Systematic review of instruments designed to predict child maltreatment during the antenatal and postnatal periods

Abstract

The purpose of this review was to identify instruments designed to predict future child maltreatment and to evaluate their predictive accuracy. A number of electronic databases were searched to identify published studies. Only studies that had utilized a prospective methodology and tested at least one standardized instrument designed to identify families during the antenatal or postnatal periods who are at increased risk of maltreatment were included in the review. Eight studies were included that had prospectively tested a standardized instrument to predict child maltreatment during the antenatal or postnatal periods. Only six of the included studies followed up the entire sample, and of these only two did not provide an intervention for some or all of the high-risk group. While many of the included instruments obtained sensitivity and specificity above 80%, only two of the included instruments combined specificity over 80% with a positive predictive value above 25%. Currently available instruments have limited accuracy, suggesting that they should only be used to focus non-punitive interventions. These findings, in conjunction with other issues such as the stigma attached to the use of such instruments and difficulties in their application within a clinical and research context, suggest the need for a new approach to the identification of parents in need of higher levels of intervention.

Evidence-based clinical guidelines for immigrants and refugees

“…Seventeen citations were selected, and five key reviews retained as evidence. [443][444][445][446][447] Studies conducted with general population and ethnic minority samples provided additional evidence that informed our recommendations related to child maltreatment among immigrants and refugees.…”

“…443,445 All screening methods attempt to predict child maltreatment on the basis of either parents' potential for maltreatment or the presence or level of risk factors associated with maltreatment, rather than on the occurrence of actual maltreatment. Three systematic reviews have reported that these instruments tend to have high sensitivity but poor specificity and false-positive rates too high for use in clinical settings.…”

“…Three systematic reviews have reported that these instruments tend to have high sensitivity but poor specificity and false-positive rates too high for use in clinical settings. [443][444][445] Sensitivity ranged between 25% and 100%, specificity between 16.5% and 94.3%, and positive predictive value (when available) between 1.7% and 28.2%. Note: CI = confidence interval; GRADE = Grading of Recommendations Assessment, Development and Evaluation; NA = not applicable; NNT = number needed to treat; RR = risk ratio.…”

Confidentiality in a Preventive Child Welfare System

“…In predicting risk of child abuse and neglect, existing risk instruments lead to an unacceptably high level of false positives (families inaccurately deemed to be high risk) and high level of false negatives (dangerous families wrongly judged safe) (Munro, 2004;Peters and Barlow, 2003). With respect to predicting criminality and social exclusion, the reports are mixed:…”

The Identification of Pregnant Women at Risk for Child Abuse: Methodology

“…5 The importance of targeted interventions at an early stage of pregnancy should not be underestimated. [6][7][8] learning and willing to stop negative behaviour that affects their unborn child. 9 To be able to do so, these high risk young women need someone to inform and empower them to stop negative behaviour and to encourage attachment with their child.…”