high-risk stress index. Program evaluation was based on 46 families and their 74 preschool-age children. Data collected were: incidence of child abuse or neglect, family stresses, observations of parent-child interactions, family goal measurement, and developmental testing of the children. A significant reduction occurred in the number of children abused or neglected as compared to a similar high-risk, nonintervention sample. The family stresses were reduced, parent-child interactions improved, and the intellectual decline of the children was prevented. Families who participated in all three services gained the most from the program.     

Lessons Learned from a Predominantly Latinx Autistic Population: Preliminary Effects of the PEERS Intervention on Neural and Perceived Educational Performance

Thirteen autistic teens, who were predominantly Latinx, completed the Program for the Education and Enrichment of Relational Skills (PEERS), a 16-week social skills intervention. Time-frequency decomposition was calculated using advanced electroencephalographic techniques to measure oscillatory brain activity during reward anticipation and processing before and after PEERS. Fourteen neurotypical teens participated but did not receive intervention. The perception of educational performance was also measured. The perception of educational performance did not differ between groups and did not change after participation in PEERS. Approach motivation increased after intervention in the autistic group. This suggests an enhancement of social motivation after learning social skills in a group composed of a majority of Latinx autistic teens.     

Families at risk of poor parenting: A model for service delivery,assessment, and intervention

The At Risk Parent Child Program is a multidisciplinary network agency designed for the secondary prevention of poor parenting and the extremes of child abuse and neglect. This model system of service delivery emphasizes (1) the coordination of existing community resources to access a target population of families at risk of parenting problems, (2) the provision of multiple special services in a neutral location (ambulatory pediatric clinic), and (3) the importance of intensive individual contact with a clinical professional who serves as primary therapist, social advocate and service coordinator for client families. Identification and assessment of families is best done during prenatal and perinatal periods. Both formal and informal procedures for screening for risk factors are described, and a simple set of at risk criteria for use by hospital nursing staff is provided. Preventive intervention strategies include special medical, psychological, social and developmental services, offered in an inpatient; outpatient, or in-home setting. Matching family needs to modality and setting of treatment is a major program concern. All direct services to at risk families are supplied by professionals employed within existing local agencies (hospital, public health department, state guidance center, and medical school pediatric clinic). Multiple agency involvement allows a broad-based screening capacity which allows thousands of families routine access to program services. The administrative center of the network stands as an independent, community-funded core which coordinates and monitors direct clinical services, and provides local political advocacy for families at risk of parenting problems.     

Developmental milestones in abused children, and their improvement with a family-oriented approach to the treatment of child abuse

Few objective measures of the efficacy of intervention programs in the treatment of child abuse exist. One such measure may be improvement in the developmental delays often seen in abused children. Using the Learning Assessment Profile, we tested 53 abused children, ages 2.5-5 years, just before and after involvement in our Family Development Center Program (FDC). The FDC emphasizes therapy-group-interaction for parents, where alternative ways of expressing anger are explored. Children attend daily preschool classes, and take occasional outside field trips. Of the 53 children tested 42 (79%) showed greater than expected developmental skills gains. Six children demonstrated no improvement in developmental skills, four of whom had severe developmental delays in one or two areas. Fine motor and language skills were significantly delayed for the group as a whole; these areas showed the greatest improvement after FDC. There did not appear to be an overall association between increased improvement in developmental skills and length of time in the FDC program, although certain subgroups of children appeared to improve with time while others appeared to lose ground. A five-year follow-up study of these children is presently underway. We conclude that a program which involves both parent and child, and focuses on their interaction, appears to be effective in dealing with abusive families; monitoring developmental levels in the abused children is one means of assessing their progress in such a program. Further controlled prospective trials are needed in this area.     

Teachers' perspectives on student problematic behavior and social skills

This study examined program outcomes of student problem behavior and social skills, based on teachers' perspectives, before and after early behavioral intervention services. The study targeted students in kindergarten through grade 5 who were identified by the school system as being at risk for emotional and behavioral disorders. Students identified received early intervention services based on individualized positive behavior supports (i.e. social skills training, functional behavioral assessment, and team collaboration). The results indicate that early intervention services that teach social skills and use functional behavioral assessments to deal with problem behaviors are beneficial to children displaying behavioral challenges.     

Stopping abuse before it occurs: Different solutions for different population groups

This paper reports on a conference at which participants reviewed indepth the literature on child abuse prevention and child development, as it pertains to different cultural and ethnic population groups, and identifies alternative prevention strategies for these different groups. The efficacy of the following interventions are analyzed: perinatal support programs, education for parents, treatment for abused children, early and periodic childhood screening and treatment programs: social skills training for children and young adults; mutual aid programs and neighborhood support groups; family support services such as crisis care; public information about child abuse and community development activities such as employment assistance. The paper concludes that although treatment services for different groups may be quite similar, prevention strategies must take account of the individual and unique values, norms and socialization patterns of different groups.     

