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Early Childhood Development: A report for the Royal Society of Canada

Early Childhood Development: A report for the Royal Society of Canada

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Published by The Province
It is generally accepted that adolescent and adult mental health, effective function, and well-being are the outcomes of a complex interaction of biological, social and environmental factors. Acting on a request from the Norlien Foundation of Calgary, the Royal Society of Canada and the Canadian Academy of Health Sciences have established jointly a panel of experts to consider this important issue.
It is generally accepted that adolescent and adult mental health, effective function, and well-being are the outcomes of a complex interaction of biological, social and environmental factors. Acting on a request from the Norlien Foundation of Calgary, the Royal Society of Canada and the Canadian Academy of Health Sciences have established jointly a panel of experts to consider this important issue.

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Categories:Types, Research
Published by: The Province on Nov 15, 2012
Copyright:Attribution Non-commercial

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12/04/2012

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As outlined in earlier chapters, there is a broad range of adverse experiences in early
development to which children can be exposed including poverty, parental use of banned
substances and child maltreatment, among others. A review of interventions to reduce exposure
to all childhood adversities and to the associated impairments is beyond the scope of this chapter.
However, we do provide an overview of the interventions aimed at preventing one of the most
pervasive and serious adversities—child maltreatment—as well as associated impairments. We
hope the approach to considering the evidence supporting interventions to prevent child
maltreatment and its associated consequences, outlined below can be applied to other adversities
such as parental mood disorder.

As discussed in earlier chapters, there can be considerable overlap in children’s exposure to early
adverse experiences, and these overlapping experiences can lead to significant cumulative risk.
Similarly, some interventions have the potential to address more than one childhood adversity.

Interventions are often developed on the basis of identified “risk factors,” that is, factors that are

significantly related to one or more outcomes (such as child maltreatment). Of identified risk

factors, some can be determined to be “causal risk factors;” that is, risk factors that are

changeable and can be manipulated such that, when successfully manipulated, the risk of the
negative outcome occurring is reduced (Kraemer et al., 1997). Identification of such causal risk
factors is important in developing effective prevention programs. A second prevention challenge
is to understand the specific mechanisms by which an adversity—once it occurs—leads to
impairment. If these mechanisms can be identified, it may be possible to intervene before the
sequelae occur. Earlier chapters have highlighted that the field has made headway in identifying
specific causal risk factors and that much is known about the correlates of impairment. However,
there remains a need for much greater investment in determining how such knowledge can be
applied to the development of interventions.

The impairments in the development of children associated with exposure to child maltreatment
are now widely recognized. This chapter reviews the current evidence about approaches to
preventing one or more of the five major subtypes of child maltreatment: physical abuse, sexual
abuse, emotional abuse, neglect and exposure to intimate partner violence (IPV), and to
preventing the impairments associated with these experiences. In addressing this topic, we follow
the framework adapted from a recent review of child maltreatment preventions ((MacMillan et
al., 2009); see Figure 5.1). We include interventions aimed at (1) preventing maltreatment before
it occurs; and (2) preventing repeat maltreatment (recidivism) and reducing adverse outcomes
associated with maltreatment among children and adolescents. “Interventions” include any
program or strategy aimed at preventing child maltreatment or associated impairments. While it
can be difficult, at times, to ascertain the onset of maltreatment and thereby separate out
prevention of maltreatment from its recurrence, programs typically identify one or the other as a
focus. We have categorized them according to their stated intervention goal. We have
deliberately avoided use of the terms “primary, secondary and tertiary” prevention, because of

282 Somerset Street West, Ottawa ON, K2P 0J6 • Tel: 613-991-6990 • www.rsc-src.ca | 86

the confusion that often arises with their application to the child maltreatment field. For example,
the World Health Organization uses primary prevention to refer to any type of intervention aimed
at stopping maltreatment before it occurs, whether administered universally or to a group
considered at high risk (or selected) (Mikton & Butchart, 2009), whereas others use primary
prevention to infer a focus on the general population, and secondary prevention to infer a focus
on families with risk factors associated with maltreatment (Child Welfare Information Gateway).

The chapter provides an evidence-based overview of what we know from the peer-reviewed
literature about the effectiveness of specific interventions in reducing child maltreatment and
associated impairment. We have focused on high-quality literature syntheses and studies of
interventions with control groups, notably randomized controlled trials (RCTs) when available.
Our aim has been to include studies of interventions that specifically address reduction of child
maltreatment and/or associated objective outcomes such as injuries, as well as impairment.

Selection of which outcomes are “primary” and which are “secondary” for purposes of

determining the effectiveness of a program is a critical methodological issue (MacMillan et al.,
2009). For example, official case reports of maltreatment are well recognized for underestimating
exposure to child maltreatment (Theodore et al., 2005). Similarly, caregiver self-reports of
harmful behaviour directed toward a child are potentially subject to underreporting because of
awareness that such behaviours are not socially acceptable (the “social desirability” bias).
Despite evidence supporting the validity of children’s self-reports of victimization (Finkelhor,
Ormrod, Turner, & Hamby, 2005), much maltreatment is experienced by children too young to
self-report. Given these (and other) limitations that are inherent in the identification of
occurrence of maltreatment (Runyan, 2008), wherever possible we focus on those studies that
have used objective measures of child and caregiver behaviours and exposure to maltreatment.

Figure 5.1. Framework for review of child maltreatment prevention interventions.

The reader is also referred to a systematic review of reviews by (Mikton & Butchart, 2009) that
synthesizes evidence for the effectiveness of the main categories of interventions for preventing
child maltreatment, such as home visiting and parent education, among others. The latter review
focuses on broad types of interventions, whereas this chapter discusses the effectiveness of
individual programs.

282 Somerset Street West, Ottawa ON, K2P 0J6 • Tel: 613-991-6990 • www.rsc-src.ca | 87

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