National Center for Health Research: June 18, 2018
Thank you for the opportunity to share our views regarding USPSTF’s draft recommendation statement regarding interventions to prevent child maltreatment. The National Center for Health Research (NCHR) is a nonprofit think tank that conducts, analyzes, and scrutinizes research, policies, and programs on a range of issues related to health and safety.
In 2016, an estimated 676,000 children in the US experienced abuse and neglect, and an estimated 1,750 children died as a result.1 Since 2014, rates of substantiated child maltreatment have not changed substantially. Although substantiated rates for all types of maltreatment have decreased since 2000, the estimated rate of neglect has decreased the least.2
The consequences of child maltreatment are devastating and can last a lifetime. Chronic exposure to stress due to maltreatment can result in negative short- and long-term health outcomes, including behavioral issues, cognitive impairment, mental health disorders, and physical health problems.3 Given the burden of child maltreatment on our society’s children, it is critical to continuously evaluate any new evidence to find effective interventions that can prevent child maltreatment. We strongly support the USPSTF’s efforts to re-evaluate currently available evidence and update the 2013 recommendation.
We agree with the USPSTF that currently there is not enough evidence to recommend child maltreatment interventions for children and adolescents 18 years or younger who have not been identified as maltreated. Studies included in this review focused on infants or young children without any signs or symptoms of maltreatment, with over half indicating that participants were from high-risk groups. Thus, we concur that the USPSTF maintain a grade of “I.”
Unfortunately, given limited studies that met eligibility criteria for this review coupled with recruitment challenges and methodological issues, such as small sample sizes and rare outcomes (e.g. hospitalizations, referral to CPS), it is difficult to draw conclusions about the balance of benefits and harms for child maltreatment interventions. Studies included in this particular review yielded mixed results, and very few had statistically significant results indicating benefits. Further, there was no information available regarding harms of the interventions.
We agree with the USPSTF’s recommendations that researchers study new and unproven intervention models based on solid theoretical foundations and designed to target specific risk factors for child maltreatment, such as conditions of the child, caregiver, and environment. For example, opioid abuse is well known to potentially contribute to serious child neglect. When studies are conducted, researchers should provide sufficient details about critical components of interventions so that replication is possible. Finally, we encourage researchers to study community-based approaches that align with the unique needs of particular populations.
Thank you for the opportunity to share our views regarding the USPSTF’s draft recommendation statement on primary care interventions to prevent child maltreatment.
For questions or more information, please contact Megan Polanin, PhD, at info@center4research.org.
References
- U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth, and Families, Children’s Bureau. Child Maltreatment 2016. Washington, DC: U.S. Department of Health and Human Services; 2018. Retrieved from https://www.acf.hhs.gov/cb/resource/child-maltreatment-2016.
- Child Trends Data Bank (2016, September). Child Maltreatment: Indicators of Child and Youth Well-Being. Retrieved from www.childtrends.org/indicators/child-maltreatment.
- Viswanathan M., Pan H., Morgenlander M., et al. Primary Care Interventions to Prevent Child Maltreatment: An Evidence Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 170. AHRQ Publication No. 18-05241-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2018.