Are two years better than one year? A propensity score analysis of the impact of Head Start program duration on children's school performance in kindergarten

Using data from a nationally representative sample, this study examined Head Start children's school outcome differences by the end of Kindergarten between children who attended Head Start program for two years and the ones who attended for one year. Propensity scores were used to match children who experienced different durations of the program on a series of demographic characteristics in order to achieve a precise estimation of the effects of program duration. The results showed that in comparison to a demographically comparable group of children who attended the Head Start program for one year, the children who experienced two years of intervention services had statistically significantly higher performance on all six academic and social outcome measures by the end of Kindergarten, which included PPVT, Woodcock–Johnson Reading Skills, Woodcock–Johnson Math Reasoning Skills, teacher-reported composite academic skills, preschool learning behaviors, and social skills. Policy and practice implications are discussed.     

Parents in prison: A child abuse and neglect prevention strategy

Parents in Prison is an innovative family support service housed at the Tennessee State Prison for Men. Developed in response to inmates' recognition of the need for child abuse and neglect prevention services relevant to men who are in prison, the program model has potential for becoming a major service delivery strategy. Leadership for Parents in Prison is provided by an inmate committee which receives consultation and assistance from a community advisory board and an institutional sponsor. Program components--correspondence and classroom courses, monthly events featuring community guest speakers, and family-focused social activities and projects--address family needs during incarceration and upon return to community living. These diverse components and the flexible service delivery format permit widespread inmate participation not readily available in a prison setting. Parents in Prison successes demonstrate that the period of incarceration can be used to improve parental skills and knowledge and to strengthen family relationships. They also demonstrate the viability of a family support service which relies on inmate leadership, community volunteer participation, and institutional support. The future success of this model depends on replication in other prison settings, dissemination of the program products which have been and continue to be developed, and rigorous, systematic examination of the impact that participation has on child abuse and neglect problems associated with a father's incarceration.     

Child maltreatment as a function of cumulative family risk: Findings from the intensive family preservation program

This study examined child maltreatment as a function of cumulative family risk in a sample of at-risk families (N = 837) who were referred to an intensive family preservation program because of child behavior problems or suspected child abuse and neglect. The goal of this intensive family preservation program is to improve parenting skills and reduce immediate family stressors that may lead to an increased risk of child abuse and neglect. The findings indicate that the most prominent family risks comprising the cumulative risk scale in our sample were socio-economic disadvantage (e.g., income, unemployment, housing instability) and parental characteristics (e.g., mental/physical health, parental use of alcohol, domestic violence). Further, the results demonstrated a strong quadratic trend in the relationship between cumulative family risk and child maltreatment, and identified a risk threshold effect at three cumulative family risks after which the child risk for maltreatment increased exponentially. These findings are interpreted in the light of the current research on differentiative interventions, supporting differentiated services to the families with low vs. higher risk for child maltreatment.     

Service needs of adolescent parents in child welfare: Is an evidence-based,structured, in-home behavioral parent training protocol effective?

SafeCare is an evidence-based behavioral parent training intervention that has been successfully implemented in multiple state child welfare systems. A statewide implementation in Oklahoma established the effectiveness of SafeCare with a diverse group of parents, which included adolescent parents under 21 years of age, a particularly at-risk group. The current study examined whether SafeCare is also effective for this subsample of 294 adolescent parents with regard to child welfare recidivism, depression and child abuse potential, and attainment of service goals. Post-treatment adolescent parent ratings of program engagement and satisfaction were also examined. Among the subsample of adolescent parents, the SafeCare intervention did not result in significantly improved outcomes in terms of preventing recidivism or reduction in risk factors associated with child abuse and neglect as compared to child welfare services as usual. Further, no significant differences in program engagement and satisfaction between SafeCare and services as usual were detected. These findings shed light on the potential differences in program effectiveness between adolescent and adult parents, and the need for future research to rigorously evaluate the effectiveness of behavioral parenting programs with adolescent parents.     

EFFECTS OF A UNIVERSAL POSITIVE CLASSROOM BEHAVIOR PROGRAM ON STUDENT LEARNING

The purpose of this study was to examine the impact of a universal program to promote positive classroom behavior on students’ approaches to learning and early academic skills. Second grade classrooms (N = 39) were randomly assigned to treatment and business‐as‐usual control conditions. Teachers in intervention classrooms implemented the Social Skills Improvement System Classwide Intervention Program (SSIS‐CIP) over a 12‐week period. Participating students’ (N = 494) engagement, motivation, and academic skills were assessed before and after treatment implementation. Results indicated that students with lower levels of engagement and motivation at pretest experienced significant improvement in these areas after exposure to the SSIS‐CIP. Although no significant differences were observed in reading, students receiving supplemental instructional services demonstrated greater gains in mathematics than did their peers in the control condition.     

