We reviewed the empirical evidence on whether early childhood primary prevention programs can reduce rates of child abuse and neglect. Fifteen studies of 14 programs for children ages birth to 5 years were completed from 1990 to 2007 and assessed impacts with methodological rigor. All but one of the programs intervened from birth to age 3 through home visits, parent education classes, or the provision of health services. The weighted average effect size of program participation was a 2.9 percentage-point reduction in maltreatment (6.6% vs. 9.5%), which is equivalent to a 31% reduction in the rate of maltreatment and a fifth of a standard deviation. Of the five programs showing significant reductions in substantiated rates of child maltreatment, three provide strong evidence of preventive effects. Only the Child-Parent Centers (CPCs) and the Nurse—Family Partnership (NFP) assessed longer term preventive effects. Common elements of these effective programs included implementation by professional staff, relatively high dosage and intensity, and comprehensiveness of scope. The major conclusion is that the evidence base for programs in early childhood to prevent child maltreatment remains relatively weak. To advance the field, more longer term studies of a variety of intervention models are needed.
Aos, S., Lieb, R., Mayfield, J., Miller, M., & Pennucci, A. (2004). Benefits and costs of prevention and early intervention programs for youth: Technical appendix (No. 04-07-3901). Olympia: Washington State Institute for Public Policy .
2.
Bakermans-Kranenburg, M.J., van Ijzendoorn, M.H., & Juffer, F. (2003). Less is more: Meta-analyses of sensitivity and attachment interventions in early childhood. Psychological Bulletin, 129, 195-215.
3.
Barrera, M., & Sandler, I.N. (2006). Prevention: A report of progress and momentum into the future. Clinical Psychology: Science and Practice , 13, 221-226.
4.
Barth, R.P. (1991). An experimental evaluation of in-home child abuse prevention services. Child Abuse & Neglect, 15, 363-375.
5.
Bickman, L. (Ed.). (1990). Advances in program theory. New directions for program evaluation series (No. 47). San Francisco: Jossey-Bass.
6.
Bilukha, O., Hahn, R.A., Crosby, A., Fullilove, M.T., Liberman, A., Moscicki, E., et al. (2005). The effectiveness of early childhood home visitation in preventing violence: A systematic review. American Journal of Preventive Medicine, 28(2S1), 11-39.
7.
Bolger, K.E., & Patterson, C.J. (2003). Sequelae of child maltreatment . In S. S. Luthar (Ed.), Resilience and vulnerability: Adaptation in the context of childhood adversities (pp. 156-181). Cambridge, UK: Cambridge University Press.
8.
Brayden, R.M., Altemeier, W.A., Dietrich, M.S., Tucker, D.D., Christensen, M.J., McLaughlin, F.J., et al. (1993). A prospective study of secondary prevention of child maltreatment. Journal of Pediatrics, 122, 511-516.
9.
Briere, J. (1996). A self-trauma model for treating adult survivors of severe child abuse. In J. Briere, L. Berliner, J. Bulkley, C. Jenny, & T. Reid (Eds.), APSAC Handbook on child maltreatment (pp. 140-157). Thousand Oaks, CA: Sage.
10.
Britner, P.A., & Reppucci, N.D. (1997). Prevention of child maltreatment: Evaluation of a parent education program for teen mothers. Journal of Child and Family Studies, 6, 165-175.
11.
Bugental, D.B., Lin, E.K., Rainey, B., Kokotovic, A., & O'Hara, N. (2002). A cognitive approach to child abuse prevention . Journal of Family Psychology, 16, 243-258.
12.
Chaffin, M., & Bard, D. (2006). Impact of intervention surveillance bias on analyses of child welfare report outcomes. Child Maltreatment, 11, 301-312.
13.
Cicchetti, D., Rogosch, F.A., & Toth, S.L. (2006). Fostering secure attachment in infants in maltreated families through preventive interventions. Development and Psychopathology, 18, 623-649.
14.
Cicchetti, D., & Valentino, K. (2006). An ecological-transactional perspective on child maltreatment: Failure of the average expectable environment and its influence on child development. In D. Cicchetti & D. Cohen (Eds.), Development and Psychopathology (Vol. 3, 2nd ed.). New York: Cambridge University Press.
15.
Cohen, J., & Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
16.
