Child Maltreatment Prevention: Primary Care Interventions

Evidence is needed linking validated risk assessment and primary care–feasible or referrable interventions to direct or intermediate measures of abuse and neglect. Notably, measures of abuse and neglect are prone to underreporting, disproportionality (e.g., overrepresentation of Black children and underrepresentation of White children), and bias (e.g., recall bias in patient-reported outcomes and surveillance bias in intervention group exposure to opportunities for reporting or diagnosing abuse). Reconceptualizing the linkages between primary care–relevant risk assessment, prevention-based interventions, and standardized, accurate, and unbiased maltreatment outcomes measures is needed.

1. Research is needed to help primary care clinicians accurately identify families who might benefit from supportive interventions that may prevent child maltreatment.
   • Research is needed to determine if accuracy of risk assessment tools differs by social factors and race and ethnicity.
   • Research is needed to understand the optimal frequency of risk assessment considering chronicity, duration, intermittency, and severity of maltreatment.
2. Studies are needed to evaluate the effectiveness of primary care–feasible or referable preventive interventions designed to reduce exposure to maltreatment, including neglect.
   • Research is needed to determine whether intervention effectiveness or child maltreatment reporting differs by social factors and race and ethnicity.
   • Studies evaluating the effectiveness of interventions using more accurate outcome measures that limit bias (e.g., surveillance) are needed. Outcome measures could also include those outside the child welfare system (e.g., composite measures).
   • In addition, consistency in outcome measure definitions, outcome types, and outcome timing across studies is needed.
   • Research is needed on the most effective ways to prevent child maltreatment (using more accurate outcome measures), including interventions that address the social determinants of health that can negatively affect families.
3. Research is needed to determine whether there are unintended harms from risk assessment (e.g., stigma or legal risks related to Child Protective Services) and to engagement in preventive interventions (e.g., risk of biased reporting for maltreatment)
   • Research is needed to understand whether potential harms differ in children by social factors and race and ethnicity.

Research Taxonomy:For additional information on research needed to address these evidence gaps, see the Research Gaps Taxonomy table on the USPSTF website (PDF) .

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment.

Child Maltreatment Prevention: Primary Care Interventions Read full statement 1