A Review of Programs to Promote Family Wellness and Prevent the Maltreatment of Children
Nelson, Geoffrey, Laurendeau, Marie-Claire, Chamberland, Claire, Canadian Journal of Behavioural Science
We review research on programs designed to promote family wellness and prevent the maltreatment of children. Based on this review, we conclude that there is currently no evidence that educational programs prevent child sexual abuse. Only home visitation programs have been shown to prevent child physical abuse and neglect, and multicomponent, community-based programs have been shown to promote family wellness and prevent a number of negative outcomes for children. The most effective programs are those that address several different ecological levels of analysis, begin at birth, are long-term and intensive, are flexible, responsive, and controlled by the local community, and are based on respectful and trusting relationships between community members and staff, who are well trained and competent.
Nous examinons la recherche entreprise dans le cadre de programmes concus pour ameliorer le bien-etre de la famille et prevenir le mauvais traitement des enfants. A partir de cet examen, nous concluons qu'il n'existe pas de preuve montrant que les programmes d'education previennent la violence sexuelle A l'endroit des enfants; seuls les programmes de visites A domicile ont montre qu'il est possible de prevenir la violence physique et la negligence A l'endroit des enfants. Aussi, il est montre que les programmes A volets multiples, axes sur la collectivite, favorisent le bien-etre de la famille et previennent un certain nombre d'abus. Les programmes les plus efficaces sont ceux qui abordent plusieurs niveaux ecologiques differents d'analyse, debutent A la naissance, sont A long tenne et intensifs, sont souples, sensibles aux besoins et geres par la collectivite locale, et fondes sur des rapports de respect et de confiance entre les membres de la collectivite et un personnel qui a ete bien forme et qui est competent.
The purpose of this paper is to describe and interpret "state of the art" programs that are designed to promote family wellness and prevent the maltreatment of preschool and school-aged children. More specifically, we: a) describe the different types of programs that have been developed to promote family wellness and prevent child maltreatment, b) review research evidence pertaining to the effectiveness of these programs, c) summarize and critique these programs, and d) conclude by noting the common elements of effective promotion and prevention programs.
As part of a larger Family Wellness Project (Prilleltensky, Nelson, & Peirson, 2001), we conducted a comprehensive review of primary and secondary prevention programs aimed at promoting family wellness and preventing child maltreatment. Due to space limitations, we do not report on each study that we reviewed. Rather, we provide a broad overview of the different types of programs aimed at promoting family wellness and preventing child maltreatment, illustrating general trends with specific studies. The criteria for inclusion in our review were: a) primary and secondary prevention programs (as defined in a subsequent section) for children ages birth to 12, b) unpublished reports, book chapters, and journal articles in English and French during the period from 1979 through 1998, and c) a prospective, controlled design (or postassessment only in the case of randomized designs). While our review attempted to capture all of the research literature using the criteria described above, we also examined innovative programs which, as yet, do not have a research foundation. We believe that part of our work in this review is to point out programs that are conceptually appealing and/or innovative, but which need to be researched.
FAMILY WELLNESS AND CHILD MALTREATMENT
We reviewed evaluations of prevention programs which included outcomes measures of child maltreatment or family wellness. Outcome measures of child maltreatment consist of direct measures, which include verified reports of child physical abuse, neglect, or sexual abuse and records of out-of-home placement of the child, and indirect or "proxy" indicators of abuse, which include hospital admissions, use of emergency room services, and incidents of accidents, ingestions, or poisonings (MacMillan, MacMillan, Offord, Griffith, & MacMillan, 1994a). …