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

800.394.3366

Email: info@childwelfare.gov

www.childwelfare.gov

ISSUE BRIEF

July 2011

Child Maltreatment 

Prevention: Past, 

Present, and Future

This issue brief was developed by 

Child Welfare Information Gateway, in 

partnership with Deborah Daro, Ph.D. 

This document is made possible by 

the Children’s Bureau, Administration 

on Children, Youth and Families, 

Administration for Children and 

Families, U.S. Department of Health 

and Human Services.

The conclusions discussed here are 

solely the responsibility of the authors 

and do not represent official Children’s 

Bureau views or policies.

What’s Inside

• Scope of the problem

• History of child abuse prevention

• Prevention today

• Identifying and implementing 

quality programs

• Promising prevention strategies

• Looking toward the future

• Conclusion

• References
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Introduction 

Child abuse prevention efforts have grown 

exponentially over the past 30 years. Some 

of this expansion reflects new public policies 

and expanded formal services such as parent 

education classes, support groups, home 

visitation programs, and safety education for 

children. In other cases, individuals working on 

their own and in partnerships with others have 

found ways to strengthen local institutions and 

create a climate in which parents support each 

other. 

This issue brief underscores the importance 

of prevention as a critical component of the 

nation’s child protection system. It outlines 

programs and strategies that are proving 

beneficial in reducing the likelihood of child 

maltreatment. Looking ahead, the brief 

identifies key issues facing high-quality 

prevention programs as they seek to extend 

their reach and impacts. 

Scope of the Problem

Recent research documenting the number 

of child maltreatment cases observed 

by professionals working with children 

and families across the country suggests 

prevention efforts are having an impact. 

For example, the Fourth Federal National 

Incidence Study on Child Maltreatment 

(Sedlak et al., 2010) reported a 19-percent 

reduction in the rate of child maltreatment 

as reported in a similar survey conducted in 

1993. Substantial and significant drops in 

the rates of sexual abuse, physical abuse, 

and emotional abuse observed by survey 

respondents occurred between 1993 and 

2006. Although no significant declines were 

observed in cases of child neglect, the NIS 

data mirror a similar drop in the number of 

physical and sexual abuse cases reported in 

recent years to local child welfare agencies 

(U.S. Department of Health and Human 

Services, 2010). Between 1990 and 2009, the 

number of substantiated cases of physical 

abuse dropped 55 percent, and the number of 

substantiated sexual abuse cases declined 61 

percent (Finkelhor, Jones, & Shattuck, 2011). 

Despite these promising trends, child 

maltreatment remains a substantial threat to a 

child’s well-being and healthy development. 

In 2009, over 3 million children were reported 

as potential victims of maltreatment. The risk 

for harm is particularly high for children living 

in the most disadvantaged communities, 

including those living in extreme poverty or 

those living with caretakers who are unable 

or unwilling to care for them due to chronic 

problems of substance abuse, mental health 

disorders, or domestic violence. In 2009, an 

estimated 1,770 children—or over 4.8 children 

a day—were identified as fatal victims of 

maltreatment. As in the past, the majority 

of these children—over 80 percent—were 

under the age of four (U.S. Department of 

Health and Human Services, 2010). While 

child maltreatment is neither inevitable nor 

intractable, protecting children remains 

challenging. 

History of Child 

Abuse Prevention

Modern public and political attention to the 

issue of child maltreatment is often pegged 

to Henry Kempe’s 1962 article in the Journal 
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of the American Medical Association on the 

“battered child syndrome” (Kempe, Silverman, 

Steele, Droegemueller, & Silver, 1962). In 

contrast to those early pioneers who had used 

clinical case studies to explain maltreatment 

patterns, Kempe and his colleagues examined 

hospital emergency room X-rays for 1 year 

from 70 hospitals around the country and 

surveyed 77 district attorneys. These efforts 

painted a vivid and disturbing picture of 

children suffering physical and emotional 

trauma as a result of overburdened parents 

or caretakers using extreme forms of corporal 

punishment or depressed single mothers 

failing to provide for their children’s basic 

emotional and physical needs. 

Armed with these descriptions, Kempe 

persuaded Federal and State policymakers to 

support the adoption of a formal child abuse 

reporting system. Between 1963 and 1967, 

all States and the District of Columbia passed 

child abuse reporting laws. Federal reporting 

guidelines were established in 1974 with the 

authorization of the first Federal Child Abuse 

and Neglect Prevention and Treatment Act. 