Cohen, P., Brown, J., & Smailes, E. (2001). Child abuse and neglect and the development of mental disorders in the general population. Development and Psychopathology, 13, 981-999.
17.
Consortium for Longitudinal Studies. (1983 ). As the twig is bent . . . lasting effects of preschool programs . Hillsdale, NJ: Erlbaum.
18.
Cucherat, M. (2001). EasyMA: Software for meta-analysis. Lyon, France: Department of Clinical Pharmacology, Cardiological Hospital.
19.
DePanfilis, D., & Dubowitz, H. (2005). Family connections: A program for preventing child neglect. Child Maltreatment, 10, 108-123.
20.
Duggan, A., Caldera, D., Rodriguez, K., Burrell, L., Rohde, C., & Crowne, S.S. (2007). Impact of a statewide home visiting program to prevent child abuse. Child Abuse & Neglect, 31, 801-827.
21.
Duggan, A.K., McFarlane, E.C., Windham, A.M., Rohde, C.A., Salkever, D.S., Fuddy, L., et al. (1999). Evaluation of Hawaii's Healthy Start Program . The Future of Children, 9(1), 66-90.
22.
Duggan, A., McFarlane, E., Fuddy, L., Burrell, L., Higman, S., Windham, A., et al. (2004). Randomized trial of a statewide home visiting program: Impact in preventing child abuse and neglect. Child Abuse & Neglect, 28, 597-622.
23.
DuMont, K., Mitchell-Herzfeld, S., Greene, R., Lee, E., Lowenfels, A., & Rodriguez, M. (2006). Healthy families New York (HFNY) randomized trial: Impacts on parenting after the first two years (Working Paper No. 1). New York: New York State Office of Children and Family Services.
24.
Eckenrode, J., Laird, M., & Doris, J. (1993). School performance and disciplinary problems among abused and neglected children. Developmental Psychopathology , 29, 53-62.
25.
Egeland, B. (1997). Mediators of the effects of child maltreatment on the developmental adaptation in adolescence. In D. Cicchetti & Toth, S. L. (Eds.), Developmental perspectives on trauma: Theory, research, and intervention (Vol. 8, pp. 403-434). Rochester, NY: University of Rochester Press.
26.
Erickson, M.F., & Egeland, B. (2002). Child neglect. In J. E. B. Myers, L. Berliner, J. Briere, C. T. Hendrix , C. Jenny, & T. A. Reid (Eds.), The APSAC handbook on child maltreatment (2nd ed., pp. 3-20). Thousands Oaks, CA: Sage.
27.
Fergusson, D.M., Hildegard, G., Horwood, L.J., & Ridder, E.M. (2005). Randomized trial of the early start program of home visitation. Pediatrics, 116, 803-809.
28.
Fromm, S. (2001). Total estimated cost of child abuse and neglect in the United States. Chicago: Prevent Child Abuse America.
29.
Galano, J., Credle, W., Perry, D., Berg, S.W., Huntington, L., & Steif, E. (2001). Developing and sustaining a successful community prevention initiative: The Hampton healthy families partnership. Journal of Primary Prevention, 21, 495-509.
Geeraert, L., Van den Noortgate, W., Grietens, H., & Onghena, P. (2004). The effects of early prevention programs for families with young children at risk for physical child abuse and neglect: A meta-analysis . Child Maltreatment, 9, 277-291.
32.
Greenberg, M.T., Domitrovich, C., & Bumbarger, B. (2001). The prevention of mental health disorders in school-aged children. Prevention and Treatment, 4, 1-59. Retrieved September, 24, 2008, from http://content.apa.org/journals/pre/4/1/1a.html
33.
Guterman, N.B. (1997). Early prevention of physical child abuse and neglect: Existing evidence and future directions. Child Maltreatment , 2, 12-34.
34.
Haapasalo, J., & Pokela, E. (1999). Child-rearing and child abuse antecedents of criminality . Aggression & Violent Behavior, 4, 107-127.
35.
Huxley, P., & Warner, R. (1993). Primary prevention of parenting dysfunction in high-risk cases. American Journal of Orthopsychiatry, 63, 582-588.
36.
Illinois Department of Child & Family Services. (2007, July, 10). Child welfare program costs. Springfield, IL: Author.
37.
