Final Research Plan
Child Maltreatment: Interventions
August 18, 2016
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
* The World Health Organization defines child maltreatment as including "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect, or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development, or dignity in the context of a relationship of responsibility, trust, or power."1 Maltreatment includes physical abuse, neglect, sexual abuse/exploitation, emotional abuse, parental substance abuse, and abandonment.2
This figure is an analytic framework depicting the key questions that will guide the systematic evidence review for this topic. This figure illustrates the intervention pathway for the population of interest, namely children and adolescents from birth to age 18 years with no known exposure to maltreatment and no signs or symptoms of current or past maltreatment. The first key question examines whether primary care–feasible or referrable interventions result in reduced exposure to abuse and neglect; improved behavioral, emotional, physical, and mental well-being; or reduced mortality. The second key question evaluates whether any harms result from such interventions.
- 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 without obvious signs or symptoms of abuse or neglect?
- What are the harms of primary care–feasible or referable interventions to prevent child maltreatment?
The contextual question will not be systematically reviewed and is not shown in the Analytic Framework.
- What is the validity and reliability of risk assessment tools to identify children and adolescents who are at risk of child maltreatment?
The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions (KQs).
| Included | Excluded | |
|---|---|---|
| Population | Children and adolescents (birth through age 18 years) with no known exposure to maltreatment and no signs or symptoms of current or past maltreatment | Symptomatic children and adolescents undergoing diagnostic evaluation for conditions related to abuse or neglect (e.g., those presenting with a broken bone or other signs of physical abuse or neglect, trauma symptoms associated with domestic violence exposure), asymptomatic children with known exposure to child maltreatment, perpetrators of maltreatment, and children who have maltreatment perpetrated against them by a caregiver |
| Interventions |
|
Communitywide interventions only, such as public awareness campaigns or public service announcements, without specific interventions linked to clinical settings |
| Comparisons | Usual care, delayed intervention, or active interventions that allow for assessment of the independent contribution of the primary care—feasible or referable preventive intervention (e.g., clinical interventions plus media campaigns vs. media campaigns) | Comparators that do not allow for assessment of the independent contribution of the primary-care–feasible or referable preventive intervention (e.g., clinical interventions plus media campaigns vs. usual care) |
| Outcomes | KQ 1: Direct or proxy measures of abuse or neglect (required):
Behavioral, emotional, mental, or physical well-being*:
|
KQ 1: Outcomes not otherwise specified; studies without direct or proxy measures of abuse or neglect KQ 2: None |
| Clinical settings | Primary care–feasible or referable settings, including pediatric, primary care, family medicine, school-based clinic, or other settings where primary care services are offered; services that could result from an assessment by a clinician (including delivery hospitals, in-home settings, and nonspecialty settings) | Settings that are not primary care–feasible or referable; populations or services/interventions that are not applicable to U.S. practice |
| Country | Research conducted in the United States or in populations similar to U.S. populations, with services and interventions applicable to U.S. practice (i.e., conducted in countries categorized as "Very High" on the Human Development Index (as defined by the United Nations Development Programme) | Research not relevant to the United States (i.e., conducted in countries not categorized as "Very High" on the Human Development Index) |
| Study designs | KQ 1: Randomized, controlled trials; systematic reviews KQ 2: Randomized, controlled trials; controlled clinical trials; systematic reviews; cohort trials with a control group; and case-control studies |
KQ 1: Nonrandomized cohort trials, case-control studies, case series, or case studies KQ 2: Case series or case studies |
| Timing | Any timing | None |
| Languages | Full text published in English | Languages other than English |
| Publication type | Original research and systematic reviews | Editorials, commentaries, or narrative reviews |
* Studies reporting these outcomes for KQ 1 that do not also report at least one child maltreatment outcome will be excluded.
The draft Research Plan was posted on the USPSTF Web site for public comment from May 12 to June 8, 2016. The USPSTF received several comments requesting clarification on the inclusion and exclusion criteria. In response, the USPSTF revised the analytic framework to specify the population of interest as "children and adolescents from birth to age 18 years" and the inclusion criteria to no longer exclude children and adolescents with serious behavioral problems. The USPSTF also clarified that the evidence review will include family-focused interventions, which may be directed at the caregiver and may not include components directed at the child, and that interventions will include primary care–feasible or referable interventions conducted in delivery hospitals, in-home settings, and nonspecialty settings, in addition to other settings specified earlier. The USPSTF added two new outcomes: improved school attendance and performance and reduced risky behaviors and outcomes (e.g., sexually transmitted diseases). Information on how children, adolescents, or their caregivers are selected for interventions (former Contextual Question 1) will be included in the evidence review and will not require an explicit question.
- World Health Organization and International Society for Prevention of Child Abuse and Neglect. Preventing Child Maltreatment: A Guide to Taking Action and Generating Evidence. Geneva, Switzerland: World Health Organization; 2006. http://www.who.int/violence_injury_prevention/publications/violence/child_maltreatment/en.
- Children's Bureau. Definitions of Child Abuse and Neglect. Washington, DC: U.S. Department of Health and Human Services; 2014. https://www.childwelfare.gov/topics/systemwide/laws-policies/statutes/define.