Interventions for Expectant and New Parents Designed to Prevent Child Abuse and Neglect in at-risk Families: Protocol for a Systematic Review and Meta-analysis

doi:10.21203/rs.3.rs-801036/v1

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Interventions for Expectant and New Parents Designed to Prevent Child Abuse and Neglect in at-risk Families: Protocol for a Systematic Review and Meta-analysis

https://doi.org/10.21203/rs.3.rs-801036/v1

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Background:

The prevention of child abuse and neglect is an urgent matter, as abuse and neglect are associated with serious effects even into adulthood, and as there is an increased risk of the offspring of abused children being abused themselves. Intervening as early as possible may prevent abuse that can begin in infancy. Although several systematic reviews and meta-analyses have investigated the effects of interventions on populations at risk for child abuse and neglect, few studies have focused on at-risk women or interventions that start during perinatal periods. This study aims to describe a systematic review to examine the effects of interventions to prevent child abuse and neglect that begin during pregnancy and just after childbirth (less than one year). The study will involve performing a systematic review and meta-analysis based on the latest research articles up to and including November 2020 and a broader literature search.

Methods:

The protocol was prepared using the 2015 statement of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. The review will follow Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines/statements. The literature search will be performed using the MEDLINE, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials databases from inception onward. Randomized controlled trials of interventions that begin during pregnancy or the first year postpartum and are designed to prevent child abuse and neglect in at-risk families will be included. Data collection, quality assessment, and statistical syntheses will be conducted by following methods in the protocol that are defined in advance.

Discussion:

The findings of this systematic review and meta-analysis will be important in clinical and political settings for the prevention of child abuse and neglect. The results of this study will provide a basis for the development of evidence-based intervention programs for expectant and new parents and child abuse prevention policies. Additionally, this study will encourage future studies to conduct more evidence-based intervention programs and illuminate the direction of research on the prevention of child abuse and neglect.

Systematic review registration:

PROSPERO CRD42021266462

Health Economics & Outcomes Research

child abuse

child neglect

child maltreatment

home visit

parent training

perinatal

antenatal

early intervention

pregnancy

at-risk

Prevention of child abuse and neglect has always been a critical issue in child health and welfare. Child abuse is usually divided into the following four categories: physical abuse, sexual abuse, neglect, and emotional abuse. Studies examining the prevalence of child maltreatment have reported ranges from 12.7–36.3% for self-reported cases and from 0.3–0.4% for informant reports [1]. Childhood abuse and neglect have serious consequences that may continue into adulthood [2–5]. Therefore, the prevention of child abuse and neglect is an urgent matter.

Home-visitation and parent-training programs are widely implemented worldwide as child abuse prevention programs to reduce the burden on parents, provide support, and educate parents on proper parenting methods, and they have been widely studied in previous systematic reviews and meta-analyses. Several researchers [6–9] have reported the effects of home visitation on preventing child abuse and neglect; other researchers [6, 10–13] have reported the effects of parent-training programs. These reports have included studies of the general population, and the age of the targeted children has varied in existing research. Systematic reviews in a mixed population reported no difference in effect by sample type [6, 13]. On the other hand, Casillas et al. [9] reported that targeted programs have a greater effect than universal programs. Chen and Chan [6] conducted a systematic review for a wide range of ages and reported that early start intervention (beginning at or before pregnancy) had better outcomes. Gubbels et al. [13], on the other hand, reported that there was no difference in the effect of child age; other studies did not take into account differences in age [10, 12].

Baldwin et al. [14] conducted a large cohort study and reported that younger maternal age, lower maternal education level, maternal mental illness, maternal smoking in pregnancy, single motherhood, larger family size, multiple deprivations, social housing, paternal un-employment, and the receipt of means-tested welfare benefits are antenatal risk factors for child maltreatment. They also reported that a greater total number of risk factors during pregnancy increased the risk of subsequent maltreatment concerns. Parents’ abusive experiences have also been demonstrated to increase the risk of those abusing their own children [15–17]. As almost half of child maltreatment deaths involve infants younger than one year of age [18], early preventive interventions are particularly important for this high-risk population during pregnancy or postnatal periods. Pinquart and Teubert [19] conducted a meta-analysis that searched for the effects of parenting education with expectant and new parents. They included 142 papers on interventions that began during pregnancy or in the first six months after birth and found that interventions had small to very small significant effects on parenting, parental stress, and child abuse. Levey et al. [8] conducted a systematic review of randomized controlled trials of intervention in which the participants were pregnant women or new mothers identified as at-risk for child abuse and neglect. Of the eight studies they identified, only three found statistically significant reductions in abuse by any measure, and only two found reductions in incidents reported to child protective services (CPS). They found that only home visitation has a significant evidence base for reducing child abuse. However, Pinquart and Teubert [19] only reported the effect of parent programs, and Levey et al. [8] only reported on home visitation. Additionally, limited studies have examined the effectiveness of preventive programs for at-risk families conducted during the perinatal period.

