USPSTF: Efforts to prevent child maltreatment still need more study

Key takeaways:

• There is not enough evidence to support interventions to prevent child maltreatment before it occurs.
• Clinicians should use their judgment regarding youth who do not show signs or symptoms of child maltreatment.

There is insufficient evidence showing the harms and benefits of primary care interventions to prevent child maltreatment, the U.S. Preventive Services Task Force ruled in a final recommendation.

The I-grade recommendation — which is given when not enough evidence is available to support a preventive service or the evidence is poor or conflicting — is consistent with the USPSTF’s 2023 draft recommendation, and applies only to youth who do not show signs or symptoms of neglect or abuse. The task force came to a similar conclusion in 2018.

“Protecting children from all forms of maltreatment is critically important, and primary care clinicians are in a unique position to help identify signs and symptoms of abuse and neglect,” USPSTF member James Stevermer, MD, MSPH, said in a press release. “Unfortunately, when we looked at the research on how to prevent child abuse and neglect in those who do not show any signs or symptoms, there is still not enough evidence on what can be done in primary care to prevent maltreatment before it occurs. The task force continues to urgently call for more research in this area.”

According to the task force, more than 600,000 children experienced some form of maltreatment in 2021, with many other cases not reported.

The USPSTF added that maltreatment can also lead to long-term physical and emotional outcomes like disability, depression and substance abuse in addition to death and injury.

The task looked at the research for several interventions, including parental education, psychotherapy and referral to community resources.

In an evidence report that accompanied the task force’s statement, Meera Viswanathan, PhD, an adjunct assistant professor at the University of North Carolina Gillings School of Global Public Health, and colleagues reviewed 25 trials (n = 14,355) to determine the effectiveness of child maltreatment interventions based on outcomes like reports to Child Protective Services (CPS), hospitalizations and ED visits and the removal of children from their homes.

The researchers found there was no difference in the likelihood of reports to CPS within 1 year of the completion of an intervention in 11 trials, nor was there a difference in the number of children removed from their homes within 1 to 3 years of follow-up in five trials. Existing interventions also offered no short-term benefits in terms of reducing ED visits and hospitalizations.

“Child abuse and neglect is a serious problem that affects far too many children,” USPSTF member Tumaini Coker, MD, MBA, said in the release. “It’s important that future research on this topic assess tools that can accurately identify children at increased risk for maltreatment. More research is also needed on the most effective ways to prevent child abuse and neglect, including interventions that address social and health-related factors that can negatively impact families and increase vulnerability to maltreatment.”

The task force recommended that physicians use their clinical judgment when deciding on interventions for youth who show no signs or symptoms or maltreatment.

In a related editorial, Samantha Schilling, MD, MSHP, an associate professor of general pediatrics and adolescent medicine at the University of North Carolina School of Medicine, and colleagues encouraged primary care providers to continue their efforts to reduce the risks for child abuse and neglect, even amid a lack of evidence.

“You are an important component of child maltreatment prevention, although your actions and support cannot be delivered (or measured) in isolation,” they wrote.

References:

• Schilling S, et al. JAMA. 2024;doi:10.1001/jama.2024.0899.
• U.S. Preventive Services Task Force issues final recommendation statement on primary care interventions to prevent child maltreatment. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/child-maltreatment-interventions-final-rec-bulletin.pdf. Published March 19, 2024. Accessed March 19, 2024.
• United States Preventive Services Task Force. JAMA. 2024;doi:10.1001/jama.2024.1869.
• Viswanathan M, et al. JAMA. 2024;doi:10.1001/jama.2024.0276.