USPSTF: More evidence needed to determine how PCPs can prevent child maltreatment

Key takeaways:

• More than 600,000 kids in the U.S. experienced maltreatment in 2021.
• The USPSTF said physicians should use their clinical judgement when deciding whether an intervention is needed for kids who show no signs.

The U.S. Preventive Services Task Force has ruled that there is not enough evidence to advocate for or against primary care interventions to prevent child maltreatment before it takes place.

The I-grade recommendation is consistent with the USPSTF’s 2018 final recommendation and applies only to children and adolescents who do not show signs or symptoms of neglect or abuse.

“No child should ever suffer from abuse or neglect. It’s disappointing that there still is not enough evidence on the effectiveness of interventions in the primary care setting to prevent child maltreatment before it occurs, or how to accurately identify at-risk kids,” USPSTF Member James Stevermer, MD, MSPH, vice chair for clinical affairs at the University of Missouri (MU) and medical director of MU Health Care Family Medicine–Callaway Physicians, said in a press release. “The task force is urgently calling for more research to address this critical issue.”

According to the USPSTF, more than 600,000 children in the United States experienced maltreatment in 2021. The CDC estimates that about 1,750 children in the U.S. died of abuse and neglect in 2020.

In addition to death and injury, incidences of maltreatment can also lead to long-term physical and emotional issues, such as depression, disability and substance use, the USPSTF noted.

Potential interventions that the task force considered for the recommendation included psychotherapy, parental education and referral to community resources.

In a draft evidence report, Meera Viswanathan, PhD, an adjunct assistant professor at the University of North Carolina Gillings School of Global Public Health, and colleagues reviewed 24 trials (n = 14,025) to determine the benefits of child maltreatment interventions based on several measures, such as reports to Child Protective Services (CPS), removal of a child from their home, hospitalizations and ED visits.

The researchers found no significant difference in reports to CPS within 1 year of intervention completion in 11 trials or removal of the child from their home within 1 to 3 years of follow-up in five trials. They also found no short-term benefit for ED visits or hospitalizations, and there was insufficient evidence for long-term outcomes of ED visits and reports to CPS. Measurements for other factors, including child development, attendance and performance at school and prevention of death were additionally inconclusive.

The USPSTF highlighted several gaps in research that still need to be determined, which include:

• whether intervention effectiveness and child maltreatment reports differ by social factors, race and ethnicity;
• the optimal frequency of risk assessments; and
• the most effective strategies to prevent child maltreatment.

“The task force deeply cares about the health of children nationwide and sincerely hopes that future research will help identify evidence-based ways to prevent child maltreatment before it occurs,” USPSTF Member Tumaini Coker, MD, MBA, division head of general pediatrics at the University of Washington School of Medicine and Seattle Children’s Hospital and codirector of the University of Washington’s Child Health Equity Research Fellowship, said in the release.

In the absence of guidance, Coker said that physicians should use their clinical judgement when deciding whether patients who do not show signs or symptoms require an intervention.

“For any child showing signs of maltreatment, clinicians should ensure that the child receives the care they need to stay safe and be prepared to report their situation to the appropriate agencies,” she said.

Both the task force’s draft recommendation statement and evidence review are open for public comments, which can be submitted here until Sept. 25.

References:

• Child maltreatment: Interventions. https://www.uspreventiveservicestaskforce.org/uspstf/document/RecommendationStatementFinal/child-maltreatment-primary-care-interventions. Published Nov. 27, 2018. Accessed Aug. 23, 2023.
• Fast facts: Preventing child abuse & neglect. https://www.cdc.gov/violenceprevention/childabuseandneglect/fastfact.html. Accessed Aug. 23, 2023.
• Primary care interventions to prevent child maltreatment: An evidence review for the U.S. Preventive Services Task Force. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/primary-care-interventions-child-maltreatment. Published Aug. 29, 2023. Accessed Aug. 29, 2023.
• U.S. Preventive Services Task Force issues draft recommendation statement on primary care interventions to prevent child maltreatment. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/child-maltreatment-interventions-draft-rec-bulletin.pdf. Published Aug. 29, 2023. Accessed Aug. 29, 2023.