A Bulletin for 

professionals

U.S. Department of Health and Human Services

Administration for Children and Families

Administration on Children, Youth and Families

Children’s Bureau

Child Welfare Information Gateway

Children’s Bureau/ACYF

1250 Maryland Avenue, SW

Eighth Floor

Washington, DC 20024

703.385.7565 or 800.394.3366

Email: info@childwelfare.gov

www.childwelfare.gov

What Do We 

Know About the 

Effectiveness of 

Prevention?

This bulletin is an excerpt from Emerging 

Practices in the Prevention of Child Abuse 

and Neglect (2003), U.S. Department of 

Health and Human Services, Administration 

for Children and Families, Administration 

on Children, Youth and Families, Children’s 

Bureau, Office on Child Abuse and Neglect. 

The findings and conclusions presented in 

this bulletin do not necessarily represent the 

official positions or policies of the Children’s 

Bureau’s Office on Child Abuse and Neglect.

July 2003

What’s Inside:

Introduction

Home Visitation Programs

Parent Education

School-Based Programs for 

Prevention of Child Sexual Abuse

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 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

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Introduction

There are three principal areas where research 

on maltreatment prevention has historically 

been most concentrated: home visitation 

programs, parent education programs, and 

school-based programs for the prevention 

of child sexual abuse. The following sections 

summarize what is known about prevention 

from research and evaluation in these areas.

Home Visitation 

Programs

Research on the impact of home visitation 

programs is one area in which there is a relative abundance of evidence, and that evidence, while not universally positive across 

all evaluations, suggests that home visiting 

can be an effective approach. David Olds, at 

the University of Colorado Health Sciences 

Center, has pioneered high quality, experimental research in the area of home visitation. Through the course of several replications and long-term follow-up studies over a 

period of 20 years, Dr. Olds has found positive, short-term and long-term outcomes for 

young, first-time mothers and their children 

in several areas, including decreased rates of 

child maltreatment, juvenile delinquency, and 

maternal criminality; increased economic self 

sufficiency; and increased social-emotional 

development (Olds et al., 1997).

The 1999 Future of Children report on home 

visiting programs also noted that despite 

some positive findings, many of the programs 

still struggled in numerous areas. Challenges 

were raised concerning enrolling, engaging, 

and retaining families. Similar issues were 

raised about the use of paraprofessionals 

versus nurses, staff retention, and the training needed by home visitors. When program 

benefits were demonstrated, this often only 

impacted a subset of families, and benefits 

were rarely seen for all program goals. The 

following are findings on home visitation from 

other recent work:

An evaluation of Family TIES, a program of 

services for first-time teen mothers during 

pregnancy, found that teen mothers who 

received weekly home visits made significantly higher gains in creating a safe and 

healthy home environment compared with 

participants who received traditional family 

support services at a health center. The 

program had no significant effect on the 

childbearing philosophies or psychological 

well-being of participating mothers (Luster 

et al., 1996).

An evaluation of the Healthy Start program, 

part of the Hampton Family Resource 

Project that provides home-based, parent 

education and support services to high-risk 

mothers, found several positive outcomes 

for families, including reductions in pregnancy risk status, birth complications, and 

subsequent pregnancies, and increases 

in childhood immunization rates and the 

number of adequate/safer home environments. The study also reported a reduced 

number of confirmed reports of child abuse 

and neglect (Galano & Huntington, 1996).

An evaluation of STEEP (Steps Toward 

Effective, Enjoyable Parenting), an intensive 

intervention program of home visits and 

group sessions for high-risk women and 

their first-born children, found that com-

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pared to a control group, program participants demonstrated better understanding 

of child development, better life management skills, fewer depressive symptoms, 

and more organized and appropriately 

stimulating home-environments. The STEEP 

program also served as a buffer against 

stress, enabling parents to remain more 

sensitive to their children’s needs even 

in the face of stressful life circumstances 

(Egeland & Erickson, 1993; Erickson & 

Egeland, 1999).

