Differences and similarities between mothers’ and fathers’ risk factors for child maltreatment

Background: Parental risk factors play an important role in child maltreatment, however, little is known about the role of fathers’ risk factors. Objective: The current study aimed to compare fathers and mothers in terms of (1) the prevalence and impact of risk factors for perpetrating child maltreatment and (2) the interplay of risk factors. Participants: The Dutch sample consisted of 4090 mothers and 3973 fathers who had a newborn and received health-and developmental checks between October 2001 and November 2002. Methods: Risk factors were assessed using the Instrument for Identification of Parents at Risk for Child Abuse and Neglect (IPARAN) and child maltreatment was defined as a verified report at Child Protection Services in a period of 3-years following completion of the IPARAN. McNemar tests and network analyses were performed. Results: Results demonstrated that the majority of assessed risk factors were related to perpetrating future child maltreatment for both fathers and mothers. In general, risk factors were more prevalent in mothers than in fathers. Inability to ask for help was the risk factor that was most prevalent for both mothers (22.4%) and fathers (22%). The risk factors worries about raising the child, unhappy during pregnancy, and losing control when angry were more strongly related to future child maltreatment in mothers compared to fathers, whereas risk factors related to their own child maltreatment in the past and experiencing a lack of support were more impactful for fathers compared to mothers. For fathers and mothers, belief in physical punishment and risk factors related to their own history of child maltreatment were most central. Conclusions: Overall, these findings underscore the importance of considering the long-lasting, intergenerational effects of child maltreatment. Intergenerational trauma may put parents at a higher risk of becoming perpetrators; our network results confirm that these risk factors deserve an important spot in prevention efforts

Long-term collateral effects of parent programs on child maltreatment proxies:Can administrative data provide useful insights?

Collecting child maltreatment data from participants is expensive and time-consuming, and often suffers from substantial attrition rates. Administrative population data may prove fruitful to overcome these barriers. The aim of this study was twofold: (1) to illustrate how administrative data may be used in evaluating long-term intervention effects; and (2) to examine collateral effects of three preventive early childhood interventions offered to families in the Netherlands (Supportive Parenting, VoorZorg, and Incredible Years). Using population data, four proxies of child maltreatment were assessed to examine collateral intervention effects: incidences of child protection orders, placements of children in residential care, crime victimization of children or their parents, and parental registrations as a crime suspect. The results revealed no significant differences between experimental and control conditions on any of these proxies, with very small effect sizes (ranging from Cramer's V = 0.01 to Cramer's V = 0.10). We conclude that the results do not provide support for collateral effects, but that studying other outcomes may provide this support. We further discuss that small sample sizes and low prevalences challenge studies using administrative data. Notwithstanding these limitations, we conclude that administrative data can strengthen the evidence base for collateral and direct intervention effects.</p

A Controlled Trial in Community Pediatrics to Empower Parents Who Are at Risk for Parenting Stress: The Supportive Parenting Intervention

The goal of the Supportive Parenting Intervention is to prevent and/or decrease parenting stress and provide a sense of empowerment to parents with a newborn child. We evaluated the effectiveness of the Supportive Parenting Intervention in terms of parenting skills, social support, self-sufficiency, resilience, and child psychosocial health. A controlled trial with pre- and post-intervention testing was conducted in the setting of community pediatrics among parents at risk for developing parenting stress. The 177 parents in the control group received care-as-usual, whereas the 124 parents in the intervention group received six home visits by a trained Youth Health Care nurse during the first 18 months of the child's life. The result with respect to parenting skills, social support (both from family and friends, and the partner), self-sufficiency, and resilience at the 18-month follow-up was either unchanged or (p < 0.05) worse compared to the respective baseline score for both groups. We found no significant difference between intervention and control group with respect to the child's Child Behavior Check List (CBCL). This study shows no positive effect with respect to the indicators of parental empowerment. We recommend research to strengthen the intervention and its application in daily practice, for example by increasing the intervention duration, and to evaluate it in a large randomized controlled trial

Concurrent validity, discriminatory power and feasibility of the instrument for Identification of Parents At Risk for child Abuse and Neglect (IPARAN)

