Preventive measures and identifying families at risk
Family situations change over time and GPs are often aware of these changes and the potential stress that it places on families. Because of this awareness, GPs are well placed to monitor families for a potential situation that may give rise to child abuse. These situations may include family break up, work stress, additions to the family, or moving location.
However, children in families where there is parental substance abuse, mental illness and/or domestic violence are at greater risk of child abuse.132 As the highest incidence of abuse and neglect happens in the first year of life, families with infants and toddlers may require specific attention and support.120 Children in the first 4 years of life are particularly vulnerable to the impact of child abuse on brain development.133
Other established risk factors for child abuse include:
- inadequate parenting, including the failure of any infant–parent attachment
- unrealistic expectations of child development
- a belief in the effectiveness and social acceptability of harsh physical punishment
- an inability to provide for high-quality childcare when the parent is absent.
Conversely, various strategies that promote early and secure infant–parent attachment and non-violent modes of discipline, and create the conditions within the family for the positive mental health development of the child, have been proved effective in preventing child abuse.
The evidence that programs focusing on parenting improvement and support are effective in preventing child abuse is strong. The two most widely evaluated and widely applied models for delivering these strategies are training in parenting programs and home visitation programs.122
The Triple-P program of training in parenting, as developed by the University of Queensland, is one example).123 A number of independent outcome evaluations of Triple-P have shown it to be effective in improving family management techniques, parental confidence in effective child rearing, and behavioural outcomes, including health behaviour and aggression.123 Resources for parents can be found on the familiesNSW website.
A meta-analysis of 40 family support prevention programs for those with children at risk of physical abuse and/or neglect returned similar positive, yet modest results.134 This analysis suggested reduction in manifestation of abuse, along with an increase of positive risk reducing behaviours such as parent–child interaction.
The Cochrane Report exploring school-based programs to prevent child sexual abuse (teaching school children about child sexual abuse and how to protect themselves) found some enhancement of children’s knowledge of abuse and their protective behaviours.135 The applicability of these studies to the Australian context needs further investigation – most of the studies were conducted in North America, there was no long-term follow-up, and several studies reported harm such as increased anxiety.
Refer to the adults surviving child abuse (ASCA) factsheet for GPs in the Further information section at the end of this chapter. It is useful to identify local services and have their details on hand to refer patients – in particular, parenting and home visit programs in your local area. It is also beneficial to work collaboratively with the local maternal and child health nurse.