MacMillan HL, Thomas BH, Jamieson E, Walsh CA, Boyle MH, Shannon HS, Gafni A.
Effectiveness of home visitation by public-health nurses in prevention of the recurrence of child physical abuse and neglect: a randomised controlled trial.
Lancet. 2005 May 21-27;365(9473):1786-93.
BACKGROUND: Recurrence of child maltreatment is a major problem, yet little is known about approaches to reduce this risk in families referred to child protection agencies. Since home visitation by nurses for disadvantaged first-time mothers has proven effective in prevention of child abuse and neglect, we aimed to investigate whether this approach might reduce recidivism. METHODS: We enrolled in a randomised controlled trial 163 families with a history of one index child being exposed to physical abuse or neglect to compare standard treatment with a programme of home visitation by nurses in addition to standard treatment. The main outcome was recurrence of child physical abuse and neglect based on a standardised review of child protection records. Analysis was by intention to treat. FINDINGS: At 3-years' follow-up, records were available for 160 of 163 (98%) families randomised. 139 (85%) completed follow-up. Recurrence of child physical abuse (31 [43%] in the control group vs 29 [33%] in the intervention group) and neglect (37 [51%] vs 41 [47%]) did not differ between groups. However, hospital records showed significantly higher recurrence of either physical abuse or neglect in the intervention group than in the control group (21 [24%] vs 8 [11%]). There were no differences between groups for the other secondary outcome measures. INTERPRETATION: Despite the positive results of home visitation by nurses as an early prevention strategy, this visit-based strategy does not seem to be effective in prevention of recidivism of physical abuse and neglect in families associated with the child protection system. Much more effort needs to be directed towards prevention before a pattern of abuse or neglect is established in a family.