The effectiveness of early childhood home visitation in preventing violence: a systematic review

Home Visiting and Child Welfare Involvement: A Matched Comparison Group Study

The present study is one of the largest quasi-experimental studies to date on the effects of home visiting on documented child maltreatment during a child's first two years of life. In this matched comparison group study, we compare 8796 families that participated in a home visiting program (HV families) to 8796 similar non-participating families (non-HV families) selected from birth records using Coarsened Exact Matching. Using sequential logistic regression, we identify that HV families have significantly higher odds of experiencing a child maltreatment investigation by their child's second birthday compared to non-HV families; however, among those that were investigated, HV families have significantly lower odds of having their first investigation substantiated for maltreatment. Overall, HV families do not differ significantly from non-HV families in the odds of experiencing a substantiated investigation over 2 years. We share implications for considering surveillance bias, and we highlight the importance of including both substantiated and unsubstantiated investigations when studying the effects of home visiting on documented child maltreatment.

Criminal Legal System Experiences Among Families Receiving Home Visiting Services: A Scoping Review of the Literature

Each year, millions of families with children in the United States (US) come into contact with the criminal legal system (CLS), the deleterious consequences of which are well documented. Families exposed to the CLS often face many stressors and may benefit from supports and services designed to enhance parent-child relationships and connect them to health-promoting resources and services. Early childhood family home visiting (FHV) is a two-generation strategy to support pregnant women and families with infants and young children, many of whom encounter the CLS. Yet, little is known about the CLS experiences of families receiving FHV. This scoping review summarizes the published research on CLS experiences among FHV-enrolled families in the US. Seven online databases were used to identify research published between 1967 and 2022. Following PRISMA guidelines, articles were required to focus on FHV and CLS involvement. Twenty-eight articles met inclusion criteria; five were systematic reviews or meta-analyses, 22 were primary sources with quantitative measures of CLS, and one was a qualitative study. Among the primary quantitative sources, more than half (55%) included CLS measures to describe the sample and the others included CLS variables as outcomes. CLS involvement was a common experience among families receiving FHV services. This scoping review provides an important first step in describing the existing research on FHV participants' CLS involvement and can inform future efforts to serve this group of families.

Expanding Early Childhood Home Visitation Services in the United States to Reach More Vulnerable Families: A Backward Mapping Analysis

Early childhood home visitation (ECHV) in the United States is a voluntary service providing health and social support to low-income families who are experiencing, or at risk for experiencing, adversities such as adolescent pregnancy, poverty, and child maltreatment. The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program funds the delivery of evidence-based early childhood home visits, but these services are chronically under-utilized despite a substantial capacity for enrollment. Of particular concern are the families likely to encounter adversity but are unable to access services due to rigid criteria for participation. Using the theory of backward mapping developed by Richard Elmore, this paper analyzes the implementation of the MIECHV Program policy to identify possible factors responsible for the under-utilization of funded services. We explore issues related to the referral process, enrollment criteria, and attrition challenges for evidence-based ECHV models with recommendations for a centralized intake system, qualitative inquiry, and universal postpartum home visits.

Strategies to Prevent Violence Against Children in the Home: A Systematic Review of Reviews

Violence against children (VAC) in the home, or by household members, is a human rights and social problem with long-lasting consequences for individuals and society. Global policy instruments like the INSPIRE package have proposed strategies to prevent VAC, including Implementation and enforcement of laws, Norms and values, Safe environments, Parent and caregiver support, Income and economic strengthening, Response and support services, and Education and life skills. This systematic review of reviews aimed to synthesize the recent evidence base (i.e., published since 2000) for each INSPIRE strategy to reduce VAC in the home or by household members. We searched four databases using controlled vocabularies and keywords and searched for additional records in prior reviews of reviews. A total of 67 studies were included in this review, including literature reviews, meta-analyses, systematic reviews, and other types of reviews. We found extensive evidence supporting the effectiveness of parent and caregiver support interventions. However, reviews on other INSPIRE strategies were scarce. We also found a vast underrepresentation of samples from low- and- middle-income countries, children with disabilities, and families affected by forced displacement and conflict. In sum, this systematic review suggests that there are several promising strategies to prevent VAC (e.g., home visiting and parent education), but further research is necessary to strengthen the current body of evidence and effectively inform the implementation and scale-up of evidence-based interventions to protect children from violence globally.

The effectiveness of interventions to prevent and reduce child maltreatment in high-income countries: An umbrella review

BACKGROUND

In recent decades, many interventions targeting the occurrence (primary prevention) or the recurrence (secondary prevention) of child abuse and neglect have been tested. Findings have been synthesized in several meta-analyses and systematic reviews. However, the range of interventions addressed in these studies is very broad, and an integrative assessment of this large spectrum is lacking.

OBJECTIVE

Focusing on high-income countries, we ask (i) what is known about the effectiveness of interventions to prevent or reduce child abuse and neglect and (ii) how robust this evidence is.

METHODS

A systematic review of systematic reviews, called an umbrella review, was conducted. Ten databases on OvidSP and Web of Science were searched up until April 2023. Narrative synthesis was used to document the publications' findings.

RESULTS

44 publications were included in the umbrella review. We did not find that any type of intervention had a clear, consistent, and robust track record of preventing or reducing the occurrence of child abuse and neglect. Rather, publications examining the effectiveness of interventions in all areas frequently reported non-existent, small or inconsistent effects. However, positive effects for particular interventions in specific settings did emerge. Research methodologies showed several and often severe problems.

CONCLUSIONS

We suggest several measures to improve the quality of research and call on practitioners to be persistent in developing more effective interventions.

Evidence From the USPSTF and New Approaches to Evaluate Interventions to Prevent Child Maltreatment

Importance

The United States Preventive Services Task Force (USPSTF) has considered the topic of prevention of child maltreatment multiple times over its nearly 40-year history, each time reaching the conclusion that the evidence is insufficient to recommend for or against interventions aimed at preventing this important health problem with significant negative sequelae before it occurs. In the most recent evidence review, which was conducted from August 2021 to November 2023 and published in March 2024, the USPSTF considered contextual questions on the evidence for bias in reporting and diagnosis of maltreatment in addition to key questions regarding effectiveness of interventions to prevent child maltreatment.