Leventhal suggests nine factors that are necessary for successful home-based services. They 

include: early intervention, intensive services 

over a sustained period, development of a 

therapeutic relationship between the home 

visitor and parent, careful observation of the 

home situation, focus on parenting skills, childcentered services focusing on the needs of the 

child, provision of “concrete” services (e.g., 

shelter, health care), inclusion of fathers in services, and ongoing review of family needs to 

determine frequency and intensity of services 

(Leventhal, 1997).

Parent Education

Some research also has concentrated on the 

impact of programs that provide education for 

parents that can reduce risks to children. The 

record is neither rich nor, on the whole, particularly compelling. However, a few studies have 

demonstrated positive findings. Many of the 

existing studies in this area rely on outcomes 

that do not include actual child maltreatment reports, but focus on short-term gains 

in knowledge, skills, or abilities. Thus, taken 

as a whole, little is known about the impact of 

these programs on child maltreatment in the 

long term.

From the late 1980s to the early 1990s, the 

William Penn Foundation funded 14 child 

abuse prevention demonstration programs in 

Philadelphia and surrounding suburban areas, 

and sponsored one of the most comprehensive evaluations of parent education services in 

the early 1990s. The National Committee for 

Prevention of Child Abuse conducted the evaluation of this initiative, integrating outcomes 

from all 14 programs. Data were gathered from 

1,078 parents who received services between 

March 1990 and July 1991 across the 14 sites.

Researchers found that parents’ potential for 

physical child abuse decreased significantly 

as measured by the Child Abuse Potential 

Inventory (CAP). Participants exhibiting the 

highest risk at pretest (i.e., the highest CAP 

scores) showed the greatest gains at post-test 

(i.e., the greatest decrease in CAP scores). 

Total CAP scores, as well as three subscales 

(distress, rigidity, and unhappiness), decreased 

significantly. In addition to an observed reduction in child abuse potential, there were 

observed reductions in the use of corporal 

punishment and inadequate supervision of 

their children, while participants demonstrated 

greater responsiveness to the emotional 

needs of their children (National Committee 

for Prevention of Child Abuse, 1992).

More recent evaluations of programs also have 

focused on families considered to be at risk 

for child maltreatment. The Bavolek Nurturing 

Program is a parenting education program 

that specifically focuses on four parenting 

constructs, including inappropriate parental 

expectations, lack of empathy toward the child, 

belief in corporal punishment, and parent-child 

role reversal. A secondary analysis using a con-
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venience sample of at-risk rural families found 

significant improvements from pre- to post-test 

in each of these four areas, as measured by 

the Adult-Adolescent Parenting Inventory, with 

the post-test results consistent with nurturing 

parenting attitudes. While the results of the 

study were positive, the researchers acknowledge critical limitations, including the lack of a 

control group (Cowen, 2001).

Another such program offered 12-week parent 

education services to teen mothers in an 

effort to promote healthy, nurturing families. 

In an analysis of mothers participating in this 

program, researchers found positive, though 

not statistically significant, increases in knowledge of child development and attitudes 

toward parenting and discipline (Britner & 

Reppucci, 1997). Furthermore, families who 

participated in the parent education program 

had significantly fewer substantiated reports of 

child maltreatment than families who did not 

participate in the program.

An earlier study focused on a group of highrisk mothers receiving services through an 

intensive parent education program administered by the National Institute of Mental 

Health. Mothers with at least one child and 

who were considered very high risk for child 

maltreatment were recruited for the program 

during pregnancy (prior to 26 weeks gestation). The intensive program offered concrete 

services (e.g., assistance with transportation, 

assistance returning to school, arranging care 

for children, reducing bad habits such as 

smoking and overeating, and financial management), as well as abstract services (e.g., 

assisting the participant in better understanding others and themselves, and providing 

someone with whom to talk).

Following participation in the study, mothers 

reported high rates of satisfaction with the 

program and improvements in their parenting 

and life skills (Pharis & Levin, 1991). Both staff 

and participants reported that positive growth 

had occurred in 13 areas of the mothers’ lives 

between onset of pregnancy (or entry into the 

program) and the interview (conducted at least 

one year after the intervention had begun).

