By Jennifer Kaminski, PhD (Health Scientist, Centers for Disease Control and Prevention and President, APA Section on Child Maltreatment)
In honor of National Child Abuse Prevention Month, I humbly offer four observations made over the last decade I have spent looking for ways to assist the field of child maltreatment prevention in making forward progress. These cannot be claimed here as new or original insights. They are simply the points on which the field has repeatedly reached a stalemate, impeding our ability to have more widespread impact on this important issue.
In a multidisciplinary field like this, one overarching and recurring obstacle is that it is easy to fall into the pattern of acknowledging only the strengths of one’s own sector/discipline/program, and only the weaknesses of others.
1. The field would benefit by consciously adopting a different paradigm of recognizing the strengths of alternate perspectives, and strategizing how best to combine our strengths.
For example, different disciplines offer unique contributions to prevention.
- Psychology brings a wealth of expertise in research methods and fostering behavior change.
- Public health brings the additional strengths of epidemiologic data collection and capacity-building for implementation.
- Systems such as social services, education, and health care offer existing infrastructures for broader dissemination of effective strategies.
Prevention that is most efficient and effective is likely to result from collaborations that highlight rather than marginalize each discipline’s contributions.
Similarly, the Federal government has enacted national policies and regulations, and provides funding for programs and research. Implementation and action on the front-line often falls to state and local governments, communities, research teams and practitioners.
Yet private and non-profit sectors can play important roles as well, through voluntary adoption of child maltreatment prevention as a part of their missions. Partnerships across multiple sectors can capitalize on the unique contributions from each group. While such partnerships are often easier said than done, the benefits of partnering can well outweigh the work required to partner effectively.
2. The field would benefit from acknowledging that all data have strengths and limitations.
There has long been a tension between the use of administrative and self-report data on child maltreatment. Though each has disadvantages, both tell valuable parts of the story.
- Child welfare data and medical data on maltreatment-related injuries allow for estimation of the economic burden of child maltreatment on social service and health systems.
- Self-report data provide information about the lived experiences of children and parents whether or not the maltreatment is noticed outside the individuals involved.
Each method will capture information that the others miss and each provides a characterization of child maltreatment better-suited to different purposes. If the field can consider these data as complementary rather than competing, they are likely to provide a stronger foundation upon which to base decisions about prevention strategies.
3. As both producers and consumers of peer-reviewed publications and other communication media, those in the field can strive for greater precision in the language used to describe data and outcomes.
Broad statements such as “child maltreatment was associated with…” or “our program showed significant effects on child maltreatment” are likely to be overgeneralizations and fail to communicate the key message that child maltreatment is a complex issue that will require complex solutions.
4. The field would benefit from resolving the tensions among evidence-based prevention approaches for child maltreatment.
These approaches vary related to:
- when the intervention begins (i.e., before maltreatment can occur, after new risk factors such as child behavior problems emerge, or after maltreatment has already occurred),
- where the intervention occurs (e.g., hospitals, health or mental health clinics, other community settings, or in the home), and
- the degree of intervention complexity (i.e., single-component vs. multi-level).
Some programs that have been deemed effective are intended for a more focused set of outcomes (e.g., specific to pediatric abusive head trauma, child physical abuse or child sexual abuse), while others take a broader approach (e.g., covering basic child care and safety, nurturing parenting, and child behavior management). Not surprisingly, different approaches have documented effects on different outcomes, on different populations, or at different child ages.
For various reasons (e.g., the need to publish positive outcomes), members of the field often feel pressured to make grand claims about the effectiveness of one approach over all others. Ultimately, this is likely to be a disservice to the children we are working to protect.
By promising dramatic impacts with a single approach, efforts that cannot live up to such high expectations may decrease the credibility of research to provide answers to this issue. Instead of continuing to ask “which is the single best approach?”, the field may want to refocus attention on “which specific approaches are best to achieve which specific outcomes with which families?” We can then determine what combination of strategies is likely to meet the needs of particular populations and communities.
We want to hear from you – tell us in the comments…
- What do you think members of the field of child maltreatment prevention can do to overcome these obstacles?
- How can they reconcile the tensions in the field mentioned above?
The findings and conclusions in this report are those of the author, and do not necessarily reflect the official position of the Centers for Disease Control and Prevention.
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