Observations

A comprehensive literature review found evidence of inaccuracies in risk assessment and racial and ethnic bias in the reporting of child maltreatment and in the evaluation of injuries concerning for maltreatment, such as skull fractures. When children are incorrectly identified as being maltreated, harms, such as unnecessary family separation, may occur. Conversely, when children who are being maltreated are missed, harms, such as ongoing injury to the child, continue. Interventions focusing primarily on preventing child maltreatment did not demonstrate consistent benefit or information was insufficient. Additionally, the interventions may expose children to the risk of harm as a result of these inaccuracies and biases in reporting and evaluation. These inaccuracies and biases also complicate assessment of the evidence for making clinical prevention guidelines.

Conclusions and Relevance

There are several potential strategies for consideration in future efforts to evaluate interventions aimed at the prevention of child maltreatment while minimizing the risk of exposing children to known biases in reporting and diagnosis. Promising strategies to explore might include a broader array of outcome measures for addressing child well-being, using population-level metrics for child maltreatment, and assessments of policy-level interventions aimed at improving child and family well-being. These future considerations for research in addressing child maltreatment complement the USPSTF's research considerations on this topic. Both can serve as guides to researchers seeking to study the ways in which we can help all children thrive.

Family Club Denmark: A Quasi-Randomized Study of a Volunteer-Based Intervention to Support Vulnerable Families

Volunteer interventions play a vital role in supporting families by offering accessible and community-based resources outside the formal professional sector. This study examines the impact of the volunteer intervention known as Family Club Denmark (FCD) on the well-being of parents and children. FCD aims to provide families with positive experiences and support relationship building. The intervention, open to families from diverse social backgrounds, comprises volunteer-led family clubs where parents and children aged 2-12 years engage in activities and meals. We allocated 510 families (363 vulnerable families) to FCD or placed them on a waiting list based on a first-come, first-served principle. We conducted baseline, post-intervention, and follow-up assessments through questionnaires, observations, and interviews. On average, families participated in 5.8 sessions, with both families and volunteers reporting high satisfaction. When compared to control families, we find that vulnerable FCD parents feel more confident playing with their children (p = 0.04, [0.01; 0.40], d = 0.25), require less assistance in playing with their children (p = 0.01, [-0.34; -0.05], d = 0.33), and report that their children have a more challenging time forming friendships (p = 0.01, [-0.51; -0.09], d = 0.29). However, we did not find significant effects on mental health, parenting stress, self-efficacy, self-worth, family routines, or child well-being. We observed similar results for the full sample. The discovery that parents feel more confident playing with their children after participating in FCD highlights the vital role of volunteer-based interventions in enhancing parental engagement and fostering positive parent-child interactions. Trial registration: ClinicalTrials.gov NCT03657888 (registered 29 August 2018).

Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping

INTRODUCTION

Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face.

AIMS AND METHODS

Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified.

RESULTS

Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity.

CONCLUSION

Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.

PROTOCOL: Effectiveness of home-based interventions to prevent child neglect: A systematic review

This is the protocol for a Campbell systematic review. The objectives are as follows. The objectives of the present study are to answer the following questions: (1) What types of home-based interventions are currently being studied to prevent child neglect? (2) How effective are the different home-based interventions for preventing child neglect? (3) What are the causes of heterogeneity among included studies and their impact on study effects?

Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review

Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.

Engaging fathers to strengthen the impact of early home visitation on physical child abuse risk: Findings from the dads matter-HV randomized controlled trial

BACKGROUND

Despite growing recognition of the importance of fathers in child abuse risk, the field of perinatal home visitation has only begun to consider fathers' roles in the implementation of such services.

OBJECTIVES

This study examines the effectiveness of Dads Matter-HV ("DM-HV"), a father-inclusion enhancement to home visitation, and hypothesized mediators of impact.

METHODS

A multisite cluster randomized controlled trial was conducted with 17 home visiting program teams serving 204 families across study conditions. Program supervisors and their teams were randomized to deliver home visiting services plus DM-HV enhanced services (intervention) or home visiting services alone (control). Data were collected at three time points: baseline, 4 months post-baseline immediately following the intervention, and 12 months post-baseline. We employed structural equation modeling to estimate the effect of the intervention on physical child abuse risk and to trace hypothesized mediators, including the quality of the father-worker relationship, parents' partner support and abuse, and the timing of service initiation.

RESULTS

Results indicated that the DM-HV enhancement improved home visitor relationships with fathers, but only for families receiving services initiated postnatally. For these families, the improved quality of the father-worker relationship predicted improved parents' support of one another and reduced bidirectional mother-father partner abuse at 4-month follow-up, which in turn lowered maternal physical child abuse risk and paternal physical child abuse risk at 12-month follow-up.

CONCLUSIONS

DM-HV can strengthen the impact of home visitation services on physical child abuse risk for families when services are initiated postnatally.

"Before I was like a Tarzan. But now, I take a pause": mixed methods feasibility study of the Naungan Kasih parenting program to prevent violence against children in Malaysia

BACKGROUND

Despite impressive strides in health, social protection, and education, children continue to experience high rates of child maltreatment in Malaysia. This mixed-methods study assessed the feasibility of a five-session, social learning-based parenting program delivered by government staff in a community setting to reduce violence against children.

METHODS

Parents of children from birth to 17 years were recruited from two communities near Kuala Lumpur to participate in the government-run program called the Naungan Kasih Positive Parenting Program ("Protecting through Love" in Bahasa Melayu). Quantitative data from female caregivers (N = 74) and children ages 10-17 (N = 26) were collected along with qualitative interviews and focus groups with parents, children, and facilitators. The primary outcome was child maltreatment with secondary outcomes including neglect, positive parenting, acceptability of corporal punishment, harsh parenting, positive discipline, and child behavior problems. Multilevel Poisson regression and multilevel linear regression were conducted to compare baseline and post-test outcomes. Qualitative interviews and focus groups examined how participants experienced the program utilizing a thematic analysis approach.

RESULTS

Quantitative analyses found pre-post reductions in overall child maltreatment, physical abuse, emotional abuse, attitudes supporting corporal punishment, parent sense of inefficacy, and child behavior problems. There were no reported changes on positive and harsh parenting, parental mental health, and marital satisfaction, nor were there any other significant changes reported by children. Qualitative findings suggested that the program had tangible benefits for female caregivers involved in the program, with the benefits extending to their family members.

