August 24, 2016
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USPSTF releases final research plan for child maltreatment interventions in primary care

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The U.S. Preventive Service Task Force has released its final research plan for primary care interventions regarding child maltreatment, with the aim of determining if such interventions reduce exposure to abuse or neglect, and if they could potentially, inadvertently cause harm.

According to the task force, the research will focus on two critical questions. The first question is, “Do primary care-feasible or referable interventions to prevent child maltreatment reduce exposure to abuse or neglect; improve behavioral, emotional, physical or mental well-being; or reduce mortality among children and adolescents who do not have obvious signs or symptoms of abuse or neglect?”

The second question is, “What are the harms of primary-feasible or referable interventions to prevent child maltreatment?”

The research approach includes a population of children and adolescents aged 18 years and younger, with no known exposure to maltreatment and no signs or symptoms of current of past abuse or neglect. The study design for the first question will be randomized, controlled trials and systematic reviews. For the second question, researchers will conduct randomized, controlled trials; controlled clinical trials; systematic reviews; cohort trials with a control group; and case-control studies.

Clinical settings will include those in pediatrics, primary care and family medicine, school-based clinics, and other settings where primary care services, or services that could result from a clinician’s assessment, are offered.

The research would analyze interventions that could result from a referral by a PCP, as well as services that may be implemented by a non-clinician, including home visiting programs, primary care-based programs, respite care, parent education, and family support and strengthening programs.

Family-focused interventions can be directed at the caregiver, but may not be directed at the child. Research would compare usual care, delayed treatment or active interventions that allow for assessment of the independent contribution of primary care-feasible preventive intervention.

Outcomes for the first key question will be direct or proxy measures of abuse or neglect, and behavioral, emotional, mental or physical wellbeing, including:

  • Physical, sexual or emotional abuse at the hands of a parent or caregiver against a child;
  • Physical, emotional, dental/medical or educational neglect;
  • Reports to Child Protective Services;
  • Removal of the child from the home;
  • Injuries such as broken bones, bruises, burns and other injuries with a high specificity for abuse;
  • ED visits;
  • Hospitalizations;
  • Decreased internalizing behaviors;
  • Decreased externalizing behaviors;
  • Healthy social-emotional development;
  • Decreased incidence of reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder or posttraumatic stress disorder;
  • Decreased incidence of traumatic stress syndrome, such as impairments in attachment, self-regulation, under- or over-controlling behaviors, executive functioning and self-concept hypervigilance; exaggerated startle response; dissociation; concentration problems; somatic problems; sleep disturbances; and nightmares;
  • Decreased suicidality and self-injury;
  • Improved school attendance and performance;
  • Reduced risky behaviors and outcomes; and
  • Mortality.

Outcomes for the second question are any harms that are a result of the intervention, and worsening of the outcomes related to the first question.

The draft research plan had been posted on the USPSTF website for public comment from May 12 to June 8. As a result of the comments, the task force added two new outcomes — improved school attendance and performance, and reduced risky behaviors and outcomes.

Information on how children, adolescents, or their caregivers, will be selected for interventions will be included in the evidence review.

Additional reading:

http://www.uspreventiveservicestaskforce.org/Page/Document/final-research-plan/child-maltreatment-primary-care-interventions1