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US Preventive Services Task Force
Evidence Report
November 27, 2018

Primary Care Interventions to Prevent Child Maltreatment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Author Affiliations
  • 1RTI International–University of North Carolina at Chapel Hill Evidence-based Practice Center
  • 2RTI International, Research Triangle Park, North Carolina
  • 3ZERO TO THREE, Washington, DC
  • 4Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill
  • 5Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill
  • 6Nationwide Children’s Hospital, Columbus, Ohio
  • 7Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
  • 8Department of Medicine, University of North Carolina at Chapel Hill
JAMA. 2018;320(20):2129-2140. doi:10.1001/jama.2018.17647
Abstract

Importance  Child maltreatment, also referred to as child abuse and neglect, can result in lifelong negative consequences.

Objective  To update the evidence on interventions provided in or referable from primary care to prevent child maltreatment for the US Preventive Services Task Force.

Data Sources  PubMed, Cochrane Library, EMBASE, and trial registries through December 18, 2017; references; experts; literature surveillance through July 17, 2018.

Study Selection  English-language fair- and good-quality randomized clinical trials that (1) included children with no known exposure to maltreatment and no signs or symptoms of current or past maltreatment, (2) evaluated interventions feasible in a primary care setting or that could result from a referral from primary care, and (3) reported abuse or neglect outcomes or proxies for abuse or neglect (eg, injury with a specificity for abuse, visits to the emergency department, hospitalization).

Data Extraction and Synthesis  Two reviewers independently assessed titles/abstracts, full-text articles, and study quality; a third resolved conflicts when needed. When at least 3 similar trials were available, random-effects meta-analyses were conducted.

Main Outcomes and Measures  Direct measures (including reports to child protective services and removal of the child from the home) or proxy measures of abuse or neglect; behavioral, emotional, mental, or physical well-being; and harms.

Results  Twenty-two trials (33 publications) were included (N = 11 132). No significant association was found between interventions and reports to child protective services within 1 year of intervention completion (10.6% vs 11.9%; pooled odds ratio [OR], 0.94 [95% CI, 0.72-1.23]; 10 trials [n = 2444]) or removal of the child from the home within 1 to 3 years of follow-up (3.5% vs 3.7%; pooled OR, 1.09 [95% CI, 0.16-7.28]; 4 trials [n = 609]). No statistically significant associations were observed between interventions and outcomes for emergency department visits in the short term (<2 years), hospitalizations, child development, school performance, and prevention of death. Nonsignificant results from single trials led to a conclusion of insufficient evidence for injuries, failure to thrive, failure to immunize, school attendance, and other measures of abuse or neglect. Inconsistent results led to a conclusion of insufficient evidence for long-term (≥2 years) outcomes for reports to child protective services (ORs range from 0.48 to 1.13; 3 trials [n = 1690]), emergency department visits (1 of 2 trials reported significant differences) and internalizing and externalizing behavior symptoms (3 of 6 trials reported reductions in behavior difficulties). No eligible trials on harms of interventions were identified.

Conclusions and Relevance  Interventions provided in or referable from primary care did not consistently prevent child maltreatment. No evidence on harms is available.

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