CONCLUSIONS

This feasibility study is one of the few studies in Southeast Asia that examined the feasibility and initial program impact of a parenting program delivered by government staff to families with children across the developmental spectrum from birth to 17 years. Promising results suggest that the program may reduce child maltreatment across a range of child ages. Findings also indicate areas for program improvement prior to further delivery and testing, including additional training and content on sexual and reproductive health, parenting children with disabilities, and online child protection.

Pilot test of a measure to assess clients' perceptions of their home visitors

Home visiting services for caregivers of infants and young children have been found to be an effective method for promoting child development. Unfortunately, such services suffer from high rates of attrition, suggesting the need to identify factors related to client retention in services. Research has indicated that the client-provider relationship is an important predictor of client retention in home visiting services; however, measures to assess this relationship are limited. This study reports on a pilot test of the Client Perceptions of Home Visitors Questionnaire, developed to assess home visiting clients' perceptions of their relationship with their home visitor. The measure was completed by 39 diverse home visiting clients during pregnancy in a midwestern town in the United States. The scale was found to have good internal consistency. Validity analyses found that the scale was positively associated with client satisfaction with services and perceived provider cultural sensitivity. The scale was also positively associated with retention in services at an 8-month follow-up. Additional research should examine the measure's psychometrics with larger samples.

The effectiveness of home visiting programs for the prevention of child maltreatment recurrence at home: a systematic review and meta-analysis

Purpose

This systematic review aimed to investigate the effectiveness of home visiting programs targeting parents who have maltreated their children on the prevention of child maltreatment recurrence.

Methods

Major databases were searched (Ovid-Medline, PubMed, Cochrane Library, CINAHL, and RISS). The frequency of maltreatment was measured for the meta-analysis, which was conducted using Review Manager 5.2 software. The effect size was measured using odds ratios (ORs).

Results

Six studies were included in the analysis, none of which were conducted in South Korea. The meta-analysis demonstrated that the risk of child maltreatment recurrence significantly decreased after a home visiting program was implemented (OR=0.45, 95% confidence interval [CI]=0.29-0.68). Nurses were the most common intervention providers.

Conclusion

Home visiting programs should be provided for families in which maltreatment has already occurred to prevent the recurrence of maltreatment and foster a home environment in which children can live safely. Since the rate of child maltreatment in Korea is increasing, further research is needed to develop and implement home visiting programs in which nurses play a major role in preventing the recurrence of child maltreatment.

Powering population health research: Considerations for plausible and actionable effect sizes

Evidence for Action (E4A), a signature program of the Robert Wood Johnson Foundation, funds investigator-initiated research on the impacts of social programs and policies on population health and health inequities. Across thousands of letters of intent and full proposals E4A has received since 2015, one of the most common methodological challenges faced by applicants is selecting realistic effect sizes to inform calculations of power, sample size, and minimum detectable effect (MDE). E4A prioritizes health studies that are both (1) adequately powered to detect effect sizes that may reasonably be expected for the given intervention and (2) likely to achieve intervention effects sizes that, if demonstrated, correspond to actionable evidence for population health stakeholders. However, little guidance exists to inform the selection of effect sizes for population health research proposals. We draw on examples of five rigorously evaluated population health interventions. These examples illustrate considerations for selecting realistic and actionable effect sizes as inputs to calculations of power, sample size and MDE for research proposals to study population health interventions. We show that plausible effects sizes for population health interventions may be smaller than commonly cited guidelines suggest. Effect sizes achieved with population health interventions depend on the characteristics of the intervention, the target population, and the outcomes studied. Population health impact depends on the proportion of the population receiving the intervention. When adequately powered, even studies of interventions with small effect sizes can offer valuable evidence to inform population health if such interventions can be implemented broadly. Demonstrating the effectiveness of such interventions, however, requires large sample sizes.

Components associated with the effect of home visiting programs on child maltreatment: A meta-analytic review

BACKGROUND

Home visiting programs are widely endorsed for preventing child maltreatment. Yet, knowledge is lacking on what and how individual program components are related to the effectiveness of these programs.

OBJECTIVE

The aim of this meta-analysis was to increase this knowledge by summarizing findings on effects of home visiting programs on child maltreatment and by examining potential moderators of this effect, including a range of program components and delivery techniques.

METHODS

A literature search yielded 77 studies (N=48,761) examining the effectiveness of home visiting programs, producing 174 effect sizes. In total, 35 different program components and delivery techniques were coded.

RESULTS

A small but significant overall effect was found (d=0.135, 95 % CI (0.084, 0.187), p<0.001). Programs that focused on improving parental expectations of the child or parenthood in general (d = 0.308 for programs with this component versus d = 0.112 for programs without this component), programs targeting parental responsiveness or sensitivity to a child's needs (d = 0.238 versus d = 0.064), and programs using video-based feedback (d = 0.397 versus d = 0.124) yielded relatively larger effects. Providing practical and instrumental assistance was negatively associated with program effectiveness (d=0.044 versus d = 0.168). Further, program effects were larger when percentages of non-Caucasians/non-Whites in samples and follow-up durations increased.

CONCLUSIONS

In general, home visiting programs can prevent child maltreatment only to a small extent. However, implementing specific components and techniques can improve program effectiveness.

Reflective parenting home visiting program: A longitudinal study on the effects upon depression, anxiety and parenting stress in first-time mothers

Objective

Our study aimed to investigate the effects of a reflective parenting home visiting program in first time-mothers at risk for depression, anxiety, and parenting stress, from three to 12 months after their child's birth.

Study design

The sample was composed by 77 first-time mothers and their healthy babies (53% boys and 47% girls). Mothers filled out the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, and the Parenting Stress Index-SF at 3, 6 and 12 months of the child. Thirty-six mothers were assigned to the experimental group and received the reflective parenting home-visiting program, the other 36 constituted the control group.

Results

Analyses showed a significant higher reduction in the level of depression, anxiety and parenting stress among mothers belonging to the experimental group, compared to the control group.

Conclusion

Our findings confirm the benefits of reflective parenting home visiting programs and underline the need to constantly evaluate the levels of depression, anxiety and parenting stress throughout the perinatal period to target effective prevention programs to foster early mother-child attachment bond.