Therefore, this study will examine the effects of intervention programs initiated in the perinatal period for at-risk families. It will use a systematic search strategy based on the latest research.

Study design

We registered this systematic review and meta-analysis protocol with the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021266462). This protocol was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) 2015 statement [20] (Additional file 1). The final review will be created according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement [21].

Search strategy

We will perform literature searches with the following electronic databases from their inception onward: MEDLINE, PsycINFO, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL). A draft MEDLINE search strategy developed by one of the authors (KO) is described in Additional file 2. After the MEDLINE strategy is completed, it will be adapted to the subject headings and syntax of the other databases. Our search terms consist of “perinatal,” “intervention program,” “child abuse,” and “randomized controlled trials” (RCTs).

Study records

We will upload the studies collected through electronic and manual searches to Rayyan [22], an Internet-based software program facilitating collaboration among reviewers during the study-selection process. Citations, titles, and abstracts will be uploaded to Rayyan. Duplicates will be removed. Then, full-text screening will be conducted using EndNote [23], a reference management software package.

Eligibility criteria

We will include original studies of RCTs; we will exclude articles that did not report original data (e.g., review, meta-analyses, and commentary papers). We will not impose limits on the publication date. The review will include only full-text, peer-reviewed articles published in the English language. The following participants, interventions, comparisons, outcomes, and study criteria (PICOS) of the studies will be included:

(P) Studies with participants who are women during pregnancy and less than one year after childbirth who are at risk of child abuse and neglect (determined to be at risk for any reason, e.g., mental illness, low income, social isolation, drug/alcohol use, smoking, and domestic violence) will be included. No age restrictions will be imposed. We will exclude studies where the participants were foster families. We will also exclude studies involving participants who started interventions more than one year after childbirth.
(I) Psychological and educational interventions that aim to prevent child abuse and neglect will be considered. Child abuse and neglect are defined and identified by the study authors. We will exclude interventions that aim to prevent specific risks but do not measure the effects of preventing child abuse and neglect (e.g., antenatal and postnatal depression, drug/alcohol use, HIV infection, smoking, intimate partner violence, family planning, and breastfeeding).
(C) Routine care, another type of intervention, placebo groups and waiting list groups, or no intervention will be included in the comparison group.
(O) Any index of child maltreatment (reports of child abuse, CPS case records, injury reports, hospital admission, and emergency room visits) will be included as a primary outcome. Additional outcomes will include measures of parenting stress (e.g., Parenting Stress Index, PSI [24]) and inappropriate parenting behavior (e.g., Conflict Tactics Scales, Parent-Child Version, CTS-PC [25]; Adult Adolescent Parenting Inventory-version 2, AAPI [26] (-2) [27]; Child Abuse Potential Inventory, CAPI [28]; CARE-Index [29]). If the included study has more than two parts, we will compare each intervention with the usual care.
(S) Peer-review articles written in English will be included. We will only include RCTs. The publication period will not be limited.

Study selection

In stage 1, two authors (HT and MS) will independently screen the titles and abstracts of all candidate studies and exclude those not applicable. Then, disagreements will be resolved by two authors, and a final list will be agreed upon. If agreement is not obtained, a third senior author (KT or YT) will arbitrate. If there is still disagreement, the article will go to the second stage. In stage 2, two authors (HT and MS) will independently evaluate for eligibility of the full-text versions of articles that have passed stage 1. Two authors (HT and MS) will resolve discrepancies by consensus, and if it is necessary, a third senior author (KT or YT) will perform the role of arbitrator.

Data extraction

HT and MS will independently pull the following related information from selected studies: author, year, publication language, location (country), intervention period (prenatal/postnatal/both), screening period for at-risk, type of risk, sample size (intervention and control), intervention program, setting (home or center), focus (support or packaged program), delivery (individual or group), occupation type of person delivering the intervention, duration of follow-up, frequency of sessions, comparison program, evaluation period, measurement tools, study results, and funding sources. The senior reviewers (KT and YT) will reconcile any disagreements.