The 1980s represented a period of 

significant expansion in public awareness 

of child maltreatment, research on its 

underlying causes and consequences, and 

the development and dissemination of 

both clinical interventions and prevention 

strategies. As more became known of the 

diversity within the maltreatment population, 

unique subpopulations were singled out for 

specific programmatic options and legislative 

attention (Daro, 1988). On the prevention 

front, two distinct programmatic paths 

emerged (Daro, 1988): 

• Interventions targeting reductions in 

physical abuse and neglect (including 

emotional neglect and attachment 

disorders), including:

o Services to new parents

o General parenting education classes

o Parent support groups

o Family resource centers

o Crisis intervention services such as 

hotlines and crisis nurseries (Cohn, 1983)

• Interventions targeting reductions in child 

sexual abuse, including: 

o Universal efforts designed to teach 

children the distinction between good, 

bad, and questionable touching; the 

concept of body ownership; or the rights 

of children to control who touches their 

bodies and where they are touched 

(Wurtele & Miller-Perrin, 1992) 

o Educational programs that encouraged 

children and youth who had been 

victimized to report these incidences and 

seek services 

The effectiveness of general parent education 

and support programs during this time was 

generally limited to parents able to access 

these options. Prevention efforts were far less 

successful in attracting and retaining families 

who did not know they needed assistance or, 

if they recognized their shortcomings, did not 

know how to access help (Daro, 1993). 

By the 1990s, emphasis was placed on 

establishing a strong foundation of support 

for every parent and child, available when a 

child is born or a woman is pregnant. And the 

way to reach new parents centered on homebased interventions (U.S. Advisory Board, 

1991). The seminal work of David Olds and 

his colleagues showing initial and long-term 
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benefits from regular nurse visiting during 

pregnancy and a child’s first 2 years of life 

provided the most robust evidence for this 

intervention (Olds, Sadler, & Kitzman, 2007). 

Equally important, however, were the growing 

number of home visitation models being 

developed and successfully implemented 

within the public and community-based 

service sectors. Although less rigorous in their 

evaluation methodologies, these models 

demonstrated respectable gains in parentchild attachment, access to preventive medical 

care, parental capacity and functioning, and 

early identification of developmental delays 

(Daro, 2000). 

Prevention Today

After implementing home visitation programs 

for over a decade, the prevention field is 

facing an important challenge. Recent Federal 

legislation included in the Patient Protection 

and Affordable Care Act of 2009 will provide 

States $1.5 billion over the next 5 years to 

expand the provision of evidence-based 

home visitation programs to at-risk pregnant 

women and newborns. While research justifies 

an expansion of several high-quality national 

home visitation models, it also indicates that 

not all families are equally well-served by this 

approach; retention in long-term interventions 

can be difficult; and identifying, training, 

and retaining competent service providers 

is challenging. Even intensive interventions 

cannot fully address the needs of the most 

challenged populations—those struggling 

with serious mental illness, domestic violence, 

and substance abuse, as well as those 

rearing children in violence and chaotic 

neighborhoods. 

Faced with the inevitable limitations of any 

individual program model, increased emphasis 

is being placed on approaches that seek 

change at a community or systems level (Daro 

& Dodge, 2009). The current prevention 

challenge is not simply expanding formal 

services but rather creating an institutional 

infrastructure that supports high-quality, 

evidence-based direct services. In addition, 

prevention efforts have embraced a more 

explicit effort to both reduce risks and 

enhance key protective factors, fostering 

strong partnerships with other local programs 

serving young children. Among the most 

salient investments in promoting protective 

factors are efforts to strengthen parental 

capacity and resilience, support a child’s social 

and emotional development, and create more 

supportive relationships among community 

residents (Center for the Study of Social Policy, 

2004). Communities where residents believe 

in collective responsibility for keeping children 

safe may achieve progress in reducing child 

abuse and strengthening child well-being. 

Identifying and Implementing 

Quality Programs 

All prevention services need to embrace a 

commitment to a set of practice principles 

that have been found effective across diverse 

disciplines and service delivery systems. A 

suggested list of best practice standards 

appears on the following page. As a group, 

these items represent best practice elements 

that lie at the core of effective interventions. 