Family Club Denmark #strongertogether - a volunteer intervention for disadvantaged families: study protocol for a quasi-experimental trial

BACKGROUND

Need-oriented family support programs are examples of voluntary-based interventions increasingly recognized by the public sector as an important contribution to health and social care provision. Voluntary interventions are attractive because of their focus on activism, inclusion, and participation, but also their low cost and easy accessibility. There is an increasing demand for documentation of the effectiveness of family support programs. Methodologically sound studies are, however, limited and findings are generally inconsistent. This trial aims to assess the effectiveness of the volunteer-based intervention Family Club Denmark on parental stress, mental health, development and well-being of parents and children and to get insight into the experiences of both volunteers and families.

METHODS

This is a prospective quasi-experimental trial with two conditions: (1) intervention group participating in Family Club Denmark and (2) wait-list control group. Participants are families with children aged 2-12 years who wish to participate in the program. Participants are allocated to intervention primarily after a first-come-first-serve principle, and further families will join the wait-list and be offered participation after around 6 months. Quantitative data are collected through web surveys at three time-points: at baseline, post-intervention (6 months after baseline), and follow-up (12 months after baseline). The primary outcome is mental health. Secondary outcomes include parenting behavior, parenting stress, self-efficacy and self-worth, family routines and child well-being. Qualitative data are collected through observations, focus groups, and interviews.

DISCUSSION

This trial is among the first experimental studies of a group-based third sector need-oriented family support program offered to a wide array of families. The trial will provide important knowledge on the effectiveness of a volunteer-based family intervention on important outcomes such as mental health, self-efficacy, family routines. Furthermore, the trial will provide knowledge on volunteer, parent, and child experiences with participating in the intervention and knowledge on how to conduct experimental trails in a complex volunteer environment.

TRIAL REGISTRATION

ClinicalTrials.govNCT03657888 (registered 29.08.2018).

Do home visiting programmes improve children's language development? A systematic review

OBJECTIVES

This review examines home visiting programmes that specifically provide home based support to vulnerable, socially disadvantaged women who are either pregnant or have recently become a new parent. Home visiting programmes often report multiple outcomes. The purpose of this review is to systematically summarise how effective home visiting programmes are at improving young children's language development.

DATA SOURCES

A comprehensive search of four online databases (Embase, Emcare, Psycinfo and Medline) between 1990 and 2020 was conducted, as well as a hand search of the references of relevant studies.

REVIEW METHOD

Studies were screened with N = 11 meeting the inclusion/exclusion criteria. The risk of bias of each study was assessed. To enable comparisons between home visiting programmes, relevant data was extracted using an adapted version of the Cochrane Public Health Group Data Extraction and Assessment Template.

RESULTS

Most of the home visiting programmes had been established in America. Six of the eleven studies reported positive language outcomes for children. Where statistical data was reported, the magnitude of the difference between the intervention and control groups represented small effect sizes. Nine different language measures were used, reporting on varying domains of language development rendering comparisons across programmes difficult. Most studies failed to report the duration of home visits, though studies which started prenatally showed the most promise in improving children's language development.

CONCLUSION

Home visiting programmes targeted at socially disadvantaged women and their children have the potential to positively influence the language development of the child. This review highlights that not all home visiting programmes measure the impact that the programme has on children's language development, and not all home visiting programmes achieve positive language outcomes. Initiating visits prenatally may help towards the improvement of children's language development. Future evaluations of home visiting programmes should explore this finding further, consider the language assessment tools selected, and improve on the reporting of their language results.

Parenting interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia: A systematic review and multi-level meta-analysis

BACKGROUND

Currently, the strongest evidence for preventing violence against children lies with social learning theory-based parenting interventions. An increasing number of experimental studies on such interventions have been conducted in low- and middle-income countries (LMICs) in East and Southeast Asia.

OBJECTIVE

To conduct a systematic review and meta-analysis on the effectiveness of parenting interventions in preventing violence against children.

PARTICIPANTS AND SETTING

Parents and primary caregivers living in LMICs in East and Southeast Asia.

METHODS

Eleven studies were retrieved through electronic databases, expert contacts, and the reference sections of previous reviews. Studies were appraised for risk of bias and effect estimates pooled using random effects multilevel meta-analysis.

RESULTS

Forty-four effect estimates were meta-analyzed based on five outcome category models, finding a small effect on abusive, harsh, or negative parenting (n = 3, d = -0.42, 95 % CI [- 0.81, -0.02], p < .01, I² = 72 %); a large, non-significant effect on parental knowledge or attitudes (n = 5, d = 1.40, 95 % CI [-0.30, 3.10], I² = 95 %); a small effect on positive parent-child interactions (n = 5, d = 0.25, 95 % CI [0.19, 0.32], p < .001, I² = 0); a small, non-significant effect on parental stress (n = 2, d = -0.13, 95 % CI [-0.38, 0.11], I² = 0); and a small, non-significant effect on family environment (n = 3, d = 0.21, 95 % CI [-0.12, 0.53], I² = 85 %).

CONCLUSIONS

The results suggest that parenting interventions can reduce rates of particular forms of violence against children, as well as promote positive parent-child interactions.

In-home obesity prevention in low-income infants through maternal and social transmission

BACKGROUND

Extant obesity efforts have had a limited impact among low-income underserved children, in part because existing programs are limited in terms of their short duration and low dosage, limited accessibility and sustainability; and failure to address barriers faced by diverse low-income families.

METHODS

This two-arm, parallel, randomized controlled trial (RCT) tests whether delivering obesity prevention, as part of an ongoing home visitation program (HVP), is an effective approach for primary (infants) and secondary (mothers) obesity prevention among low-income, underserved families. This RCT further examines the role of maternal and social factors as key mechanisms of transmission of infants' obesity risk, and the real-life costs of delivering obesity prevention as part of HVPs. Specifically, 300 low-income mothers/infants (6mo at baseline) participating in the Healthy Families America home visitation program in Antelope Valley (CA) will be recruited and enrolled in the study. Home visitors serving families will be randomly assigned to deliver the standard HVP curriculum with or without obesity prevention as part of their weekly home visits for two years. Anthropometric, metabolic and behavioral assessments of mothers/infants will be conducted at enrollment and after 6 and 18 months of intervention.

DISCUSSION

This study addresses the need to develop interventions targeting at-risk infants before they become obese. The proposed research is timely as the Institute of Medicine, the United States Department of Agriculture, and the Department of Health and Human Services are revising their recommendations to address key factors influencing obesity risk in children from birth to 24 months of age.

