Study Review

Parenting Programmes to prevent child physical abuse recurrence

Behavioural parenting programmes aimed at improving the parent-child relationship and preventing the recurrence of child physical abuse by changing parenting practices and skills.

Outcome Overall
effectiveness

This rating shows how effective the intervention is at achieving the evaluated outcome.

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Strength of
evidence

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.

Risk of child abuse recurrence Overall effectiveness: 1 (maximum 2) Strength of evidence : 2 (maximum 3)
Harsh parenting and physical punishment Overall effectiveness: mixed (maximum 2) Strength of evidence : 2 (maximum 3)

Headline points

  • This systematic review looked at 14 RCTs of eight different parenting programmes, including a meta-analysis of four of these studies that compared randomised interventions with treatment as usual.
  • All 14 studies contained parenting programmes that were underpinned by the social learning theory. These programmes focus on changing parental behaviours to improve parenting styles, in order to prevent child physical abuse recurrence.
  • There is some evidence that targeting the parent-child relationship through social learning theory-based parenting programmes may be effective in preventing physical child abuse recurrence.
  • Effects on harsh punishment were mixed. One intervention found benefits of a parenting intervention for harsh punishment. However two others found that the intervention was no better than an alternative.
  • Research is needed that identifies the key components of parenting programmes for preventing physical child abuse recurrence and how to improve programme effectiveness.

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What is this?

Behavioural parenting programmes are aimed at improving the parent-child relationship and preventing the recurrence of child physical abuse by challenging parenting practices and skills.

The review included 14 studies evaluating the effectiveness of eight behavioural parenting programmes based on social learning theory.

The behavioural parenting interventions included in the review were:

  • STEP-TEEN
  • Parent-Child Interaction Therapy
  • Child Management Program
  • Incredible Years
  • Project Support
  • (Child-parent) Cognitive Behavioural Therapy
  • Home visitation (SafeCare or home visitation with nurses)
  • I-inTERACT

Programmes varied in specific components and delivery settings, however they all shared common features:

  • Programmes were focused on teaching parenting skills and child management strategies so that the negative cycles of coerciveness in parent-child relationships could be broken.
  • Programmes gave parents the opportunity to practice these skills. Some programmes also included other modules on health and safety.

How is it meant to work?

These parenting programmes focus on challenging parental behaviours based on the notion that improving parenting styles prevents child physical abuse recurrence.

This is based on theory that child abuse results from coercive parent-child interactions which lead to an escalation in violent behaviour, resulting in harsh discipline. These parenting programmes aim to break this cycle, changing parental behaviours by teaching other forms of discipline and increasing the use of positive parenting strategies, thereby preventing child physical abuse recurrence.

What are the evaluated outcomes?

Two outcomes were identified and assessed within the review:

  • Risk of child abuse recurrence
  • Harsh parenting and physical punishment

The primary outcome measure (risk of re-abuse) was measured via re-reports of referrals to CPS, police (or similar agencies). In one study parent and child self-reports of the number of new abuse incidents were used.

The secondary measures (harsh parenting and punishment) were measured by above threshold scores in standardized measures of physical child abuse that validly and reliably identify physical abuse occurrence.

What are the evaluated outcomes?

  • Risk of child abuse recurrence
  • Harsh parenting and physical punishment

How effective is it?

Based on seven studies, overall the parenting programmes had a positive effect on reducing the risk of child abuse recurrence.

However, when compared to alternative family or parenting interventions, the evidence was mixed.

  • Individual child-parent CBT had a significant positive effect on child physical abuse recurrence when compared to family therapy.
  • STEP-TEEN and Child Management Program showed no significant difference in child physical abuse recurrence compared with another active intervention.
  • Parent-Child Interaction Therapy and SafeCare found significant positive effects in increasing the time to recurrence of physical abuse when compared to control groups.

Based on three studies, the parenting programmes had mixed effects overall on levels of harsh parenting and physical punishment. Project support showed better outcomes than treatment as usual. However, combined parent-child Cognitive Behavioural Therapy and STEP-TEEN were no better than alternative interventions.

The evidence base is relatively strong. All 14 studies were Randomised Controlled Trials. The review includes a meta-analysis of four studies that compared manualized interventions with treatment as usual.

However, the authors acknowledge several limitations in this review. These include small sample sizes in some studies. No studies blinded participants to which intervention they were receiving (although this is difficult in psychological interventions). Three of the 14 studies reported unsuccessful randomisation and drop out rates ranged from 2-23% across interventions.

Where has it been studied?

Of the 14 studies included in the review, 12 were carried out in the US and two in Canada.

Who does it work for?

The intervention is targeted towards parents or primary caregivers using physical punishment to discipline their children.

All 14 studies comprised of a minimum of 15% physically abusive parents, although one study was included with 14%. Seven studies included only physically abusing parents, whilst others ranged from 23% to 62%. The number of participants in each study ranged substantially from 26 to 2176.

The review does not report whether there are participant characteristics or contextual factors that make the intervention more or less successful.

When, where and how does it work?

The review included a range of intervention types and delivery formats. However, it did not include evidence on what factors make behavioural parenting programmes more or less effective. The interventions included in the review did share common features: teaching parenting skills/child management strategies and giving parents an opportunity to practice these skills.

What are the costs and benefits?

No economic analysis was included in the review.

How is it implemented?

There was considerable variation in how the 8 programmes in the 14 studies were implemented.

  • Most of the eight programmes included weekly sessions of between one and two hours a session.
  • While programme duration varied from 6 weeks to 8 months, most programmes ran for between four to eight months.
  • Programmes were delivered individually or in groups in a variety of settings including healthcare clinics, at home or online.
  • Children were aged between 0 and 17 years.

Who can deliver it?

The backgrounds of professionals delivering the interventions is not stated in the review.

What are the training and supervision requirements?

The individual requirements for each programme are not reported in the review.

What supports good implementation?

In the four studies included in the meta-analysis, the fidelity of the intervention was supported by using a manualized approach. Within the other studies used in the systematic review, methods for maintaining fidelity are unclear.

In summary...

  • There is some evidence that targeting the parent-child relationship though social learning theory-based parenting programmes may be effective in preventing physical child abuse recurrence.
  • Of the three interventions looking at harsh parenting and physical punishment as a secondary measure of physical child abuse, only one had a significant difference in favour of the intervention (Project Support).
  • Further research is needed to identify the key components of parenting programmes that successfully prevent physical child abuse recurrence to improve programme effectiveness.

Further resources

This evidence summary is based on the following systematic review:
Vlahovicova, K., Melendez-Torres, G.J., Leijten, P., Knerr, W. and Gardner, F. (2017). Parenting programs for the prevention of child physical abuse recurrence: a systematic review and meta-analysis. Clinical Child and Family Psychology Review, 20(3),
351-365.