To the extent that direct service providers and 

prevention policy advocates hope to maximize 

the return on their investments, supporting 
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service strategies that embrace the following 

principles will be essential:

• A strong theory of change that identifies 

specific outcomes and clear pathways for 

addressing these core outcomes, including 

specific strategies and curriculum content

• A recommended duration and dosage 

or clear guidelines for determining when 

to discontinue or extend services that is 

systematically applied to all those enrolled 

in services

• A clear, well-defined target population with 

identified eligibility criteria and strategy 

for reaching and engaging this target 

population

• A strategy for guiding staff in balancing 

the task of delivering program content 

while being responsive to a family’s cultural 

beliefs and immediate circumstances

• A method to train staff on delivering the 

model with a supervisory system to support 

direct service staff and guide their ongoing 

practice

• Reasonable caseloads that are maintained 

and allow direct service staff to accomplish 

core program objectives

• The systematic collection of information 

on participant characteristics, staff 

characteristics, and participant service 

experiences to ensure services are being 

implemented with fidelity to the model, 

program intent, and structure

Several researchers suggest that the more 

universal or broadly targeted prevention 

efforts have greater success in strengthening 

a parent’s or child’s protective factors than in 

eliminating risk factors, particularly for parents 

or children at highest risk (Harrell, Cavanagh, 

& Sridharan, 1999; Chaffin, Bonner, & Hill, 

2001; MacLeod & Nelson, 2000). Others 

argue that prevention strategies are most 

effective when they focus on a clearly defined 

target population with identifiable risk factors 

(Guterman, 2001; Olds et al., 2007). In truth, 

a wide range of prevention strategies has 

demonstrated an ability to reduce child abuse 

and neglect reports as well as other child 

safety outcomes such as reported injuries and 

accidents. In other cases, prevention efforts 

have strengthened key protective factors 

associated with a reduced incidence of child 

maltreatment such as improved parental 

resilience; stronger social connections; positive 

child development; better access to concrete 

supports such as housing, transportation, and 

nutrition; and improved parenting skills and 

knowledge of child development (Horton, 

2003). 

Promising Prevention Strategies
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Strengthening Families and Communities: 

2011 Resource Guide supports service 

providers in their work with parents, 

caregivers, and their children to strengthen 

families and prevent child abuse and 

neglect. It focuses on the five protective 

factors and provides tools and strategies 

to integrate the factors into existing 

programs and systems. It was developed 

by the U.S. Department of Health and 

Human Services, Children’s Bureau, 

Office on Child Abuse and Neglect, 

its Child Welfare Information Gateway, 

the FRIENDS National Resource Center 

for Community-Based Child Abuse 

Prevention, and the Center for the Study 

of Social Policy, with input from numerous 

national organizations, Federal partners, 

and parents. 

www.childwelfare.gov/preventing/

preventionmonth/guide2011

Public Awareness Efforts: In the years 

immediately following Kempe’s 1962 article 

on battered child syndrome, public awareness 

campaigns were developed to raise awareness 

about child abuse and to generate political 

support for legislation to address the problem. 

Notably, the nonprofit organization Prevent 

Child Abuse America (PCA America; formerly, 

the National Committee to Prevent Child 

Abuse) joined forces with the Ad Council to 

develop and distribute nationwide a series 

of public service announcements (PSAs) for 

television, radio, print, and billboards. 

Between 1975 and 1985, repeated public 

opinion polls documented a sharp increase 

in public recognition of child abuse as an 

important social problem and steady declines 

in the use of corporal punishment and verbal 

forms of aggression in disciplining children 

(Daro & Gelles, 1992). More recently, broadly 

targeted prevention campaigns have been 

used to alter parental behavior. For example, 

the U.S. Public Health Service, in partnership 

with the American Academy of Pediatrics 

(AAP) and the Association of SIDS and Infant 

Mortality Programs, launched its “Back to 

Sleep” campaign in 1994 designed to educate 

parents and caretakers about the importance 

of placing infants on their backs to sleep as a 

strategy to reduce the rate of sudden infant 

death syndrome (SIDS). Notable gains also 

have been achieved with universal education 

programs to prevent shaken baby syndrome 

(Dias, Smith, deGuehery, Mazur, & Shaffer, 

2005; Barr et al., 2009).

Child Sexual Assault Prevention Classes:

In contrast to efforts designed to alter 

the behavior of adults who might commit 

maltreatment, a category of prevention 

programs emerged in the 1980s designed 

to alter the behavior of potential victims. 

Often referred to as child assault prevention 

or safety education programs, these efforts 

present children with information on the topic 

of physical abuse and sexual assault, how to 

avoid risky situations, and, if abused, how to 

respond. A key feature of these programs is 

their universal service delivery systems, often 

being integrated into school curricula or into 

primary support opportunities for children 

(e.g., Boy Scouts, youth groups, recreation 

programs). Although certain concerns have 

been raised regarding the appropriateness of 

these efforts (Reppucci & Haugaard, 1989), the 

strategy continues to be widely available. 

