As described elsewhere on this website, the Child Development Programmes have the fundamental aim of empowering parents to enable them to deal more successfully with their child-rearing challenges. While the programmes are not formally aimed at the reduction of child abuse, it is expected that parents who become more aware of their potential for influencing their children, and more confident in their ability to deal with the many situations that can lead to child abuse, will usually succeed in avoiding abusive behaviour.
In a study of 31,000 children whose parents had been involved in a period of programme visiting over a period of several years, the rates of physical abuse and placement on the Child Protection Register (CPR) for these children were compared with similar rates for all children in the health authority geographical areas that included the programme areas. The comparison showed a halving in the rate of physical abuse, compared with control children, and a 40 per cent reduction in placement on the CPR. A senior research officer of the National Society for the Prevention of Cruelty to Children assisted with information about abuse rates, as did the Statistics Director of the Department of Health and the equivalent official in the Welsh Office.
Collaboration with 24 health authorities
The study was undertaken in collaboration between the Early Childhood Development Centre and 24 health authorities (as they were then named), spread throughout much of the United Kingdom. Information was gathered from more than 150 health visitors who had taken part in the pro¬gramme. These visitors examined the records of all the families with whom they had done programme visits in recent years - totaling more than 31,000. The visitors used the clinics’ standard child records to find how many of those children had been placed on the Child Protection Register, and how many had been physically abused, together with the circumstances of such abuse.
The more difficult part of the study arose from the need to obtain reliable comparisons, to determine whether the registrations and rates of physical abuse for programme children were better or worse than might be expected among the generality of families within each of the 24 health authorities. This difficulty arose because the programme children were nearly all under one year of age at the time that their parents were receiving programme visits; the infants were born to first-time mothers, with a higher proportion than usual being teenage mothers; and the areas in which the families lived tended to be less advantaged than the average for each authority as a whole, with a higher proportion of 'fractured families' than in the area’s general population.
The report describes the methods used to take account of the significant dif¬ferences between the programme families and the health authority families as a whole. When the adjustments are made to achieve comparability, the comparisons point strongly to a 50% reduction in the rate of physical abuse and a reduction of over 40% in the rate of CPR placement for programme children. This is a considerable achievement, based in most cases on one ante-natal visit and eight or more semi-structured post-natal visits to a family, each visit lasting up to an hour.
The tentative nature of the analyses should be emphasised. For example, it has been necessary to use the NSPCC's assumptions that their partial evidence as to the proportions of first-born children, teenage mothers and 'fathers" occupational status groups, in relation to child abuse levels, can be extrapolated to a situation in which full information was provided on all cases. The extrapolations seem justified, as it is likely that fuller information would show even higher proportions of those vulnerable groups being involved in abuse. Thus, experience in this data recording for the programme authorities shows that when 'father's occupation' is omitted, it is often because he has never had a job and the mother does not want to volunteer that information; in other cases the present 'father' may be the second or third male partner, or there may be no male partner in attendance.
The long term outcomes of the programme have yet to be assessed, but experience with Headstart, a major US community and parent-based pre-school initiative, suggests that developmental support programmes have powerful and positive effects on the children’s behaviour as teenagers and adults, many years later. The reasons for the success of the programme in reducing rates of child abuse are discussed in the next section of this article..
Reasons for major reduction in abuse rates
It cannot be emphasised too strongly that the phenomenon of child abuse is nearly always fundamentally related to the stresses of parenting in family situations which damage or destroy the parents' self-esteem and cause them to lose belief in their capacity to cope with those stresses. Abusive responses to stress situations is not inherent in parents’ poverty or other disadvantaging circumstances. The vast majority of parents living in those circumstances - more than 990 out of every 1,000 - cope with the stresses without abusing their children. One is therefore discussing abuse rates among only a small handful of families in every 1,000 families, even among the most disadvantaged.
It has also been pointed out that there is a fine margin between the majority of parents who are frustrated and often depressed by their children's seemingly impossible behaviours, and the very small minority (less than ten in a thousand) who end up abusing their children. Because this is a prob¬lem on the margins, initiatives such as the programme do not require a vast input of health visi¬tor time to move the margin further in the direction of enabling parents to learn how to cope and deal with the seemingly 'impossible behaviours'; however such health visitor input does need to be target¬ed at the key issues of self-esteem and empowerment of parents, coupled with competent monitoring, rather than at surveillance and advice.
It is also necessary to emphasise once again that the Child Development Programme by its very nature cannot be used as a kind of anti-child abuse programme. Its success in achieving the results reported here has come about because parents have been supported, encouraged and empowered to become better parents. This in turn has reduced the inevitable stresses and ten¬sions of parenting, especially in situations where economic and social disadvantage add to the parenting burdens.