OBJECTIVES: To determine the feasibility, concurrent validity and discriminatory power of the instrument for Identification of Parents At Risk for child Abuse and Neglect (IPARAN) among Dutch parents with a newborn child.SETTING: Community paediatrics.PARTICIPANTS: Data from a controlled trial were used. In total, 2659 Dutch parents with a newborn child were invited to participate. Of the 2659 parents, 759 parents filled in the consent form and participated in the study.PRIMARY AND SECONDARY OUTCOME MEASURES: Concurrent validity was determined by calculating correlations-using the Pearson's correlation (r)-between the IPARAN score and related constructs from the following instruments: the Empowerment Questionnaire 2.0, the Family Functioning Questionnaire and the Parenting Stress Questionnaire. Discriminatory power was determined by calculating receiver operating characteristic (ROC) curves between high-risk mothers and low-risk mothers according to their scores on the related constructs. Feasibility was determined by examining the percentage of missing answers.RESULTS: In terms of concurrent validity, we found that 3 out of 12 correlations between the IPARAN score and related constructs were strong (ie, r>0.50) and 4 out of 12 were medium (ie, r=0.30-0.49). In terms of discriminatory power, mothers with a score in the borderline/clinical range or lowest 10 percent (P10) range of the related constructs (high-risk mothers) had a higher IPARAN score than mothers with a score in the normal range or highest 90 percent (P90) range of the related constructs (low-risk mothers). Effect sizes varied from d=0.37 to d=1.93, and the area under the ROC curve varied from 0.62 to 0.93. Regarding feasibility, the part of the IPARAN filled in by the mother had on average 0.7% missing answers, whereas the part of the IPARAN filled in by the father had on average 1.7% missing answers.CONCLUSION: The results of this study support the concurrent validity, discriminatory power and feasibility of the IPARAN among a population of Dutch parents with a newborn child

Study protocol: randomized controlled trial of manualized components in home visitation to reduce mothers’ risk for child maltreatment

Background This study tests whether home visitation to prevent child maltreatment can be improved by adding manualized program components, targeting four key risk factors for child maltreatment: low parental self-efficacy, high levels of perceived stress, parental anger, and post-traumatic stress symptoms. Home visitation is widely implemented, but effects on child maltreatment risk tend to be modest at best. Home visitation tends to be rather flexible (i.e., professionals decide how to support each family). We will test whether adding manualized program components increases program effectiveness, by ensuring that key risk factors are addressed, while maintaining flexibility. In addition, we will test whether any component effects on reduced child maltreatment risk can be explained (i.e., is mediated) by ameliorated risk factors. Lastly, we will test whether the components are more effective for some mothers (e.g., those at highest child maltreatment risk) than for others. Methods We will conduct a randomized controlled trial among 398 mothers enrolled in a Dutch home visiting program targeting families at risk for child maltreatment. Mothers in the experimental group will receive the manualized components in two consecutive home visits, while mothers in the control group will receive regular home visits (care as usual). Mothers will fill out questionnaires at four time points: before and after each of the two home visits. Outcome variables include the four targeted risk factors parental self-efficacy, perceived stress, parental anger, and (recognition of) post-traumatic stress symptoms, as well as parenting practices (e.g., rejection and affection), and risk for child maltreatment. Discussion This study aims to determine whether adding manualized program components to a flexible home visiting program increases program effectiveness on risk for child maltreatment. In addition, our test of whether the effects of the components on risk for child maltreatment is explained (i.e., mediated) by amelioration of the targeted risk factors, may contribute to our understanding of the role of these risk factors in child maltreatment. Our tests of which mothers benefit most from adding the components may help move the field towards evidence-based personalized family support. Trial registration This trial has been retrospectively registered in the Netherlands Trial Register (NL8005)

Study protocol: randomized controlled trial of manualized components in home visitation to reduce mothers’ risk for child maltreatment

Background This study tests whether home visitation to prevent child maltreatment can be improved by adding manualized program components, targeting four key risk factors for child maltreatment: low parental self-efficacy, high levels of perceived stress, parental anger, and post-traumatic stress symptoms. Home visitation is widely implemented, but effects on child maltreatment risk tend to be modest at best. Home visitation tends to be rather flexible (i.e., professionals decide how to support each family). We will test whether adding manualized program components increases program effectiveness, by ensuring that key risk factors are addressed, while maintaining flexibility. In addition, we will test whether any component effects on reduced child maltreatment risk can be explained (i.e., is mediated) by ameliorated risk factors. Lastly, we will test whether the components are more effective for some mothers (e.g., those at highest child maltreatment risk) than for others. Methods We will conduct a randomized controlled trial among 398 mothers enrolled in a Dutch home visiting program targeting families at risk for child maltreatment. Mothers in the experimental group will receive the manualized components in two consecutive home visits, while mothers in the control group will receive regular home visits (care as usual). Mothers will fill out questionnaires at four time points: before and after each of the two home visits. Outcome variables include the four targeted risk factors parental self-efficacy, perceived stress, parental anger, and (recognition of) post-traumatic stress symptoms, as well as parenting practices (e.g., rejection and affection), and risk for child maltreatment. Discussion This study aims to determine whether adding manualized program components to a flexible home visiting program increases program effectiveness on risk for child maltreatment. In addition, our test of whether the effects of the components on risk for child maltreatment is explained (i.e., mediated) by amelioration of the targeted risk factors, may contribute to our understanding of the role of these risk factors in child maltreatment. Our tests of which mothers benefit most from adding the components may help move the field towards evidence-based personalized family support. Trial registration This trial has been retrospectively registered in the Netherlands Trial Register (NL8005)