Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: Systematic Review to Update the U. S. Preventive Services Task Force Recommendation: Evidence Synthesis Number 98

This systematic review is an update for the U. S. Preventive Services Task Force (USPSTF) that addresses the effectiveness and adverse effects of behavioral interventions and counseling to prevent child abuse and neglect for children at potentially increased risk. This review focuses on children without obvious signs or symptoms of abuse or neglect who are seen in health care settings. A separate review examines screening women for intimate partner violence and screening for elder abuse. In 2004, based on results of a previous review of screening for abuse and neglect, the USPSTF found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children (I statement). The USPSTF could not determine the balance between the benefits and harms of screening because of the lack of critical evidence. Limitations included the following: Interventions were predominantly home visitation programs that utilized varied and often inadequately described components during the prenatal, postpartum, and early childhood periods. It is unknown whether these models would work in other populations or with older children; There were no studies of screening for child abuse and neglect in health care settings that reported health outcomes, including premature death and disability; There were no studies of the adverse effects of screening and interventions; There was no demonstration of a gold standard screening instrument. Instruments designed to screen for child abuse and neglect had fairly high sensitivity in the few studies evaluating test performance, but they had low specificity. Instruments were primarily directed at pregnant women and lacked testing in other populations, particularly older children in the context of usual health care; Studies were conducted in high-risk populations; There were no studies of the feasibility of screening procedures and interventions in the primary care setting, including identification of barriers to screening. The purpose of this publication is to review new evidence on the benefits and harms of behavioral interventions and counseling in health care settings to reduce child abuse and neglect and related health outcomes for the U. S. Preventive Services Task Force.