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RESEARCH TRIANGLE PARK, N.C. – In 2011, 6.2 million children in the United States were referred to child welfare agencies for suspected physical abuse, sexual abuse or neglect. Children who have experienced maltreatment are at serious risk for a host of mental health and other problems that can persist throughout childhood and adulthood. Yet the results of a new systematic review of interventions with maltreated children under age 15 reveals striking limitations in the scientific evidence supporting these approaches, according to a review produced by the RTI-UNC Evidence-based Practice Center.
The article, published today in the Journal of Developmental and Behavioral Pediatrics, reports findings from the review focused on the effectiveness of clinical interventions in improving children’s mental health and developmental outcomes when compared with usual care or conventional practices used widely in the field. The review was funded by the U.S. Agency for Healthcare Research and Quality (AHRQ).
“Although many interventions show promise, the central finding was how preliminary the research is in this field,” said the lead author of the review, Jenifer Goldman Fraser, Ph.D., associate director for the Child Witness to Violence Program at Boston Medical Center. After analyzing research spanning 22 years, the authors found only 25 studies that met criteria to be included in the full review. According to the authors, the evidence base was severely limited by single studies evaluating the intervention, small sample sizes, and short-term outcomes. Most interventions were tested in studies conducted by the treatment developer, under the best of circumstances, as opposed to replication studies conducted in real world settings.
The promising interventions that emerged in this review included psychotherapy approaches that specifically addressed trauma symptoms or other serious emotional difficulties experienced by children exposed to sexual or physical abuse. For very young children, existing psychotherapeutic approaches focused on repairing the child-caregiver attachment relationship were applied to maltreating parents. In contrast, interventions with foster parents were psychoeducational, providing information and strategies to promote caregiving responsive to the particular needs of children in foster care and to manage challenging behaviors. Although pharmacological interventions are used to target particular symptoms or diagnoses in this population, the review found no studies that met criteria for inclusion.
“Investigating the effectiveness of interventions for maltreated children is daunting for many reasons, including the complexity of clinical needs of children and families and challenges conducting research with families involved with child welfare services,” noted Meera Viswanathan, Ph.D., a senior research analyst at RTI and the paper’s co-author.
“Even so, this review shows that the field would benefit significantly from a greater commitment to research, particularly collaborative clinical trials,” Goldman Fraser said. “We hope that our findings will mobilize the action needed to build the evidence for effective interventions that reduce the potentially life-long impact of maltreatment."
