Law enforcement personnel should investigate abuse allegations, public health nurses should help at-risk families before abuse or neglect occurs, and social workers should be involved in counseling and helping families, but not investigating crime, Dr. Abraham B. Bergman of Harborview Medical Center in Seattle writes in an editorial in this months' issue of Archives of Pediatrics and Adolescent Medicine.
Bergman's editorial is a commentary on a study published in the same issue of the journal that found investigations of suspected child maltreatment didn't improve risk factors known to increase the likelihood of child abuse, including lack of social support and poor family functioning.
In the study, Dr. Kristine A. Campbell of the University of Utah in Salt Lake City and her colleagues looked at 595 children at risk for maltreatment, 164 of whom (28 percent) had been investigated for suspected maltreatment between age 4 and age 8. The children's primary caregivers were interviewed every two to four years, from the time the children were 4 years old up until they reached age 18.
The researchers looked at whether a Child Protective Services investigation had an effect on any of seven different modifiable risk factors for abuse and neglect, including poverty, maternal education, anxious or depressive child behaviors, and aggressive or destructive child behaviors.
At age 8, they found no difference in most of these risk factors between the children whose households had been investigated and those who had not, although mothers in the investigated households did have higher levels of depressive symptoms.
The study suggests that we may be missing an opportunity for secondary prevention of maltreatment and maltreatment consequences, Campbell and her colleagues conclude.
But Campbell told Reuters Health the findings shouldn't be seen as evidence that Child Protective Services are no longer useful.
I see a very important role for Child Protective Services in making sure that a child is safe, and that a family is safe, in an acute setting, the researcher said. However, she added, Child Protective Services are increasingly being relied on to help with parenting problems and other family issues that they don't have the time, or skills, to address.
Additional services are needed, Campbell said, to keep at-risk children and families safe long-term. There are interventions that have been shown to be helpful in preventing first-time or repeat abuse, she and her colleagues note in their report, such as parent-child interaction therapy, greater social support, and cognitive behavioral therapy.
We need to move forward ... to find an evidence base for interventions that can help improve outcomes in these families, the researcher added.
Dr. Bergman's editorial is fascinating, and I think having people consider new systems approaches and new intervention approaches is important. I also though think that recognizing that Child Protective Services has an extremely difficult job and remains an important player within the community is also important.
Campbell emphasized: I wouldn't want to be perceived as having declared Child Protective Services a failure or anything like that -- I rely on them on a regular basis.