Quality assessment and risk of bias

Two review authors (HT and MS) will independently check the risk of bias in each study that is included; a third review author (KT or YT) will resolve discrepancies by negotiation. We will use the revised Cochrane risk-of-bias tool for randomized trials to check the risk of bias in each study [25]. The tool includes the following domains: randomization process, deviations from the intended interventions, missing outcome data, measurement of the outcome, selection of the reported result, and overall risk of bias. The assessment process will involve extracting the appropriate information from each study (e.g., a detailed description of the method used for the randomization process) and evaluating the risk of bias in that area (e.g., adequate randomization process). We will determine risk of bias for each item as low, high, or of some concern while including a supporting description from the study report along with the reasoning for our judgment in a risk-of-bias table.

Statistical analysis

We plan to provide a narrative synthesis of the characteristics and findings from the included studies using text and tables. The synthesis will be based on intervention type and will describe the characteristics of each of the included studies and supply information about the effective measures for relevant outcomes and study quality.

A meta-analysis can be conducted depending on the availability of data and the degree of heterogeneity of each study. If there are studies with the same types of intervention and outcome measurement, we will conduct a random-effect meta-analysis and present a forest plot generated using the Review Manager 5.4. software.

Sub-group analyses will be considered based on the characteristics of the participants (e.g., age and socio-economic status, type of intervention (e.g., duration), timing of the intervention (during pregnancy and/or postpartum), and assessment points. A sensitivity analysis will be conducted to assess the effect of studies with a high risk of bias.

Reporting bias assessment

If there are 10 or more studies in the meta-analysis, we will examine reporting biases with funnel plots and visually consider any funnel plot asymmetry.

Certainty assessment

We will evaluate the quality of the evidence across studies by using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Each result’s quality of evidence will be evaluated by using the study’s limitation, imprecision, indirectness, inconsistency, and publication bias [31].

This study will systematically review and analyze evidence on the effectiveness of interventions to prevent child abuse and neglect among pregnant and postpartum women. The strength of this study is that it will investigate a broader range of electronic bibliographic databases, including MEDLINE, PsycINFO, Embase, and CENTRAL, using a systematic search strategy. The study will be based on the latest articles, and the publication period will not be limited.

Because child abuse and neglect have severe outcomes, the findings of this study may be helpful for the prevention of child abuse and neglect in clinical and political settings. That is, the results will provide a basis for the development of evidence-based intervention programs and child abuse prevention policies. Moreover, this study will encourage future studies with more evidence-based intervention programs and illuminate the direction of research on the prevention of child abuse and neglect.

However, the planned systematic review and meta-analysis has several limitations. We will only include peer-review articles written in English; therefore, there may be a publication bias that excludes related research published in other languages and gray literature. Another limitation will be that we only access limited databases. Additionally, using different methods to assess child abuse and neglect may cause heterogeneity among studies.

PROSPERO: Prospective Register of Systematic Reviews

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

PRISMA-P: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols

PICOS: Participants, Interventions, Comparisons, Outcomes, and Study criteria

CPS: Child Protective Services

PSI: Parenting Stress Index

CTS-PC: Conflict Tactics Scales: Parent-Child Version

AAPI (-2): Adult Adolescent Parenting Inventory – version 2

CAPI: Child Abuse Potential Inventory

GRADE: Grading of Recommendations, Assessment, Development, and Evaluation

Ethics approval and consent to participate: Not applicable

Consent for publication: Not applicable

Availability of data and materials: Not applicable

Competing interests: The authors declare that they have no competing interests.

Funding: This study is supported by the Health and Labor Science Research Grant on Children, Youth, and Families (20DA1009) provided by the Japanese Ministry of Health, Labour, and Welfare.

Authors’ contributions: HT, MS, KO, KT, and YT designed the study. HT wrote the first draft of the manuscript, and all other authors revised the manuscript critically. KO executed the search strategies. All authors approved the final version of the manuscript.

Acknowledgments: Not applicable

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Additionalfile1TAMON.docx
Additional file 1: PRISMA-P 2015 Checklist.
Additionalfile2TAMON.docx
Additional file 2: MEDLINE search strategy.

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Journal Publication

published 20 Nov, 2022

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Interventions for Expectant and New Parents Designed to Prevent Child Abuse and Neglect in at-risk Families: Protocol for a Systematic Review and Meta-analysis

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