 School-Based Programs 

for Prevention of Child 

Sexual Abuse

Programs for children and parents that are 

designed to raise awareness about child 

sexual abuse is another area where there has 

been a recent and relatively concentrated 

research focus. Available research suggests 

that such programs can be successful at 

imparting information, but there is little evidence to conclude that these programs actually prevent child sexual abuse. A recent study 

published in 2000 utilized meta-analysis techniques to evaluate existing school-based, child 

sexual abuse prevention programs. Based on 

27 control group studies, the study reported 

that children who participated in prevention 

programs performed significantly higher than 

control group children on outcome measures 

used in the studies, indicating improvements 

in knowledge and skills concerning sexual 

abuse. In the process of developing the 

sample of studies to include in the analysis, 

the researchers indicated that they identified 

no studies that had analyzed the effect of 

prevention programs on actual rates of abuse 

(Davis & Gidycz, 2000).
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 This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare 

Information Gateway. Available online at www.childwelfare.gov/preventing/programs/whatworks/effective.cfm.

Few studies have attempted to establish a 

relationship between acquisition of knowledge 

about child sexual abuse and subsequent 

behavior change in children. In perhaps the 

only study of its kind, Finkelhor et al. conducted a national telephone survey of 2,000 

children ages 10-16. The researchers found 

that children who had participated in schoolbased sexual abuse prevention programs not 

only demonstrated greater knowledge about 

sexual abuse, but also reported that these 

children were more likely to exhibit protective behaviors and utilize protective strategies 

when threatened or victimized (Finkelhor & 

Dzuiba-Leatherman, 1995).

In a follow-up study conducted the next year, 

during which a considerable proportion of the 

original 2,000-child sample was recontacted, 

the researchers again found that children who 

had participated in school-based sexual abuse 

prevention programs were more likely to use 

protective strategies (e.g., yelling, running, 

telling an authority). However, there was no 

evidence that these children, when threatened 

with abuse, were any more likely to stop the 

victimization than children who had not participated in school-based sexual abuse prevention programs (Finkelhor, Asdigian, & DzuibaLeatherman, 1995).

Since then, two recent studies have explored 

the correlation between knowledge gains and 

behavior change, and actual victimization. 

In an important recent study of 825 female 

undergraduates, for example, researchers 

found that young women who had not participated in a school-based prevention program 

were nearly twice as likely to have experienced child sexual abuse as young women 

who had participated in a program (Gibson 

& Leitenberg, 2000). Also within the last few 

years, results of a survey of high school students found that students who had participated in a general abuse prevention program 

were significantly less likely to have reported 

an incident of physical abuse. There appeared 

to be no difference between the two groups 

of students in terms of the incidence of sexual 

abuse (Ko & Cosden, 2001). Both of these 

studies, however, utilized small, local samples 

and relied considerably on self-report data 

of past experiences. Thus, there are important concerns with the generalizability of the 

results, as well as the vulnerability of the data 

to the hazards of memory.

The full report on the Emerging Practices

project, Emerging Practices in the 

Prevention of Child Abuse and Neglect, 

can be found on the Child Welfare 

Information Gateway website:

HTML: www.childwelfare.gov/preventing/

programs/whatworks/report

PDF: www.childwelfare.gov/preventing/

programs/whatworks/report.pdf

A print copy of the report can be ordered 

by contacting Information Gateway at 

800.394.3366, 703.385.3206 (fax), 

info@childwelfare.gov (email). 

The full report on the Emerging Practices

project, Emerging Practices in the 

Prevention of Child Abuse and Neglect, 

can be found on the Child Welfare 

Information Gateway website:

HTML: www.childwelfare.gov/preventing/

programs/whatworks/report

PDF: www.childwelfare.gov/preventing/

programs/whatworks/report.pdf

A print copy of the report can be ordered 

by contacting Information Gateway at 

800.394.3366, 703.385.3206 (fax), 

info@childwelfare.gov (email).