Parent Education and Support Groups:

Educational and support services delivered 
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to parents through center-based programs 

and group settings are used in a variety 

of ways to address risk factors associated 

with child abuse and neglect. Although the 

primary focus of these interventions is typically 

the parent, quite a few programs include 

opportunities for structured parent-child 

interactions, and many programs incorporate 

parallel interventions for children. For instance, 

programs may include:

• Weekly discussions for 8 to 14 weeks with 

parents around topics such as discipline, 

cognitive development, and parent-child 

communication

• Group-based sessions at which parents 

and children can discuss issues and share 

feelings

• Opportunities for parents to model the 

parenting skills they are learning

• Time for participants to share meals and 

important family celebrations such as 

birthdays and graduations

Educational and support services range from 

education and information sharing to general 

support to therapeutic interventions. Many of 

the programs are delivered under the direction 

of social workers or health-care providers. 

A meta-analysis conducted by the Centers 

for Disease Control and Prevention (2009) on 

training programs for parents of children ages 

birth to 7 identified components of programs 

that have a positive impact on acquiring 

parenting skills and decreasing children’s 

externalizing behaviors. These components 

included the following: 

• Teaching parents emotional communication 

skills

• Helping parents acquire positive parentchild interaction skills

• Providing parents opportunities to 

demonstrate and practice these skills while 

observed by a service provider 

Home Visitation: As noted earlier, home 

visitation has become a major strategy 

for supporting new parents. Services are 

one-on-one and are provided by staff with 

professional training (nursing, social work, 

child development, family support) or by 

paraprofessionals who receive training in the 

model’s approach and curricula. The primary 

issues addressed during visits include:

• The mother’s personal health and life 

choices

• Child health and development

• Environmental concerns such as income, 

housing, and community violence

• Family functioning, including adult and 

child relationships

• Access to services

Specific activities to address these issues may 

include:

• Modeling parent-child interactions and 

child management strategies

• Providing observation and feedback

• Offering general parenting and child 

development information

• Conducting formal assessments and 

screenings

• Providing structured counseling 

In addition to working with participants 

around a set of parenting and child 
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development issues, home visitors often 

serve as gatekeepers to the broader array of 

services families may need to address various 

economic and personal needs. Critical reviews 

of the model’s growing research base have 

reached different conclusions. In some cases, 

reviewers conclude that the strategy, when 

well implemented, does produce significant 

and meaningful reduction in child-abuse risk 

and improves child and family functioning 

(AAP, Council on Child and Adolescent Health, 

1998; Geeraert, Van den Noortgate, Grietens, 

& Onghena, 2004; Guterman, 2001; Hahn, 

et al., 2003; Stoltzfus & Lynch, 2009). Others 

are more sobering in their conclusions, noting 

the limitations outlined earlier (Chaffin, 2004; 

Gomby, 2005).

In 2008, the Children’s Bureau within the 

Administration for Children and Families 

at the U.S. Department of Health and 

Human Services funded 17 cooperative 

agreements to generate knowledge about 

the use of evidence-based home visiting 

programs to prevent child maltreatment. 

Information about the grantees, the 

home visiting models they are using, the 

cross-site evaluation, and home visiting 

resources is available on the Supporting 

Evidence Based Home Visiting website at 

www.supportingebhv.org/home

In 2010, the President signed into law the 

Patient Protection and Affordable Care 

Act of 2010 (Affordable Care Act) (P.L. 

111-148), legislation designed to make 

quality, affordable health care available 

to all Americans, reduce costs, improve 

health-care quality, enhance disease 

prevention, and strengthen the health-care 

workforce. Through a provision authorizing 

the creation of the Maternal, Infant, and 

Early Childhood Home Visiting Program, 

the Health Resources and Services 

Administration (HRSA) awarded $88 million 

in grants, provided under the Affordable 

Care Act, to support evidence-based and 

promising home visiting programs focused 

on improving the well-being of families 

with young children. In addition, ACF, in 

collaboration with HRSA, awarded 13 grants 

totaling $3 million for the Tribal Maternal, 

Infant, and Early Childhood Home Visiting 

Grant Program. 
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Community Prevention Efforts: The 

strategies previously outlined focus on 

individual parents and children. Recently, 

increased attention is being paid to prevention 

efforts designed to improve the community 

environment in which children are raised. 

Among other things, these efforts institute 

new services, streamline service delivery 

processes, and foster greater collaboration 

among local service providers. This emerging 

generation of “community child abuse 

prevention strategies” focuses on creating 

supportive residential communities where 

neighbors share a belief in collective 

responsibility to protect children from harm 

and where professionals work to expand 

services and support for parents (Chaloupka & 

Johnson, 2007; Doll, Bonzo, Sleet, Mercy, & 

Haas, 2007; Farrow, 1997; Mannes, 

Roehlkepartain, & Benson, 2005). 

