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

Author:

Hart Laura C.12,Viswanathan Meera34,Nicholson Wanda K.56,Silverstein Michael57,Stevermer James58,Harris Sheena9,Ali Rania34,Chou Roger10,Doran Emma11,Hudson Kesha34,Rains Caroline34,Sathe Nila34,Zolotor Adam J.11

Affiliation:

1. Nationwide Children’s Hospital, Columbus, Ohio

2. The Ohio State University College of Medicine, Columbus

3. RTI International–University of North Carolina at Chapel Hill Evidence-Based Practice Center, Chapel Hill

4. RTI International, Research Triangle Park, North Carolina

5. US Preventive Services Task Force, Rockville, Maryland

6. George Washington University, Washington, District of Columbia

7. Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island

8. University of Missouri, Columbia

9. Agency for Healthcare Research and Quality, Rockville, Maryland

10. Oregon Health Sciences University, Portland

11. University of North Carolina at Chapel Hill, Chapel Hill

Abstract

ImportanceThe 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.ObservationsA 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 RelevanceThere 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.

Publisher

American Medical Association (AMA)

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