Draft Research Plan
Prevention of Child Maltreatment: Primary Care Interventions
February 17, 2022
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
- For children without obvious signs and symptoms of abuse or neglect, do primary care–feasible or referable preventive interventions reduce exposure to abuse or neglect; improve behavioral, emotional, physical, or mental well-being; or reduce mortality? Does the effectiveness of interventions differ by populations of interest (e.g., defined by child or caregiver characteristics such as age, sex, gender identity, race and ethnicity, sociodemographic characteristics, or special needs)?
- What are the harms from interventions intended to prevent child maltreatment? Do the harms of interventions differ by populations of interest (e.g., defined by child or caregiver characteristics such as age, sex, gender identity, race and ethnicity, sociodemographic characteristics, or special needs)?
Contextual Questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What are current practices for a) identifying children at risk of maltreatment, b) referring children or families to prevention programs, c) reporting children or families to Child Protective Services, and d) diagnosing child maltreatment outcomes? Do current practices in identification, referral, reporting, and diagnosis of outcomes of child maltreatment differ by race or ethnicity of the child or caregiver? If evidence exists of practice differences, what factors might explain these differences?
- What are the validity and reliability of risk assessment tools to identify children and adolescents who are at risk of child maltreatment? Does the reported validity and reliability (of risk assessment tools) differ by race and ethnicity? If yes, what might explain these differences? Is there evidence that these tools alter or increase inequity?
The Proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the Key Questions.
|Population||Children or adolescents (younger than age 18 years) with no known exposure to maltreatment and no specific signs or symptoms of current or past maltreatment||Symptomatic children and adolescents undergoing diagnostic evaluations for conditions related to abuse or neglect (e.g., those presenting with a broken bone or other signs of physical abuse or neglect, or trauma symptoms associated with domestic violence exposure), children with known exposure to child maltreatment and perpetrators of maltreatment, and children of caregivers who perpetrated maltreatment toward them|
|Interventions||Primary care–based programs or services; services that could result from a referral by a primary care provider
Services may include home visiting programs, respite care, parent education programs, and family support and family strengthening programs
Services may be implemented by nonclinicians(Interventions may be directed at the caregiver and may or may not include components directed at the child)
|Communitywide interventions such as public awareness campaigns or public service announcements only, without specific interventions linked to clinical settings|
|Comparisons||Usual care, delayed intervention, active interventions that allow for the assessment of the independent contribution of primary care–relevant preventive intervention (e.g., clinical interventions + media campaigns vs. media campaigns)||Comparators that do not allow for the assessment of the independent contribution of the effect of primary care–feasible or referable preventive interventions (e.g., clinical interventions + media campaigns vs. usual care)|
|Outcomes||KQ 1: Direct or proxy measures of abuse or neglect (required):
Behavioral, emotional, mental, or physical well-being*:
KQ 2: Any harms that result as an effect of interventions (e.g., stigma, labeling, legal risks, risks of further harm to the child, or dissolution of families), or worsening of outcomes listed for KQ 1
|KQ 1: Outcomes not otherwise specified, studies without direct or proxy measures of abuse of neglect, and parent-reported measures of exposure to abuse or neglect
KQ 2: None specified
|Clinical settings||Pediatrics, primary care, family medicine, school-based clinic, or other settings where primary care services are offered; services that could result from an assessment by a clinician (including delivery hospitals, in-home settings, and nonspecialist settings)||Not a primary care–feasible or referable setting, populations or services/interventions not applicable to U.S. practice|
|Geographic setting||Research conducted in the United States or in populations similar to U.S. populations, with services and interventions applicable to U.S. practice (countries categorized as “very high” on the United Nations Human Development Index, as defined by the United Nations Development Programme)||Research not relevant to the United States in countries categorized as less than “very high” on the Human Development Index|
|Study designs||KQ 1: RCTs
KQ 2: RCTs, controlled clinical trials, systematic reviews; cohorts with controls, and case-control studies
Systematic reviews will be hand searched for additional eligible studies
|KQ 1: Systematic reviews, nonrandomized cohort trials, case-control, case series, and case studies
KQ 2: Systematic reviews, case series and case studies
|Timing||Any timing||No exclusion based on timing|
|Languages||Full text published in English||Non-English language|
|Publication type||Original research and systematic reviews||Editorials, commentaries, and narrative reviews|
Abbreviations: KQ=key question; RCT=randomized, controlled trial.