美国青少年《生活技能训练》课程特点与策略

《生活技能训练》课程是美国针对青少年成瘾性不良行为而设计开发的,该课程的核心内容是如何培养青少年良好的健康行为和社会生活技能,课程目的是促进青少年健康发展。该课程主要采用参与互动式的教学策略。     

Randomized trial of a statewide home visiting program to prevent child abuse: impact in reducing parental risk factors

OBJECTIVES: To assess the impact of a home visiting program in reducing malleable parental risk factors for child abuse in families of newborns identified, through population-based screening, as at-risk of child abuse. METHODS: This randomized trial focused on Healthy Start Program (HSP) sites operated by three community-based organizations on Oahu, HI, USA. From 11/94 to 12/95, 643 families were enrolled and randomly assigned to intervention and control groups. Mothers in both groups were interviewed annually for 3 years (88% follow-up each year) to measure mental health, substance use, and partner violence. HSP records were reviewed to measure home visiting services provided. Home visitors were surveyed annually to measure their perceived competence. RESULTS: Malleable parental risks for child abuse were common at baseline. There was no significant overall program effect on any risk or on at-risk mothers' desire for and use of community services to address risks. There was a significant reduction in one measure of poor mental health at one agency and a significant reduction in maternal problem alcohol use and repeated incidents of physical partner violence for families receiving > or =75% of visits called for in the model. Home visitors often failed to recognize parental risks and seldom linked families with community resources. HSP training programs were under-developed in preparing staff to address risks and to link families with community resources. CONCLUSIONS: Overall, the home visiting program did not reduce major risk factors for child abuse that made families eligible for service. Research is needed to develop and test strategies to improve home visiting effectiveness in reducing parental risks for child abuse.     

Treatment of Parent-Adolescent Conflict Through Behavioral Technology Training: A Case Study

A two-phase parent consultation intervention was used to treat a noncompliant 14-year-old girl. Phase I was a management training program modeled after the Forehand and McMahon program for conduct disordered children. Phase 2 was a communication and problem-solving skills training program that incorporated procedures prescribed by Foster and Robin. Case progress was monitored using a parent's daily log of the child's behavior, direct observations of the family meetings, and a measure of the family issues that were resolved. After consultation, the child was meeting an average of 86% of the parents' objectives, family members were making fewer derogatory comments and more comments indicating effective listening during family meetings, and both the parents and the child agreed that important issues had been resolved. The case serves as an example of the application of case study strategies within a behavioral technology training approach to consultation services.     

Child sexual abuse prevention: evaluation and one-year follow-up

Because of the high incidence and negative psychological consequences of child sexual abuse, prevention programs have been developed and implemented nationwide. Few programs, however, have been comprehensively evaluated. In this multimodal study, a 3-session adaptation of the Feeling Yes, Feeling No curriculum was provided to 286 third and fourth graders from four schools whose responses were compared to 113 delayed-treatment control children from two schools. Program impact was assessed using a knowledge scale, the State-Trait Anxiety Inventory for Children, a videotape vignettes measure, a parent questionnaire, and disclosure data. Treatment children exhibited significantly greater knowledge and better ability to discriminate safe from unsafe situations on the video measure than control children at posttesting. These gains were maintained at 6-week follow-up testing. There were no differences in treatment and control children's self-reported anxiety or parents' reports of negative emotional/behavioral consequences, which were minimal. Over 5% of participating children reported ongoing or past sexual abuse. In the One-Year Follow-Up Study, children's knowledge gains and prevention skills scores on the video measure were maintained at one-year follow-up. A 1-session "booster shot" program further enhanced children's safety discrimination skills on the video measure.     

Project 12-ways: Measuring outcome of a large in-home service for treatment and prevention of child abuse and neglect

Described here is Project 12-Ways, a large service project employing an ecobehavioral approach to the treatment and prevention of child abuse and neglect. By ecobehavioral it is meant that multifaceted in-home services are provided to clients, and that in-home data are collected on as many variables related to these services as possible. Four levels of research, data collection, and assessment are used to evaluate these services: Included here is a discussion of these levels of assessment. They are: data collected for clinical purposes; data from single-case experiments; research through the use of single-subject design logic applied to several subjects or groups of subjects, or by group statistical research designs; and program evaluation. The particular focus here is the program evaluation data which compare incidents of abuse and neglect during and after treatment between 50 families served by Project 12-Ways and 47 comparison protective service families. The data showed significantly fewer combined abuse and neglect incidents among the families served by Project 12-Ways. Suggestions for additional program evaluation data are provided along with a discussion of the limitations of the current analysis.     

Analysis and treatment of child abuse: A set of behavioral propositions

Five propositions are presented to suggest the potential of a behavioral approach to the understanding and treatment of child abuse. Each proposition deals with an important source of child abuse: (a) ineffective child management techniques; (b) deliberately punitive child rearing practices; (c) impulsive acts by the parent triggered by the child; (d) high levels of stress; and (e) negative attitude toward the child. For each proposition we discuss supportive findings from both child abuse and general psychological research as well as the additional information that would be needed in order to obtain a better functional analysis of clinical cases. Based on this discussion, behavioral therapy strategies are proposed with special attention being given to the various measures needed to evaluate the effectiveness of treatment programs.     

Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data

This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12–17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach.