The effect of family-based therapies on the recurrence of physical abuse and neglect among children in high-risk families: preliminary findings from a systematic review of experimental and quasi-experimental studies

The effect of family-based therapies on the recurrence of physical abuse and neglect among children in high-risk families: preliminary findings from a systematic review of experimental and quasi-experimental studies

Presenter: George Economidis

Author names: 1Economidis, G., 3Pilkington, R., 1Shakeshaft, A., 1Powell, M., 3Lynch, J., and 2Falster, K.

Author affiliations: 1National Drug and Alcohol Research Centre

2University of New South Wales

3University of Adelaide

Introduction: Family-based therapies have been heralded as promising interventions for the prevention and treatment of child maltreatment.

Aims: In this study, the evidence on the effectiveness of family-based therapies in reducing the recurrence of physical abuse and neglect, compared with usual care, was systematically reviewed.

Methods: 7,921 publications from three databases (CINAHL, Scopus and PsycINFO) and the grey literature met the search criteria from inception to 22 February 2020. After screening titles, abstracts and full text, 20 studies met inclusion criteria; 17 randomised controlled trials and 3 quasi-experimental studies. Data were extracted for three post-treatment outcomes, including: notifications of child maltreatment to child protection services; out-of-home care placement; and other measures of recurrent child maltreatment, such as the Child Abuse Potential Inventory Scale.

Results: 15 of 20 studies were at moderate-to-high risk of biases on 3 or more domains. There were several common methodological concerns. In 4/6 RCTs reporting post-treatment notification rates of child maltreatment, imbalances in baseline characteristics between groups were evident, but there was no adjustment for confounding to estimate the effect of the intervention. Although all studies reported crude outcome rates for the intervention and usual care groups, the majority of studies did not generate a main causal effect estimate. Some studies made within-group comparisons (e.g. pre-post baseline measures), instead of the between-group comparisons of post-treatment measures that are necessary to estimate a causal effect.  There were also issues with how loss to follow-up and missing data were reported and handled in analyses, leaving concerns regarding selection bias.

Implications: Although a couple of the family therapy interventions may have a beneficial effect on recurrent abuse and neglect, there is a need for greater epidemiological rigour when undertaking comparative effectiveness research in the child maltreatment field to understand ‘what works’, which is critical for making service delivery decisions.