Primary Care Interventions to Prevent Child Maltreatment

Evidence Report and Systematic Review for the US Preventive Services Task Force


Child maltreatment—abuse and neglect in childhood—can result in serious negative physical, psychological, and behavioral consequences that can span a life course and have potential effects on subsequent generations.1,2 In theory, efficacious preventive interventions may avert child maltreatment and its negative sequelae. In 2018, the US Preventive Services Task Force (USPSTF) concluded that the evidence was insufficient to assess the balance of benefits and harms of primary care interventions to prevent child maltreatment.3 This review updates the evidence on primary care–based or referable interventions to prevent maltreatment among children and youth 18 years and younger to inform an updated statement by the USPSTF.


Scope of the Review

The analytic framework and key questions that guided the review are shown in Figure 1. Detailed methods, evidence tables, and information on 3 contextual questions (CQs) are available in the full evidence report; the CQs are shown in Figure 1.4 CQs addressed overall patterns and variations by race/ethnicity in identification/diagnosis and reporting, accuracy of risk assessment tools, and association between child maltreatment prevention interventions and social determinants of health (SDOH).

Data Sources and Searches

PubMed, the Cochrane Library, and Health and Psychosocial Instruments were searched for English-language articles published from June 18, 2016, through February 2, 2023. and the World Health Organization International Clinical Trials Registry Platform were also searched. To supplement systematic electronic searches (eMethods in the Supplement), reference lists of pertinent articles and studies suggested by reviewers were also searched. Article alerts and targeted searches of journals to identify major studies published in the interim that may affect the conclusions or understanding of the evidence and the related USPSTF recommendation were used as part of ongoing surveillance. The last surveillance was conducted on December 6, 2023, and identified no studies affecting the findings.

Study Selection

Two investigators independently reviewed titles, abstracts, and full-text articles using prespecified inclusion criteria for each key question (eMethods in the Supplement); disagreements were resolved by discussion or by a third reviewer. English-language studies that included children and adolescents 18 years or younger, were of fair or good methodological quality, and were conducted in countries categorized as very highly developed by the 2018 United Nations Human Development Index5 were eligible. Inclusion was restricted to English-language, randomized clinical trials (RCTs) of youth through age 18 years (or their caregivers) with no known exposure or signs or symptoms of current or past maltreatment that reported direct measures of abuse or neglect (reports to Child Protective Services [CPS], removal of the child from the home) or proxies for abuse or neglect (injury, visits to the emergency department, hospitalization), or harms. For such studies, we also synthesized the evidence on behavioral, developmental, emotional, mental, or physical health and well-being and mortality. Studies that included a majority of participants who had previously been reported for maltreatment were ineligible for the review.

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