How Disasters and Trauma Can Affect Children’s Empathy

The researchers at OHSU analyzed 11 studies that evaluated the effectiveness  of child abuse and neglect prevention programs or interventions that took place  in clinics — such as meetings with a social worker, for example. They gave  parents questionnaires that assessed such risk factors as substance abuse,  depression, stress and attitudes  toward physical punishment — as well as noting whether parents were concerned  that their child may have been physically or sexually abused. Doctors discussed  the risk factors with parents and referred them to social workers if needed.  After three years, researchers found that parents who took part in risk  assessments and received social work referrals, if necessary, had decreased  incidences of abuse, fewer reports to Child Protective Services (CPS) and  better adherence to immunization schedules.

But the studies’ results were not persuasive enough to warrant new  recommendations for physicians, says Dr. Heidi Nelson, senior author of the  study analysis published in Annals of Internal Medicine and a research  professor in medical informatics, clinical epidemiology and medicine at OHSU. “This is not about identifying kids who are being abused,” says Nelson. “This is  about determining if a family in front of me is at risk for abuse in the  future.”

A major challenge with determining who is at risk for child abuse is how — and to whom — to pose questions. If the parents who bring a child to a check-up  are mistreating that child, says Grossman, it’s not likely they will volunteer  that information. “You are potentially asking the perpetrators if there is a  problem,” he says.

While evidence underpinning the effectiveness of screening questions is  scanty, home visits seem to have had more success. Last year, a study in the Journal of the American Medical  Association (JAMA) found that home visits can cut child maltreatment cases  by up to half. States determine eligibility for home visits in different  ways, but poor moms, single moms, homeless moms, teen moms and those with a  history of domestic violence typically top the list. Home visitors serve as a  sounding board and support system, educating moms about normal infant behavior,  cautioning them against shaking crying babies and offering suggestions for  stress relief and interacting with their babies. Parenting can be overwhelming  even for educated, well-to-do women, but those who are less fortunate stand to  benefit even more from having someone help them navigate the challenges of  child-rearing. In fact, when researchers evaluated the effect of home  visitations, they found that those babies whose families were visited by nurses  were less likely to die of all causes by age 9 than other children. Some studies  showed that children who benefited from home visits had less contact with CPS  and fewer trips to the hospital.

But other studies on home visits have shown mixed results, leading the task  force to stop short of issuing a blanket recommendation for primary-care clinics  across the U.S to adopt the program for families they perceive to be at risk. “It’s one thing to say that it’s a good idea, but it’s another to say that we  have definite proof,” says Nelson.

The task force last took up this issue in 2004; it will take another look at  any new studies that have emerged five years from now to see if things have  changed. In the meantime, for the next 30 days the public is welcome to submit comments on the task force’s preliminary  recommendations. “We are looking to see if we missed any key pieces of  evidence,” says Grossman.

Credits: http://healthland.time.com/2013/01/23/child-abuse-why-its-so-hard-to-determine-whos-at-risk/#ixzz2JUcdo28r

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