Barriers and Facilitators to the Implementation of Interventions to Prevent Youth Violence in Latin America: A Systematic Review and Qualitative Evidence Synthesis

Youth violence in Latin America is an important public health problem. However, the evidence from preventive programs within the region to address this problem is limited. Identifying context-specific factors that facilitate or hinder the success of interventions is necessary to guarantee the successful implementation of new preventive strategies. We present a systematic review and synthesis of qualitative studies to identify factors affecting the implementation of programs to prevent youth violence in Latin America. We searched 10 electronic databases and websites of international institutions. The quality of the studies was assessed using the critical appraisal skills program checklist, while the certainty of the findings of the synthesis was assessed using the certainty of the qualitative evidence approach. We included eight papers describing five programs in Argentina, Venezuela, Peru, El Salvador, and Mexico. Most of the factors affecting the implementation of programs were aspects related to features of the programs and social/political constraints. The synthesis suggests that future programs can benefit from having a multidisciplinary and/or multisectoral approach involving different key players. At the same time, potential strategies for avoiding problems related to such active engagement should be planned via promoting effective channels for communication and supervision. The review also suggests the importance of increasing awareness and motivation toward the problem of youth violence among relevant agencies and stakeholders. While the limited volume and quality of the literature impact on the ability to draw conclusions, the results could be useful for new programs being designed and the ones seeking to be adapted from other contexts.

Integrating Early Child Development and Violence Prevention Programs: A Systematic Review

Limited evidence describes promoting development and reducing violence in low- and middle-income countries (LMICs), a missed opportunity to protect children and promote development and human capital. This study presents a systematic literature review of integrated early childhood development plus violence prevention (ECD+VP) interventions in LMICs. The search yielded 5,244 unique records, of which N = 6 studies met inclusion criteria. Interventions were in Chile, Jamaica, Lebanon, Mexico, Mozambique, and Turkey. Five interventions were parent education programs, including center-based sessions (n = 3) and home visiting (n = 2), while one intervention was a teacher education program. All but one study reported improvements in both child development and maltreatment outcomes. The dearth of evidence on ECD+VP interventions suggests additional research is needed. Integrated ECD+VP interventions may improve multiple child outcome domains while leveraging limited resources in LMICs.

How adverse childhood experiences relate to single and multiple health risk behaviours in German public university students: a cross-sectional analysis

Background

Adverse childhood experiences (ACEs) have been shown to be linked to health risk behaviours (HRBs). This study aims to identify risk factors for ACEs and to examine the associations between ACEs and single and multiple HRBs in a sample of university students in Germany.

Methods

An online-based cross-sectional study was conducted among public university students (N = 1466). The widely applied ACE questionnaire was used and extended to operationalise 13 categories of childhood adversity. First, variables for each type of ACE and HRB were dichotomised (single ACEs and single HRBs), and then used for cumulative scores (multiple ACEs and multiple HRBs). Frequencies were assessed, and (multinomial) logistic regression analyses were performed.

Results

Prevalence rates of ACEs ranged from 3.9 to 34.0%, depending on the type of childhood adversity. Sociodemographic risk and protective factors for single/multiple ACEs varied strongly depending on the outcome. In particular, a high family socioeconomic status seemed to be a consistent protective factor for most ACEs. After adjusting for sociodemographic characteristics, both single and multiple HRBs were associated with single events of ACEs. Moreover, dose-response relationships between multiple ACEs and various single and multiple HRBs were found.

Conclusions

The study provides strong evidence that ACEs are associated with HRBs. The number of ACEs may play a role in single or multiple HRBs. Reducing the number of ACEs could thus decrease HRBs, which account for many of the leading causes of morbidity and death. The findings highlight the importance of trauma-informed health interventions designed to prevent the occurrence of ACEs, and build capacity among children and adults.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5926-3) contains supplementary material, which is available to authorized users.

A Randomized Trial of Home Visitation for CPS-Involved Families: The Moderating Impact of Maternal Depression and CPS History

Home visitation (HV) interventions may hold promise to improve parenting and prevent child maltreatment recidivism in families reported to child protective services (CPS) with young children, but this has rarely been studied. Findings are presented from an 18-month randomized controlled trial in which intact families ( N = 122) with at least one CPS report were provided with a facilitated connection to a paraprofessional evidence-based HV program or usual care services from child protection. Results are reported for changes in maternal stress, depression, and social support outcomes and repeat reports to CPS. No significant changes were found in maternal outcomes by group. Among nondepressed mothers or families without multiple CPS reports prior to study enrollment, HV was associated with a significantly lower likelihood of CPS report recidivism. These results indicate potential for HV to prevent maltreatment recidivism but suggest that higher intensity intervention is warranted for mothers exhibiting significant depressive symptoms or families with extensive CPS histories.

Habit formation intervention to prevent obesity in low-income preschoolers and their mothers: A randomized controlled trial protocol

BACKGROUND

Low-income and racial/ethnic minority mothers and their young children are at increased risk for obesity. Lack of access to evidence-based obesity prevention and treatment services further contributes to these disparities.

METHODS

This two-arm, parallel, randomized controlled trial (RCT) tests the effectiveness of a simple obesity intervention (HABITS) delivered as part of ongoing home visitation services, compared to the existing home visitation services without obesity-related content on mothers' and children's obesity risks. HABITS focuses on habit formation and modifications of food and activity cues in the home to support habit formation. Habit formation is focused on improving five behaviors: 1) fruits/vegetables, 2) fried foods, 3) sugar-sweetened beverages, 4) physical activity and 5) self-monitoring. Participants will be 298 mothers (>50% African American; 100% low income) and their children (3-5yo at baseline) enrolled in a home visitation program in central Alabama. Home visitors will be randomly assigned to deliver the home visitation curriculum with or without HABITS as part of their weekly home visits for 9 months. Assessments of mothers (weight, waist circumference, and habit strength of targeted behaviors), children (rate of weight gain), and the food/activity household environment will be conducted at enrollment, post-intervention (9 month), and one year post-intervention follow-up.

DISCUSSION

This research is poised to have a substantial impact because the delivery modalities of current obesity efforts disproportionally restrict the reach and engagement of underserved, low-income children and their caregivers who are most at-risk for health and obesity disparities.

