MacMillan Harriet L, Thomas B Helen, Jamieson Ellen, Walsh Christine A, Boyle Michael H, Shannon Harry S, Gafni Amiram
Department of Psychiatry and Behavioural Neurosciences, McMaster University, ON, Canada.
Lancet. 2005;365(9473):1786-93. doi: 10.1016/S0140-6736(05)66388-X.
Recurrence of child maltreatment is a major problem, yet little is known about approaches to reduce this risk in families referred to child protection agencies. Since home visitation by nurses for disadvantaged first-time mothers has proven effective in prevention of child abuse and neglect, we aimed to investigate whether this approach might reduce recidivism.
We enrolled in a randomised controlled trial 163 families with a history of one index child being exposed to physical abuse or neglect to compare standard treatment with a programme of home visitation by nurses in addition to standard treatment. The main outcome was recurrence of child physical abuse and neglect based on a standardised review of child protection records. Analysis was by intention to treat.
At 3-years' follow-up, records were available for 160 of 163 (98%) families randomised. 139 (85%) completed follow-up. Recurrence of child physical abuse (31 [43%] in the control group vs 29 [33%] in the intervention group) and neglect (37 [51%] vs 41 [47%]) did not differ between groups. However, hospital records showed significantly higher recurrence of either physical abuse or neglect in the intervention group than in the control group (21 [24%] vs 8 [11%]). There were no differences between groups for the other secondary outcome measures.
Despite the positive results of home visitation by nurses as an early prevention strategy, this visit-based strategy does not seem to be effective in prevention of recidivism of physical abuse and neglect in families associated with the child protection system. Much more effort needs to be directed towards prevention before a pattern of abuse or neglect is established in a family.
儿童虐待的复发是一个主要问题，但对于降低转介至儿童保护机构的家庭中这种风险的方法，我们知之甚少。由于护士对弱势初产妇进行家访已被证明在预防儿童虐待和忽视方面有效，我们旨在研究这种方法是否可以减少再犯情况。
我们纳入了163个有一名指标儿童曾遭受身体虐待或忽视史的家庭，进行一项随机对照试验，以比较标准治疗与除标准治疗外增加护士家访计划的效果。主要结局是基于对儿童保护记录的标准化审查得出的儿童身体虐待和忽视的复发情况。分析采用意向性分析。
在3年随访时，163个随机分组家庭中有160个（98%）家庭有记录可查。139个（85%）完成了随访。儿童身体虐待的复发情况（对照组31例[43%]，干预组29例[33%]）和忽视的复发情况（对照组37例[51%]，干预组41例[47%]）在两组间无差异。然而，医院记录显示干预组身体虐待或忽视的复发率显著高于对照组（21例[24%]对8例[11%]）。其他次要结局指标在两组间无差异。
尽管护士家访作为一种早期预防策略取得了积极成果，但这种基于家访的策略似乎对预防与儿童保护系统相关家庭中身体虐待和忽视的再犯无效。在家庭中建立虐待或忽视模式之前，需要付出更多努力进行预防。