It is equally important to recognise that the programme should not be used as a selective instrument to target 'vulnerable' parents or those whom professionals consider have a strong chance of becoming abusers. Attempts at selective use of the programme through screening for a child abusing potential is unethical and counter-productive. New parents ‘selected’ for visiting will soon come to recognise that they have been screened and are probably being offered the programme because they have been identified as potential abusers, not because they are simply in need of support as parents. When that happens many parents will refuse to have the programme, and rightly so. Moreover there is evidence (see reference at end) that so-called vulnerability screens not only fail to identify a majority of those parents who later become abusers, but also regrettably identify many innocent parents who never become abusers, whether or not any support is offered.
The programme has therefore to remain targeted on the generality of parents, even if resource limitations mean that some residential areas or some GP practices are more likely to become programme areas than others. But within those areas or practices people need to feel that this is a service provided for every new parent who wants such support.. The programme has therefore to remain targeted on the generality of parents, even if resource limitations mean that some residential areas or some GP practices are more likely to become programme areas than others. But within those areas or practices people need to feel that this is a service provided for every new parent who wants such support..
Can the programme costs be justified by the results?
Finally, what is it about the Child Development Programme that contributes to this substantial lowering in the rates of child abuse, across a wide range of different environments? It cannot be simply the additional visits by the health visitor. It would be very difficult to mount a controlled study on child abuse in which half the samples received the same number of conventional visits, with no contamination from the philosophy or strategies of the CDP, and the other half received programme visits. The evidence for the effectiveness of programme visiting as such has to come from the many authorities where the CDP is in operation.
The reason for the success of the programme, in this regard as in many others, can be summed up in a few sentences. The programme helps parents to feel good about themselves, because it uses structured methods and provides support focused on the parents' concerns rather than on those issues formulated by the health visitor for the parents. When parents find that their own concerns are of real importance to the visitor, they feel empowered and are then more open to sharing their concerns over their parenting problems, in regard to their children's health, nutrition, behaviour or development. Their self-esteem is boosted by what the pro¬gramme helps them to achieve, rather than from any superficial assurances.
It can be asked whether the costs of the programme can be justified by the results. The current costs of the extra visiting in the programme are modest, since all parents normally receive several visits from their health visitor after the birth of a baby; these conventional visits may be prolonged if there are problems, or alternatively when crises develop a visitor may call a number of times until the crisis has been resolved.
One big saving from the programme comes from the fact that crisis visits are virtually eliminated during the period of programme visiting and, according to reports, greatly reduced once the programme has ended. Evidence is not yet available on whether programme parents need less support for their second and subsequent babies, but this seems highly likely. Other evidence, from studies in single health authorities, points to a variety of positive programme effects, with consequent savings, when comparing programme families with non-programme families; the difficulty with such studies is that it has not yet been possible to take full account of differing levels of advantage and disadvantage in the programme and control samples, as has been done in the present study.
In the absence of adequate cost benefit studies on child-rearing for representative samples of the population as a whole, it is not possible to determine the long-term benefits of the savings in injuries and other forms of child abuse resulting from the programme. It is known that the US Headstart programme, which puts extra support into pre-schools and involves the local commu¬nities in a great many disadvantaged areas, was shown (as referenced in the Thousand families intervention study article on this page) ten years after the introduction of that programme, to have achieved remarkable success. It may be found, in time, that children whose parents were involved in the Child Development Programme have also achieved at school well beyond what might have been expected. But research into that outcome would be a major undertaking, and would require the same kind of painstaking study of all the relevant factors which differentiate programme parents as a whole from the population as a whole.
To conclude, the evidence from this study offers reasonably convincing evidence that the Child Development Programme has resulted in a major reduction in the rates of placement on the Child Protection Register among families who have had the benefit of this programme. Even firmer evidence is provided by the indications of a halving in the rate of physical abuse of chil¬dren in those families. The findings suggest that the intimate and personal support which the programme offers to parents in their homes is the kind of support that should be available to every parent faced with the daunting task of rearing a new child.
Barker, W (1990) Practical and ethical doubts about screening for child abuse Health Visitor 63 January 14-17
Barker, W, Anderson, R and Chalmers, C (1992) Child protection: the impact of the Child Development Programme - Evaluation Document No. 14 (44 pps) Early Childhood Development Centre. This report can be ordered from the ECDC at the address on the website’s Contact page.Return to page on Research Findings
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