Screening for social determinants of health in clinical care: moving from the margins to the mainstream

Background

Screening for the social determinants of health in clinical practice is still widely debated.

Methods

A scoping review was used to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care.

Results

Over the last two decades, a growing number of screening tools have been developed to help frontline health workers ask about the social determinants of health in clinical care. In addition to clinical practice guidelines that recommend screening for specific areas of social risk (e.g., violence in pregnancy), there is also a growing body of evidence exploring the use of screening or case finding for identifying multiple domains of social risk (e.g., poverty, food insecurity, violence, unemployment, and housing problems).

Conclusion

There is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice. There is also a growing number of high-quality evidence-based reviews that identify interventions that are effective in promoting health equity at the individual patient level, and at broader community and structural levels.

Follow-up study regarding the medium-term effectiveness of the home-visiting program "Pro Kind" at age 7 years: study protocol for a randomized controlled trial

BACKGROUND

Pro Kind is a German adaptation of the US Nurse Family Partnership program. It is an intervention based on home visits targeting first-time mothers from disadvantaged populations. Pro Kind was implemented as a randomized control trial from 2006 to 2012 with N = 755 first-time mothers (TG n = 394, CG n = 391). The 7-8-year follow-up aims to assess the mid-term effects of the program.

METHODS/DESIGN

Mid-term outcomes are being assessed by trained assessors. In a multimethod approach telephone interviews, on-site interviews, observations and developmental tests will be held in order to assess children's and mothers' life satisfaction, mental health, cognitive and social development, parenting behavior, signs of child abuse or neglect as well as the family's socio-economic status. Furthermore, administrative data will be accessed to obtain information regarding the mother's usage of pediatric health care, welfare usage and employment history.

DISCUSSION

Results regarding the mid-term effects of the intervention from the Pro Kind Follow-up will provide a scientific basis for future primary prevention programs as well as help stakeholders legitimizing early childhood investments.

TRIAL REGISTRATION

German Clinical Trial Registration DRKS-ID, ID: DRKS00007554 . Registered on 11 June 2015, updated on 6 October 2017.

Connecting the Dots: State Health Department Approaches to Addressing Shared Risk and Protective Factors Across Multiple Forms of Violence

Violence takes many forms, including intimate partner violence, sexual violence, child abuse and neglect, bullying, suicidal behavior, and elder abuse and neglect. These forms of violence are interconnected and often share the same root causes. They can also co-occur together in families and communities and can happen at the same time or at different stages of life. Often, due to a variety of factors, separate, "siloed" approaches are used to address each form of violence. However, understanding and implementing approaches that prevent and address the overlapping root causes of violence (risk factors) and promote factors that increase the resilience of people and communities (protective factors) can help practitioners more effectively and efficiently use limited resources to prevent multiple forms of violence and save lives. This article presents approaches used by 2 state health departments, the Maryland Department of Health and Mental Hygiene and the Colorado Department of Public Health and Environment, to integrate a shared risk and protective factor approach into their violence prevention work and identifies key lessons learned that may serve to inform crosscutting violence prevention efforts in other states.

Trying to bridge the worlds of home visitation and child welfare: Lessons learned from a formative evaluation

Young children in families contacting the child welfare system are at high risk of recurrent maltreatment and poor developmental outcomes. Home visitation programs to support parenting may offer hope as a preventive resource but these programs are rarely linked with child welfare. This article describes findings from a formative evaluation of a program designed to connect child welfare-involved families to an existing evidence-supported home visitation program. The program, Early Childhood Connections (ECC), was developed by a field-university partnership including leaders from a public state child welfare system, regional early childhood education systems, and several local agencies providing family support services. Despite extensive and rigorous planning by the workgroup and collaborative refining of the intervention approach as agency needs changed, the continued structural and policy changes within both the home visitation agency and the child welfare agencies created significant ongoing barriers to implementation. On the other hand, child welfare-involved families were receptive to engaging with home visitation. Implications of lessons learned for ongoing program development in this area are discussed.

Promoting father involvement in early home visiting services for vulnerable families: Findings from a pilot study of "Dads matter"

Despite mounting evidence on the importance of fathers in children's development, evidence-based perinatal home visitation programs have largely overlooked fathers in the design and delivery of services. This paper describes the design, development, and pilot testing of the "Dads Matter" enhancement to standard home visiting services. Dads Matter is a manualized intervention package designed to fully incorporate fathers into perinatal home visiting services. Twenty-four families were enrolled in a pilot study to assess the feasibility, acceptability, and preliminary outcomes of the intervention. Using a quasi-experimental time-lagged design, 12 families received standard home visiting services and completed baseline and four-month post-tests. Home visitor staff were then trained and supervised to implement the Dads Matter enhancement in addition to standard services. Twelve additional families were then enrolled and completed baseline and four-month post-tests. Implementation data indicated that Dads Matter was implemented as planned. Cohen's d scores on outcome measures indicate positive trends associated with Dads Matter in the quality of the mother-father relationship, perceived stress reported by both parents, fathers' involvement with the child, maltreatment indicators, and fathers' verbalizations toward the infant. Effect sizes generally ranged from moderate to large in magnitude and were larger than overall effect sizes of home visitation services alone reported in prior meta-analyses. Dads Matter appears to be a feasible, acceptable, and promising approach to improving fathers' engagement in home visiting services and promoting family and child well-being.

Surveillance Bias in Child Maltreatment: A Tempest in a Teapot

Background: Children are believed to be more likely to be reported for maltreatment while they are working with mental health or social service professionals. This "surveillance bias" has been claimed to inflate reporting by fifty percent or more, and has been used to explain why interventions such as home visiting fail to reduce official maltreatment reporting rates. Methods: We use national child abuse reporting data (n = 825,763), supplemented by more detailed regional data from a multi-agency administrative data study (n = 7185). We determine the percentage of all re-reports made uniquely by mental health and social service providers within and across generations, the report sources which could be subject to surveillance bias. Results: At three years after the initial Child protective services (CPS) report, the total percentage of national reports uniquely made by mental health or social service providers is less than 10%, making it impossible that surveillance bias could massively inflate CPS reporting in this sample. Analysis of national data find evidence of a very small (+4.54%) initial surveillance bias "bump" among served cases which decays to +1.84% within three years. Our analysis of regional data showed similar or weaker effects. Conclusions: Surveillance bias effects appear to exist, but are very small.

