Individual and group-based parenting programmes for the treatment of physical child abuse and neglect

  • Review
  • Intervention

Authors


Abstract

Background

Child physical abuse and neglect are important public health problems for which there are currently few effective treatments. Many of the risk factors for child abuse and neglect are not amenable to change in the short term. Intervening to change parenting practices may, however, be important in its treatment. Parenting programmes are focused, short-term interventions aimed at improving parenting practices, and may therefore be useful in the treatment of physically abusive or neglectful parenting.

Objectives

To assess the efficacy of group-based or one-to-one parenting programmes in addressing child physical abuse or neglect.

Search methods

A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychINFO, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library, Campbell Library (including SPECTR and CENTRAL), National Research Register (NRR) and ERIC, from inception to May 2005.

Selection criteria

Only randomised controlled trials or randomised studies evaluating the effectiveness of standardised group-based or one-to-one parenting programmes aimed at the treatment of physical child abuse or neglect were included.

Data collection and analysis

The results for each outcome in each study have been presented, with 95% confidence intervals.

Main results

A total of seven studies of variable quality were included in this review. Only three studies assessed the effectiveness of parenting programmes on objective measures of abuse (e.g. the incidence of child abuse, number of injuries, or reported physical abuse), and only one of these found significant differences between the intervention and control groups.

Data were also extracted on over fifty outcomes that are used as predictive measures of abusive parenting. These measured a range of aspects of parenting (e.g. parental child management, discipline practices, child abuse potential and mental health), child health (e.g. emotional and behavioural adjustment) and family functioning, thereby precluding the possibility of undertaking a meta-analysis for most outcomes for which data were extracted. While none of the programmes were effective across all of the outcomes measured, many appeared to have improved some outcomes for some of the participating parents, although many failed to achieve statistical significance.

Authors' conclusions

There is insufficient evidence to support the use of parenting programmes to treat physical abuse or neglect. There is, however, limited evidence to show that some parenting programmes may be effective in improving some outcomes that are associated with physically abusive parenting. Further research is urgently needed.

摘要

背景

治療孩童身體虐待及忽略,以個人及團體為基礎的養育計畫

孩童身體受虐和被忽視,為重要的公共健康議題,而最近關於此方面的盛行率估計顯示,其遠比我們至今所了解的要高。許多孩童受虐和被忽視的危險因子,在短期內都沒有辦法順利的改變。然而,介入以改變養育習慣在其治療上是很重要的。養育計畫的重點及短期介入的目標,在於改善養育方式以及其它項目的預後 (其中有許多也是孩童受虐的危險因子,如父母的精神病理狀態、以及養育的態度和習慣) ,因此,對治療身體虐待或忽視的雙親也許有用。

目標

評估以團體為基礎或者一對一的養育計畫,在處理兒童身體受虐或被忽略上的效力。

搜尋策略

搜尋生物醫學和社會科學的資料庫,包括MEDLINE,EMBASE,CINAHL,PsychINFO,Sociofile,Social Science Citation Index,ASSIA,the Cochrane Library,Campbell Library (包括SPECTR和CENTRAL) ,National Research Register (NRR) 和ERIC,從開始到2005年5月。

選擇標準

只有比較兩種治療的隨機對照試驗或隨機研究被收納進來。研究中包括至少一種標準化工具,用來量測施與虐待或忽視的雙親的某些面向。在缺少使用客觀方式評估孩童受虐之試驗的狀況下,使用替代性代評估施虐雙親的試驗也被收納進來。只有評估針對身體受虐或被忽視的孩子,以標準化團體為基礎、或一對一的養育計畫做治療,其治療功效的文獻才被收納。另外試驗必須符合孩子年齡介於0 – 19歲,且雙親有接受過身體虐待或忽視的調查時,才適合放入研究分析。

資料收集與分析

在每一個試驗,對每一項預後的治療效果,皆以綜合標準差 (pooled standard deviation) 除以所謂 ‘對於接受介入和治療的組別,使用所得到之介入治療後分數’ 的平均差 (mean difference) 來標準化,以得到效果大小 (effect size) 。每個試驗的每項預後之結果皆以95% 信賴區間呈現。無法合併任何結果於統合分析 (metaanalysis) 中。

主要結論

總共有7篇品質不一的文獻被收納入這篇回顧。只有兩篇是評估養育計畫對於孩童受虐之發生率、或受傷數目之效果。其中1篇文獻顯示,在接受介入治療的組別中沒有受虐的報告,而在控制組則有1個受虐的報告。在另1篇文獻中,受傷害的數量過少,因而排除統計分析的可能性。使用替代性評估施虐雙親的50個預後資料也被選用。整體測量的面向是多樣性的,包括養育方面 (如親子經營、管理實踐、孩童受虐可能性及心智健康) ,孩童健康 (如情緒及行為之適應) ,和家庭的功能,如此一來,排除了對所得資訊大多的預後結果進行統合分析的可能性。雖然沒有一項養育計畫對所有預後都有效果,且許多皆未達到統計上的顯著,但多數計畫仍能改善某些參與的雙親的某些預後,

作者結論

沒有足夠的證據支持使用養育計畫,來治療身體受虐或忽視 (比方說,從受虐報告、受傷、或在保護列管之下的孩童數量,所得之孩童受虐的發生率) 。然而,有限的證據顯示,某些養育計畫可能對改善某些預後,特別是關於身體虐待的養育部份有幫忙。更進一步針對養育計畫效果的積極評估,特別是對身體受虐或忽視的治療,不管是獨立、或是照護配套的部份,是迫切需要的。這些評估應包含客觀的預後,加個別養育評估、以及身體虐待案例數目。為了這些目的,進一步研究應有長期的追蹤。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

孩童身體受虐和忽視是個重大議題,改變養育方式也許是重要的處理方式。這篇回顧檢視了養育計畫 (相對短期、結構性的介入方式,目標擺在改變養育的執行) 在施虐或忽視的養育上,其治療的效果。總共有7篇品質不一的試驗被收納進這篇回顧。結果顯示,沒有足夠的證據,支持使用養育計畫來減少身體施虐或忽視 (比方說,客觀評估虐待,包括受虐報告、保護列管之下的孩童數量) 。然而,有限的證據顯示,某些養育的計畫,可能對某些預後有幫助,特別是相關於身體虐待的養育部份。更進一步針對養育計畫效果的積極評估,特別是對於治療身體受虐或忽視的治療、不管是獨立的或是屬於照護配套的部份,是迫切需要的。

Plain language summary

Parenting programmes for the treatment of physical child abuse and neglect

Physical abuse and neglect of children are significant problems and changing parenting practices may be an important means of addressing them. This review examines the extent to which parenting programmes (relatively brief and structured interventions that are aimed at changing parenting practices) are effective in treating physically abusive or neglectful parenting. A total of seven studies of mixed quality were included in the review. The findings show that there is insufficient evidence to support the use of parenting programmes to reduce physical abuse or neglect (i.e. using objective assessments of abuse such as reports of child abuse; children on the children protection register etc). There is, however, limited evidence to show that some parenting programmes may be effective in improving some outcomes that are associated with physically abusive parenting. There is an urgent need for further rigorous evaluation of the effectiveness of parenting programmes that are specifically designed to treat physical abuse and neglect, either independently or as part of broader packages of care.

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