Abstract

Charting the Waves of Prevention

 

Prepared by:  Deborah Richardson, M.S.

                        Assistant Specialist, Child Development

                        Oklahoma Cooperative Extension Service

                        104 HES Room 233, Oklahoma State University

                        Stillwater, OK  74078

                        405-744-6231

                        dlricha@okstate.edu

 

Daro, D., & Donnelly, A.C. (2002). Charting the waves of prevention:  two steps forward, one step back.  Child Abuse and Neglect, 26, 731-742.

Text Box: IMPLICATIONS FOR COOPERATIVE EXTENSION: Several Family and Consumer Science programs and educational approaches used by Cooperative Extension include the prevention of child maltreatment as a potential positive outcome, either directly or indirectly. Over the past 30 years, the political response to child maltreatment and its prevention in the U.S. has experienced periods of frantic activity, often followed by long periods of benign neglect. To an extent, this pattern reflects deep differences among child welfare advocates, researchers, and practitioners on how to best proceed. This article summarizes the relative gains and limitations of prevention efforts and lessons for formulating future prevention policies and programs. Such an analysis is critical in understanding the context for of Cooperative Extension’s current programming, policies at the community, state and federal levels, and effective choices about future directions.


 

While most everyone agrees that “it shouldn’t hurt to be a child,” how to prevent this hurt and at what cost is less clear.   To address this dilemma, prevention advocates, researchers, and practitioners have struggled with a variety of conceptual frameworks and programmatic reforms.  Over the past 30 years, the prevention field has experienced a series of “waves,” each of which offered great promise and, unfortunately, much disappointment. 

 

Wave 1:  The Prevention Concept (1974-1980)

Public and political recognition of the issues was solidified with the passage of the Child Abuse Prevention and Treatment Act in 1974.  All states had implemented formal reporting laws and expanded their child welfare service systems.  Efforts focused on public service announcements and news coverage.  Reports to public agencies of suspected child abuse rose dramatically.  Various ways to reach at-risk families were being tested.  Home visitation and parenting education were featured components.

 

Some cautioned against putting too much faith in simple, legislative initiatives or single service models.  Increasingly, the field came to recognize that the roots of maltreatment lie partly in individual parental and familial characteristics and partly in the context or environment in which families live.  There was rapid realization that the problem was perhaps more widespread and numerous than first thought.

 

Wave 2:  The Prevention Continuum (1980-1990)

Specific federal legislation to provide funding for child abuse prevention was established. Dozens of community programs sprang up that not only offered families a diverse array of options to choose from but also facilitated the development of broad-based coalitions. 

 

Focus was on a parent’s knowledge of child development, the demands of parenting, bonding and communication, peer support and reducing family isolation, and access to social and health services.  A wide range of programs developed that varied in coverage, duration, and intensity.  Sexual abuse and exploitation and emotional maltreatment received additional attention and efforts expanded to equip potential child victims with tools to protect themselves and ways to address potential perpetrators. 

 

However, many of the community services were not sustained over time. There was not a significant reduction in the number of child abuse reports or fatalities.  There was far less success in creating a system that would attract and retain families who did not know they needed assistance or how to access help. 

 

Wave 3:  The Prevention System (1990-present)

Dramatic advances in brain research and understanding the way in which early childhood experiences shape subsequent physical and emotional development galvanized public policy interest in the 0 to 3 population.  Clinical trials and quasi-experimental designs provided increased confidence in the efficacy of early intervention services in altering parental behavior and preventing child abuse, especially home visitation. Efforts are now focused on creating a strong, widely available prevention system that begins at pregnancy and around the time of birth then builds additional services on top of this foundation, one developmental stage at a time.   

 

In terms of specific outcomes, however, the research findings are ambiguous.  Many program evaluations have found that when home visitation services are offered in a consistent, intensive high-quality manner by well trained and well supervised staff, there are numerous positive outcomes.  It is not clear, however, that programs are achieving sustained change with the majority of families they serve or are effective in addressing the needs of those at risk because of substance abuse, domestic violence, or serious mental health problems.  The majority of families leave a program before reaching their service goals.

 

Six common mistakes or pitfalls of the prevention field are identified:

Ø      Oversimplifying the problem of child abuse and promoting singular solutions.

Ø      Overstating preventions’ potential, allowing rhetoric to outpace research and empirical support.

Ø      Misrepresenting the pool of families programs can successfully attract and retain in voluntary prevention services

Ø      Failing to establish a significant partnership with child protective services, instead positioning prevention and child welfare as alternatives to one another.

Ø      Compromising depth or quality in an effort to maximize breadth or coverage of services.

Ø      Failing to fully establish the public will and political clout to bring to fruition the policies and programmatic reforms needed to prevent child abuse.

 

Yet, there are reasons for hope. 

Ø      Practitioners, advocates and researchers have a greater appreciation for the complexity of the problem and are slightly more resistant to overstating their case.

Ø      Prevention efforts have established stronger, more diversified partnerships that are engaging more people and institutions.                   

Ø      Prevention research is more rigorous in terms of methods and measures and is more frequently cited in the articulation of specific program and policy decisions.

Ø      Program evaluations are documenting more consistent and robust outcomes.

Ø      The field is less competitive and is learning to work together across service models and problem areas.

Ø      State and county governments are finding ways to pool their resources and think beyond their own agency and bureaucratic boundaries.

 

The next wave of child abuse prevention is developing a shared vision and sense of common purpose.  Rather than defining the goal as what to avoid, the absence of abuse, prevention advocates may focus more on what it wants to accomplish, seeking partners to maximize the potential of all children.  It will take more than simply replicating a single strategy or reform.  It will require more rigorous research and a willingness to use results in a self-critical manner.