THRIVES: Using the best evidence to prevent violence against children

More than 1 billion children - half the children in the world - are victims of violence every year. As part of the Post-2015 sustainable development agenda, the UN has issued a global call-to-action: to eliminate violence against children. Essential to preventing violence against children is guidance to countries on using the best available evidence to address this problem. THRIVES provides this evidence. It represents a framework of complementary strategies that, taken together, have potential to achieve and sustain efforts to prevent violence against children. These strategies, which span health, social services, education, and justice sectors, include Training in parenting, Household economic strengthening, Reduced violence through legislative protection, Improved services, Values and norms that protect children, Education and life skills, and Surveillance and evaluation. For each THRIVES area, we review evidence for effectiveness and identify programmatic or policy examples. This framework will facilitate commitments to effective, sustainable, and scalable action.

The Cultural Adaptation of a Community-Based Child Maltreatment Prevention Initiative

A unique primary prevention effort, Strong Communities for Children (Strong Communities), focuses on changing attitudes and expectations regarding communities' collective responsibilities for the safety of children. Findings from a 6-year pilot of the initiative in South Carolina have shown promise in reducing child maltreatment, but efforts to adapt the initiative to different cultural contexts have been lacking. No models exist for adapting an initiative that takes a community-level approach to ensuring children's safety. Thus, this article addresses the gap by providing an overview of the original initiative, how the initiative was adapted to the Israeli context, and lessons learned from the experience. Building on conceptualizations of cultural adaptation by Castro et al. (Prevention Science, 5, 2004, 41) and Resnicow et al. (Ethnicity and Disease, 9, 1999, 11), sources of nonfit (i.e., sociodemographic traits, political conflict, government services, and the presence and role of community organizations) were identified and deep and surface structure modifications were made to the content and delivery. Ultimately, this article describes the adaption and dissemination of a community-based child maltreatment prevention initiative in Tel Aviv, Israel, and addresses researchers' calls for more publications describing the adaptation of interventions and the procedures that need to be implemented to achieve cultural relevance.

The Prevention of Child Maltreatment Through the Nurse Family Partnership Program: Mediating Effects in a Long-Term Follow-Up Study

We examine maternal life-course mediators of the impact of a nurse home visitation program on reducing child maltreatment among participants in the Elmira trial of the Nurse Family Partnership program from the first child's birth through age 15. For women having experienced low to moderate levels of domestic violence, program effects on the number of confirmed maltreatment reports were mediated by reductions in numbers of subsequent children born to mothers and their reported use of public assistance. Together, the two mediators explained nearly one half of the total effect of nurse home visiting on child maltreatment. The long-term success of this program on reducing child maltreatment can be explained, at least in part, by its positive effect on pregnancy planning and economic self-sufficiency.

Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention

BACKGROUND

Extant obesity efforts have had limited impact among low-income underserved children, in part because of limitations inherent to existing programs: (i) short duration and low intensity; (ii) late timing of implementation, when children are already overweight or obese; (iii) intervention delivery limiting their accessibility and sustainability; and (iv) failure to address barriers such as a lack of culturally competent services, poverty and housing instability, which interfere with healthy lifestyle changes.

OBJECTIVE

This concept paper proposes an innovative model of obesity prevention implemented in infancy and sustained throughout early childhood to address the limitations of current obesity prevention efforts. Specifically, we propose to integrate sustained, weekly, in-home obesity prevention as part of the services already delivered by ongoing Home Visitation Programs, which currently do not target obesity prevention.

CONCLUSION

The home visiting structure represents an ideal model for impactful obesity prevention as home visitation programs: (i) already provide comprehensive services to diverse low-income infants and families who are most at risk for obesity and poor health because of socio-economic and structural conditions; (ii) services are initiated in infancy and sustained throughout critical developmental periods for the formation of healthy/unhealthy behaviors; and (iii) have been in place for more than 40 years, with a widespread presence across the United States and nationwide, which is critical for the scalability and sustainability of obesity prevention.

Interventions to prevent youth violence in Latin America: a systematic review

OBJECTIVES

This review aims to summarise evidence on the effectiveness of interventions to prevent youth violence in Latin America.

METHODS

A systematic search on 13 academic databases was conducted to locate studies evaluating a primary or secondary prevention intervention in Latin America. Studies could use any type of quantitative design to assess outcomes related to youth violence. A search of websites, references and citation searching was also carried out. The quality of each study was assessed.

RESULTS

Nine studies were identified. Most documented positive effects of the interventions on the perception of youth violence present in the community/school. Evidence was found of a reduction in homicides and juvenile crimes in three studies, two of which evaluated a community-based intervention. There were mixed results for the self-report of participation on violent acts. The majority of the studies lacked of a rigorous design.

CONCLUSIONS

Most of the interventions had some promising results, including the reduction of homicides within communities. Community-based programmes were the most consistent regarding an effectiveness to prevent violence. However, the evidence for Latin America is still scarce and relies on non-rigorously designed studies.

Translating an Evidence-Based Injury Prevention Program for Implementation in a Home Visitation Setting

Safe N' Sound (SNS), a computer-based childhood injury prevention program, provides individually tailored information to parents about their child's injury risks with specific behavioral recommendations. We translated SNS for implementation in a home visitation organization in order to increase its capacity to effectively address injury prevention and decrease the burden of injury experienced by high-need families. The aim of this study was to identify behavioral and organizational barriers and facilitators to translating and implementing SNS in a home visitation setting. Nurse home visitors (NHVs) participated in semistructured interviews that examined perceptions of program implementation, intervention characteristics, individual characteristics of NHVs, and recommendations for improving implementation. The utility of the program for promoting injury prevention systematically and its alignment with the organization's mission were facilitators of successful implementation. Barriers included NHVs' concerns about overburdening clients and missed educational opportunities related to injury risks not addressed by the program and delayed delivery of educational reports. Findings illustrate the dynamic interactions of intervention characteristics with organizational and individual factors and suggest that customizing implementation to organizational capacity and specific needs may better support successful program implementation in home visitation settings.

