Study protocol: randomized controlled trial of manualized components in home visitation to reduce mothers’ risk for child maltreatment

Abstract

Background: This study tests whether home visitation to prevent child maltreatment can be improved by adding manualized program components, targeting four key risk factors for child maltreatment: low parental self-efficacy, high levels of perceived stress, parental anger, and post-traumatic stress symptoms. Home visitation is widely implemented, but effects on child maltreatment risk tend to be modest at best. Home visitation tends to be rather flexible (i.e., professionals decide how to support each family). We will test whether adding manualized program components increases program effectiveness, by ensuring that key risk factors are addressed, while maintaining flexibility. In addition, we will test whether any component effects on reduced child maltreatment risk can be explained (i.e., is mediated) by ameliorated risk factors. Lastly, we will test whether the components are more effective for some mothers (e.g., those at highest child maltreatment risk) than for others.Methods: We will conduct a randomized controlled trial among 398 mothers enrolled in a Dutch home visiting program targeting families at risk for child maltreatment. Mothers in the experimental group will receive the manualized components in two consecutive home visits, while mothers in the control group will receive regular home visits (care as usual). Mothers will fill out questionnaires at four time points: before and after each of the two home visits. Outcome variables include the four targeted risk factors parental self-efficacy, perceived stress, parental anger, and (recognition of) post-traumatic stress symptoms, as well as parenting practices (e.g., rejection and affection), and risk for child maltreatment. Discussion: This study aims to determine whether adding manualized program components to a flexible home visiting program increases program effectiveness on risk for child maltreatment. In addition, our test of whether the effects of the components on risk for child maltreatment is explained (i.e., mediated) by amelioration of the targeted risk factors, may contribute to our understanding of the role of these risk factors in child maltreatment. Our tests of which mothers benefit most from adding the components may help move the field towards evidence-based personalized family support. Trial registration: This trial has been retrospectively registered in the Netherlands Trial Register (NL8005).

Spotlight on Maternal Perceptions of Child Behavior: A Daily Diary Study with Child Welfare-Involved Mothers

“…Other early work linked parental stress with anger in relation to parents’ abuse risk [ 41 , 42 ], suggesting that reductions in negative affect from both stress and anger could decrease risk for abuse. A treatment program focused on both attributional retraining and anger management to reduce parents’ abuse risk demonstrated that parents perceived fewer child problem behaviors after treatment [ 43 ], consistent with other programs that incorporate parent training in regulating anger [ 44 ]. Such treatment effects suggest that reductions in parental anger and negative attributions can precipitate changes in parents’ perceptions of child behavior problems.…”

Role of Emotion in Child Maltreatment Risk during the COVID-19 Pandemic

“…The current study extends that work, demonstrating that anger was related to all three forms of maltreatment risk during the pandemic. This expansion has relevance for prevention programming, some of which incorporate anger management (Altafim & Linhares, 2016;Sanders et al, 2004;de Wit et al, 2020); the present findings suggest anger should be more widely adopted in an effort to broadly reduce maltreatment risk. Limited data has been available on the experience of anger and frustration during the pandemic (APA, 2020), despite its potential relevance to child maltreatment risk.…”

“…However, parents' emotions are recognized contributors to child maltreatment risk (see Stith et al, 2009 for review), and theorists have urged more consideration of affective factors (Milner, 2000;Rodriguez & Pu, 2020). In particular, parents' anger has received the most empirical inquiry, with research demonstrating that anger relates to risk for physical abuse and neglect (McCarthy et al, 2016;Rodriguez & Richardson, 2007;Pidgeon & Sanders, 2009;Stith et al, 2009), exacerbates cognitive factors (Rodriguez, 2018), mediates the association between childhood abuse history and parental maltreatment risk (Smith et al, 2014), and represents a target in some abuse prevention programs (e.g., Altafim & Linhares, 2016;Sanders et al, 2004;de Wit et al, 2020). Notably, much of the work that has evaluated anger in child maltreatment risk has focused on physical abuse, with substantially less attention to the connection between parents' anger and neglect (Stith et al, 2009) or between anger and psychological aggression (Rodriguez & Richardson, 2007).…”

Role of maternal emotion in child maltreatment risk during the COVID-19 pandemic

“…The current study extends that work, demonstrating that anger was related to all three forms of maltreatment risk during the pandemic. This expansion has relevance for prevention programming, only some of which incorporate anger management (Altafim & Linhares, 2016 ; Sanders et al, 2004 ; de Wit et al, 2020 ). The present findings suggest anger management should be more widely adopted in an effort to broadly reduce maltreatment risk, but also with particular attention to anger directly in response to perceived child misbehavior.…”

“…Parents’ anger in particular has garnered the most empirical inquiry, with research demonstrating that anger relates to risk for physical abuse and neglect (McCarthy et al, 2016 ; Rodriguez & Richardson, 2007 ; Pidgeon & Sanders, 2009 ; Stith et al, 2009 ), exacerbates maternal cognitive risk factors in physical child abuse risk (Rodriguez, 2018 ), and mediates the association between childhood abuse history and maternal physical abuse risk (Smith et al, 2014 ). Thus, although most abuse prevention programs focus on shifting cognitions, some programs incorporate anger management components based on the premise that a greater tendency to experience anger will be invoked to result in maltreatment behavior (e.g., Altafim & Linhares, 2016 ; Sanders et al, 2004 ; de Wit et al, 2020 ). Notably, most of the work that has evaluated anger in relation to child maltreatment risk has focused on physical abuse, with less attention in the literature (either pre-pandemic or during the pandemic) to whether parental anger is linked to their psychological aggression or neglect.…”