Johnson-Reid, M. (1998). Youth violence and exposure to violence in childhood: An ecological review. Aggression and Violent Behavior, 3, 159-179.
38.
Kaplan, S.J., Pelcovitz, D., & Labruna, V. (1999). Child and adolescent abuse and neglect research: A review of the past 10 years. Part I. Physical and emotional abuse and neglect . Journal of the Academy of Child and Adolescent Psychiatry , 38, 1214-1222.
39.
Kelley, B.T., Thornberry, T.T., & Smith, C.A. (1997). In the wake of childhood maltreatment. Washington, DC: National Institute of Justice. Retrieved January 24, 2008, from http://www.ncjrs.gov/pdffiles1/165257.pdf
40.
Kinard, E.M. (1999). Psychosocial and academic performance in abused childrenChildren and Youth Services Review, 21, 351-376.
41.
Landsverk, J., Carrilio, T., Connelly, C., Ganger, W., Slymen, D., Newton, R., et al. (2002). Healthy families San Diego clinical trial: Technical report. San Diego, CA: Child and Adolescent Services Research Center and San Diego Children's Hospital and Health Center.
42.
Leventhal, J.M. (2001). The prevention of child abuse and neglect: Successfully out of the blocks. Child Abuse & Neglect, 25, 431-439.
43.
Love, J.M., Kisker, E., Ross, C., Raikes, H., Constantine, J., Boller, K., et al. (2005). The effectiveness of Early Head Start for 3-year-old children and their parents: Lessons for policies and programs. Developmental Psychology, 41, 885-901.
44.
MacLeod, J., & Nelson, G. (2000). Programs for the promotion of family wellness and the prevention of child maltreatment: A meta-analytic review. Child Abuse & Neglect, 24, 1127-1149.
45.
MacMillan, H.L. (2000). Preventive health care, 2000 update: Prevention of child maltreatment. Canadian Medical Association Journal , 163, 1451-1458.
46.
Malcolm, M. (2005). Can buy me love: The effect of child welfare expenditures on maltreatment outcomes. Unpublished report.
47.
Malinosky-Rummell, R., & Hansen, D.J. (1993). Long-term consequences of childhood physical abuse . Psychological Bulletin, 114, 68-79.
48.
Marcenko, M.O., Spence, M., & Samost, L. (1996). Outcomes of a home visitation trial for pregnant and postpartum women at-risk for child placement. Child and Youth Services Review, 18, 243-259.
49.
Mersky, J.P. (2006). Disentangling child maltreatment and juvenile delinquency: A prospective examination of direct and subgroup effects. Unpublished doctoral dissertation, University of Wisconsin-Madison .
50.
National Advisory Mental Health Council Workgroup on Mental Disorder Prevention Research. (2001). Priorities for Prevention Research at NIMH. Prevention and Treatment, 4 (Article 17a) . Retrieved September 23, 2008, from http://content.apa.org/journals/pre/4/1/17a.html
51.
National Center on Child Abuse Prevention Research. (1996). Intensive home visitation: A randomized trial, follow-up and risk assessment study of Hawaii's healthy start program: Final report. Chicago: Prevent Child Abuse America (formerly, National Committee to Prevent Child Abuse).
52.
Olds, D., Eckenrode, J., Henderson, C., Kitzman, H., Powers, J., Cole, et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: Fifteen year follow-up of a randomized trial. Journal of the American Medical Association, 278, 637-643.
53.
Olds, D.L., Henderson, C., Chamberlin, R., & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized trial of nurse home visitation. Pediatrics, 78, 65-78.
54.
Olds, D.L., Henderson, C.R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93, 89-98.
55.
Olds, D.L., Henderson, C.R., Kitzman, H.J., Eckenrode, J.J., Cole, R.E., & Tatelbaum, R.C. (1999). Prenatal and infancy home visitation by nurses: Recent findings. Future of Children , 9(1), 44-65.
56.
Olds, D.L., Robinson, J., Pettit, L., Luckey, D., Holmberg, J., Ng, R.K. et al. (2004). Effects of home visits by paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial. Pediatrics, 114, 1560-1568.
57.
Parents as Teachers National Center. (2003 a). Parents as teachers research overview: Key outcomes for families. St. Louis, MO: Parents as Teachers National Center.
58.
