Child abuse prevention as a concept and as a field has come a long way in the past thirty years (Daro & Cohn-Donnelly, 2002). Prevention practitioners, advocates and researchers have a greater appreciation for the complexity of the problem they seek to resolve and are slightly more resistant to overstating their case. Prevention efforts have established stronger, more diversified partnerships that are engaging more people and institutions.

Prevention research is more rigorous in terms of methods and measures and is more frequently cited in the articulation of specific program and policy decisions. Program evaluations are documenting more consistent and robust outcomes. As a field, prevention advocates are less competitive and are learning how to work across service models and problem areas. Evidence of this commitment to collaboration can be found in the growing number of community partnerships and collaborations to promote child protection and early childhood education. State and county governments across the country are finding ways to pool their resources and think beyond their own agency or bureaucratic boundaries. All of these trends suggest society can expect more from its future investments in prevention. To garner these added benefits, however, prevention practitioners and researchers need to value what has been learned and recognize they need to do better.

LESSONS LEARNED
In investigating the features of successful programs, many have written about the importance of building innovations around strong theories of change that establish clear, coherent linkages among participant needs, program goals, program structure and staff skills (Berlin, O’Neal & Brooks-Gunn, 1998; Fulbright-Anderson, Kubisch & Connell, 1998; Olds, et al., 1999; Weiss, 1995). Others have emphasized the need for greater attention to the role community values and resources play in a child’s development (Earls, 1998; Melton & Berry, 1994; Schorr, 1997) and the importance of continuous adherence to quality standards in both structuring programs and hiring and supervising staff (Dunst, 1995; Schorr, 1997; Wasik & Bryant, 2001).

Within these parameters, child abuse prevention advocates have designed and implemented a number of diverse and effective prevention efforts. Concerns over parental rights and family privacy have led prevention advocates to frame these efforts in terms of those risk factors identified in the literature as resulting in a higher probability of abuse or neglect. Such factors include both demographic characteristics (e.g., poverty, single parent status, young maternal age, etc.) as well as psychosocial characteristics (e.g., low frustration tolerance, substance abuse, limited knowledge of child development, situational stress, etc.). When prevention efforts have sought universal coverage, they generally involve efforts that pose minimal threats to family privacy or parental control.

Volumes have been written about the efficacy of individual prevention strategies and broad prevention systems (Daro, 1988; Daro & Cohn-Donnelly, 2001; Willis, Holden & Rosenberg, 1992). Home visitation programs, group-based interventions, family resource centers, public awareness campaigns and institutional reforms all have been used to reduce a child’s risk for physical abuse or neglect.

Each strategy has produced some changes in targeted outcome areas with selected populations. Several center based programs and support groups have demonstrated strong outcomes in extending the time between pregnancies and improving parental capacity among teen moms (Baker, Piotrkowski & Brooks-Gunn, 1999; Carter & Harvey, 1996; Daro & Cohn-Donnelly, 2001). In contrast, home based interventions appear particularly attractive to low income new parents struggling the balance the demands of child rearing with their own need for personal support (Daro & Cohn-Donnelly, 2001; Guterman, 2001). Strong empirical support for any of these strategies, however, is limited. In some cases, the absence of consistent outcomes reflects measurement difficulties (e.g., the absence of solid baseline data, the lack of standardized assessment measures in certain domains, incomplete or inaccurate administrative data systems, etc). In other cases, the evaluations of these strategies have not incorporated rigorous designs (e.g., controlled randomized trials or quasi-experimental designs) or identified samples large enough to detect more subtle changes in attitudes or behaviors. In other cases, implementation difficulties such as high staff turnover rates, poor participant identification procedures, or dramatic changes in community context have limited a strategy’s potential.

Despite these difficulties, the number of prevention efforts is increasing and most continue to enjoy strong political support. Not all efforts, however, are equally effective or appropriate across cultures or parenting difficulties. Research suggests that child abuse prevention programs can improve their effectiveness by embracing certain best practice standards (Daro, 2000; Guterman, 2001). Among the most promising standards are the following:

• Initiate services early in the parent-child relationship, either at the time a baby is born or, if possible, when a woman is pregnant.
• Offer a service dosage compatible with service objectives
• Recognize that achieving sustained change with high-risk families requires intensive, long term efforts
• Address a participant’s personal needs as well as her parenting responsibilities
• Provide a specific set of developmentally appropriate services for children
• Offer strong linkages to other local service providers.

Finally, program managers need to pay special attention to whom they hire and how they support them (Wasik & Bryant, 2000). Those funding prevention efforts need to keep in mind that prevention is often about building relationships not simply delivering a product. Consequently, care must be taken to insure that caseloads are low enough to allow staff to spend the time necessary with each family to establish firm relationships. Also, programs must offer intensive training at the front end and solid, reflective supervision to avoid worker burnout and sustain service quality.

MOVING FORWARD Despite early and thoughtful interventions, many recipients will indeed mistreat their children or remain unable to provide the consistent nurturing and supervision necessary for their child’s safe and full development. Such limitations call for new thinking in how prevention efforts are crafted and presented to potential participants. Specifically, these reflections suggest that future prevention efforts need to be built upon three key principals.

First, prevention programs need to focus not merely on changing individual behaviors but also on using these services as a springboard for systemic reforms in health and social service institutions. Establishing a series of solid, well-implemented direct service programs is one level of change. Integrating these efforts into a coherent system of support that can be used to leverage broader, institutional change is a more challenging and less obvious process. While many private and public agencies have engaged in efforts to alter the way major institutions interface with families, few consistent success stories exist (Kagan, 1996; Schorr, 1997; St. Pierre, Layzer, Goodson & Bernstein, 1997). Developing and sustaining such systemic success stories is essential.

Second, such efforts need to offer community planners flexible, empirically based criteria for “building” their own prevention programs. Simply adopting predetermined, monolithic intervention strategies has not produced a steady expansion of high quality, effective interventions (Brookings Institute, 1998; Schorr, 1997). Replication efforts need to include a specific planning phase in which local stakeholders (e.g., potential participants, local service providers, funders, the general public, etc.) assess the scope of maltreatment in their community, identify local human and social service resources, and craft a service delivery system in keeping with local realities.

Finally, intensive efforts for those families facing the greatest challenges need to be nested within a more broadly defined network of support services. Successfully engaging and retaining those parents facing the greatest challenges will not result from more stringent efforts to identify and serve only these parents. Until systems are established which normalize the parent support process by assessing and meeting the needs of all new parents, prevention efforts will continue to struggle with issues of stigmatization and deficit-directed imagery.

At present, the vast majority of public and social investment in addressing the problem of child abuse is focused on tertiary care. In the absence of any dramatic shift in mission, agency directors and line staff have no incentive to retool their operations or to alter their funding streams to accommodate the alternative service delivery methods and values represented by prevention advocates. Prevention efforts will remain marginalized and, ultimately, ineffective until this imbalance is corrected.

REFERENCES

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