Preventing Child Maltreatment in High Risk Families

预防儿童虐待的潜力最大的是高危人群。不幸的是，家访儿童虐待预防方案未能在最高风险人群中预防儿童虐待，例如父母有药物使用障碍、亲密伴侣暴力、父母抑郁或其他多重风险因素的家庭。对高危人群的这些令人沮丧的结果最好理解为服务目标和家庭需求的不匹配。在许多方面，高危儿童虐待预防人群与儿童福利案件的共同之处多于围产期预防人群。儿童福利人群中虐待儿童的累犯减少

The greatest potential for child maltreatment prevention effectsis with high-risk populations. Unfortunately, home-visiting child maltreatment prevention programs have failed to prevent child maltreatment in the highest-risk populations, such as families with parental substance use disorders, intimate partner violence IPV), parental depression or other multiple risk factors. These discouraging results with high risk populations may be best understood as a mismatch of service aims and family needs. In many respects, high-risk child maltreatment prevention populations have more in common with child welfare cases than with perinatal prevention populations. Reductions in child maltreatment recidivism with child welfare populations has been found with the home-based intervention model SafeCare, a promising intervention for high-risk child maltreatment prevention. OUHSC has conducted a randomized pilot and feasibility trial of SafeCare, enhanced with specific components to address substance abuse, IPV, and depression in high risk prevention populations(SC+). The initial results are encouraging.The overarching goal of the proposed project is to extend our current work by conducting a full-scale randomized efficacy trial of the SC+ protocol with a high risk child maltreatment prevention population. The main hypotheses are: Hypothesis1: Compared to services as usual(SAU), high-risk parents randomized to receiveSC+ will have improved survival for future child welfare reports,and will have lower rates of out-of-home placements due to child maltreatment. Hypothesis2: Compared to SAU, families randomized to receive SC+ will show greater improvements on factors proximal to childmaltreatment, including observed measures of the home environment, home safety, physical childcare, and self-reports of verbal and physical aggression toward children. Hypothesis3: Compared to SAU, high-risk parents randomized to receiveSC+ will show greater improvements on risk factors, including measures of child abuse potential, levels of IPV, depression and substance abuse.