Parents as Teachers National Center. (2003 b). Future research directions for the parents as teachers program: Final report of the scientific advisory committee. St. Louis, MO: Parents as Teachers National Center.
59.
Paxson, C., & Waldfogel. J. (2003). Welfare reforms, family resources, and child maltreatment . Journal of Policy Analysis and Management, 22, 85-113.
60.
Puma, M., Bell, S., Cook, R., Heid, C., Lopez, M., & Zill, N. (2005). Head Start impact study: First year findings. Washington, DC: U. S. Department of Health and Human Services, Administration for Children and Families.
61.
Reynolds, A.J. (2000). Success in early intervention: The Chicago child-parent centers. Lincoln, NE: University of Nebraska Press.
62.
Reynolds, A.J., & Robertson, D. (2003). School-based early intervention and later child maltreatment in the Chicago Longitudinal Study. Child Development , 74(1), 3-26.
63.
Reynolds, A.J., Temple, J.A., & Ou, S. (2003). School-based early intervention and child well-being in the Chicago Longitudinal Study. Child Welfare, 82, 633-656.
64.
Reynolds, A.J., Temple, J.A., Ou, S., Robertson, D.L., Mersky, J.P., Topitzes, J.W., et al. (2007). Effects of a school-based early childhood intervention on adult health and well-being: A 19-year follow-up of low-income families. Archives of Pediatrics & Adolescent Medicine , 161, 730-739.
65.
Reynolds, A.J., Temple, J.A., Robertson, D.L., & Mann, E.A. (2002). Age 21 cost-benefit analysis of the Title 1 Chicago Child-Parent Centers. Educational Evaluation and Policy Analysis , 24, 267-303.
66.
Rossi, P.H., Freeman, H.E., & Lipsey, M. (2005). Evaluation: A systematic approach (6th ed.). Thousand Oaks, CA: Sage.
67.
Shields, A.M. (1996). Disruptive behaviors among maltreated and impoverished children: The effects of emotion regulation and representations of caregivers . Rochester, NY: University of Rochester Press.
68.
Shields, A.M., Cicchetti, D., & Ryan, R.M. (1994). The development of emotional and behavioral self-regulation and social competence among maltreated school-age children. Development and Psychopathology, 6, 57-75.
69.
Slack, K.S., Holl, J.L., Lee, B.J., McDaniel, M., Altenbernd, L., & Stevens, A.B. (2003). Child protective intervention in the context of welfare reform: The effect of work and welfare on maltreatment reports. Journal of Policy Analysis and Management, 22, 517-536.
70.
Stevens-Simon, C., Nelligan, D., & Kelly, L. (2001). Adolescents at risk for mistreating their children part II: A home- and clinic-based prevention program. Child Abuse & Neglect, 6, 753-769.
71.
Sweet, M.A., & Appelbaum, M.I. (2004). Is home visiting an effective strategy? A meta-analytic review of home visiting programs for families with young children. Child Development, 75, 1435-1456.
72.
Temple, J.A. & Reynolds, A.J. (2007). Benefits and costs of investments in preschool education: Evidence from the Child-Parent Centers and related programs. Economics of Education Review, 26, 126-144.
73.
Topitzes, J.W. (2006). The effects of child maltreatment on adult crime: Examination of a long-term developmental model. Unpublished doctoral dissertation , University of Wisconsin- Madison .
74.
Toth, S.L., Maughan, A., Manly, J.T., Spagnola, M., & Cicchetti, D. (2002). The relative efficacy of two interventions in altering maltreated preschool children's representational models: Implications for attachment theory. Development and Psychopathology, 14, 877-908.
75.
Troia, N. (2003). Prevention of child abuse and neglect (POCAN): Final evaluation report. Madison, WI: Department of Health and Family Services: Office of Strategic Finance: Evaluation Section.
76.
Wagner, M.M., & Clayton, S.L. (1999). The parents as teachers program: Results from two demonstrations. The Future of Children, 9(1), 91-115.
77.
Widom, C.S., & Maxfield, M.G. (2001). An update on the "cycle of violence" (No. NCJ 184894). Washington, DC: U.S. Department of Justice.
78.
Zigler, E., Gilliam, W. S. , & Jones, S. M. (Eds.). (2006). A vision for universal preschool education. New York: Cambridge University Press.