Effects of Parenting Programs on Child Maltreatment Prevention: A Meta-Analysis

The objective of this study is to evaluate the effectiveness of parenting programs in reducing child maltreatment and modifying associated factors as well as to examine the moderator variables that are linked to program effects. For this meta-analysis, we searched nine electronic databases to identify randomized controlled trials published before September 2013. The effect sizes of various outcomes at different time points were computed. From the 3,578 studies identified, we selected 37 studies for further analysis. The total random effect size was 0.296. Our results showed that parenting programs successfully reduced substantiated and self-reported child maltreatment reports and reduced the potential for child maltreatment. The programs also reduced risk factors and enhanced protective factors associated with child maltreatment. However, the effects of the parenting programs on reducing parental depression and stress were limited. Parenting programs produced positive effects in low-, middle-, and high-income countries and were effective in reducing child maltreatment when applied as primary, secondary, or tertiary child maltreatment intervention. In conclusion, parenting programs are effective public health approaches to reduce child maltreatment. The evidence-based service of parenting programs could be widely adopted in future practice.

Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families

OBJECTIVES

Our aim was to estimate the effects of Healthy Families Massachusetts, a statewide home visiting program serving first-time adolescent parents, on parenting, child development, educational attainment, family planning, and maternal health and well-being.

METHODS

We used a randomized controlled trial design to randomly assign the 704 participants to a group receiving home visiting services or a control group. Between 2008 and 2012, telephone and in-person interviews were conducted and administrative data obtained at 12 and 24 months after enrollment. Intention-to-treat analyses compared group differences across 5 outcome domains: parenting, child health and development, educational and economic achievement, family planning, and parental health and well-being.

RESULTS

The home visiting program had a positive influence on parenting stress, college attendance, condom use, intimate partner violence, and engagement in risky behaviors. No negative findings were observed.

CONCLUSIONS

A paraprofessional home visiting program specifically targeting young mothers appears effective in domains of particular salience to young parents and their infants and toddlers. Expanding participation in the program appears a worthy goal for program administrators and policymakers.

Violence in the United States: Status, Challenges, and Opportunities

IMPORTANCE

Interpersonal violence, which includes child abuse and neglect, youth violence, intimate partner violence, sexual violence, and elder abuse, affects millions of US residents each year. However, surveillance systems, programs, and policies to address violence often lack broad, cross-sector collaboration, and there is limited awareness of effective strategies to prevent violence.

OBJECTIVES

To describe the burden of interpersonal violence in the United States, explore challenges to violence prevention efforts and to identify prevention opportunities.

DATA SOURCES

We reviewed data from health and law enforcement surveillance systems including the National Vital Statistics System, the Federal Bureau of Investigation's Uniform Crime Reports, the US Justice Department's National Crime Victimization Survey, the National Survey of Children's Exposure to Violence, the National Child Abuse and Neglect Data System, the National Intimate Partner and Sexual Violence Survey, the Youth Risk Behavior Surveillance System, and the National Electronic Injury Surveillance System-All Injury Program.

RESULTS

Homicide rates have decreased from a peak of 10.7 per 100,000 persons in 1980 to 5.1 per 100,000 in 2013. Aggravated assault rates have decreased from a peak of 442 per 100,000 in 1992 to 242 per 100,000 in 2012. Nevertheless, annually, there are more than 16,000 homicides and 1.6 million nonfatal assault injuries requiring treatment in emergency departments. More than 12 million adults experience intimate partner violence annually and more than 10 million children younger than 18 years experience some form of maltreatment from a caregiver, ranging from neglect to sexual abuse, but only a small percentage of these violent incidents are reported to law enforcement, health care clinicians, or child protective agencies. Moreover, exposure to violence increases vulnerability to a broad range of mental and physical health problems over the life course; for example, meta-analyses indicate that exposure to physical abuse in childhood is associated with a 54% increased odds of depressive disorder, a 78% increased odds of sexually transmitted illness or risky sexual behavior, and a 32% increased odds of obesity. Rates of violence vary by age, geographic location, sex, and race/ethnicity, and significant disparities exist. Homicide is the leading cause of death for non-Hispanic blacks from age 1 through 44 years, whereas it is the fifth most common cause of death among non-Hispanic whites in this age range. Additionally, efforts to understand, prevent, and respond to interpersonal violence have often neglected the degree to which many forms of violence are interconnected at the individual level, across relationships and communities, and even intergenerationally. The most effective violence prevention strategies include parent and family-focused programs, early childhood education, school-based programs, therapeutic or counseling interventions, and public policy. For example, a systematic review of early childhood home visitation programs found a 38.9% reduction in episodes of child maltreatment in intervention participants compared with control participants.

CONCLUSIONS AND RELEVANCE

Progress has been made in reducing US rates of interpersonal violence even though a significant burden remains. Multiple strategies exist to improve violence prevention efforts, and health care providers are an important part of this solution.

Social support and child protection: Lessons learned and learning

Social support has been a topic of research for nearly 50 years, and its applications to prevention and intervention have grown significantly, including programs advancing child protection. This article summarizes the central conclusions of the 1994 review of research on social support and the prevention of child maltreatment prepared for the U.S. Advisory Board on Child Abuse and Neglect, and surveys advances in the field since its publication. Among the lessons learned twenty years ago are (a) the diversity of the social support needs of at-risk families and their association with child endangerment, (b) the need to supplement the emotionally affirmative aspects of social support with efforts to socialize parenting practices and monitor child well-being, (c) the desirability of integrating formal and informal sources of social support for recipients, and (d) the importance of considering the complex recipient reactions to receiving support from others. The lessons we are now learning derive from research exploring the potential of online communication to enhance social support, the neurobiology of stress and its buffering through social support, and the lessons of evaluation research that are identifying the effective ingredients of social support interventions.

Home environments of infants from immigrant families in the United States: findings from the new immigrant survey

Data from the New Immigrant Survey were used to describe the home environments of 638 children ages birth to 3 years whose parents legally immigrated to the United States. Thirty-two indicators of home conditions were clustered into four domains: discipline and socioemotional in support, learning materials, enriching experiences, and family activities. Results revealed variation in how frequently infants from every country (Mexico, El Salvador, India, Philippines) and region (East Asia, Europe, Caribbean, Africa) studied experienced each home environmental condition. There were differences between countries and regions on many indicators as well as differences based on parents' level of education. The experiences documented for children of recent legal immigrants were similar to those documented for children of native-born families in other studies.