In 2009, prevention researchers Daro and 

Dodge examined five community child abuse 

prevention programs that seek to reduce child 

abuse and neglect. Their review concluded 

that the case for community prevention 

is promising. At least some of the models 

reviewed by Daro and Dodge show the ability 

to reduce reported rates of child abuse, 

reduce injury to young children, improve 

parent-child interactions, reduce parental 

stress, and improve parental efficacy. Focusing 

on community building, such programs can 

mobilize volunteers and engage diverse 

sectors within the community, including 

first responders, the faith community, local 

businesses, and civic groups. This mobilization 

exerts a synergistic impact on other desired 

community outcomes such as economic 

development and better health care.

Achieving stronger impacts with young 

children and their families will require 

continued efforts at developing and testing 

a broad array of prevention programs and 

systemic reforms. No one program or one 

approach can guarantee success. Although 

compelling evidence exists to support early 

intervention efforts, beginning at a time a 

woman becomes pregnant or gives birth, 

the absolute “best way” to provide this 

support is not self-evident. The most salient 

protective factors or risk factors will vary 

across populations as well as communities. 

Finding the correct leverage point or pathway 

for change for a specific family, community, 

or State requires careful assessment in which 

the final prevention plan is best suited to the 

needs and challenges presented by each 

situation. 

As the prevention field moves forward, 

current strategies, institutional alignments and 

strategic partnerships need to be reevaluated 

and, in some cases, altered to better address 

current demographic and fiscal realities. Key 

challenges and the opportunities they present 

include the following: 

• Improving the ability to reach all those 

at risk: The most common factors used to 

identify populations at risk for maltreatment 

include young maternal age, poverty, 

single parent status and severe personal 

challenges such as domestic violence, 

substance abuse, and mental health issues. 

Although such factors are often associated 

with elevated stress and reduced capacity 

to meet the needs of the developing child, 

no one of these factors is consistently 

Looking Toward the Future
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predictive of poor parenting or poor 

child outcomes. In addition, families that 

present none of these risk factors may find 

themselves in need of preventive services 

as the result of a family health emergency, 

job loss, or other economic uncertainties. 

In short, our ability to accurately identify 

those who will benefit from preventive 

services is limited and fraught with the 

dual problems of overidentification and 

underidentification. Building on a public 

health model of integrated services, 

child abuse prevention strategies may be 

more efficiently allocated by embedding 

such services within a universal system of 

assessment and support. 

• Determining how best to intervene with 

diverse ethnic and cultural groups: Much 

has been written about the importance of 

designing parenting and early intervention 

programs that are respectful of the 

participant’s culture. For the most part, 

program planners have responded to 

this concern by delivering services in a 

participant’s primary language, matching 

participants and providers on the basis 

of race and ethnicity, and incorporating 

traditional child rearing practices into a 

program’s curriculum. Far less emphasis 

has been placed on testing the differential 

effects of evidence-based prevention 

programs on specific racial or cultural 

groups or the specific ways in which 

the concept of prevention is viewed by 

various groups and supported by their 

existing systems of informal support. 

Better understanding of these diverse 

perspectives is key to building a prevention 

system that is relevant for the full range of 

American families.

• Identifying ways to use technology to 

expand provider-participant contact 

and service access: The majority of 

prevention programs involve face-to-face 

contact between a provider and program 

participant. Indeed, the strength and quality 

of the participant-provider relationship is 

often viewed as one of the most, if not the 

most, important determinant of outcomes. 

Although not a replacement for personal 

contact, the judicial use of technology 

can help direct service providers offer 

assistance to families on their caseload. 

For example, home visitors use cell phones 

to maintain regular communication with 

parents between intervention visits; 

parent education and support programs 

use videotaping to provide feedback to 

parents on the quality of their interactions 

with their children; and community-based 

initiatives use the Internet to link families 

with an array of resources in the community. 

Expanding the use of these technologies 

and documenting their relative costs and 

benefits for both providers and program 

participants offer both potential costs 

savings as well as ways to reach families 

living in rural and frontier communities. 

• Achieving a balance between enhancing 

formal services and strengthening 

informal supports: Families draw on 

a combination of formal services (e.g., 

health care, education, public welfare, 

neighborhood associations, and primary 

supports) and informal support (e.g., 

assistance from family members, friends, 

and neighbors) in caring for their 

children. Relying too much on informal 

relationships and community support may 

be insufficient for families unable to draw 

on available informal supports or who 
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live in communities where such supports 

are insufficient to address their complex 

needs. In contrast, focusing only on formal 

services may ignore the limitations to public 

resources and the importance of creating 

a culture in which seeking assistance in 

meeting one’s parenting responsibilities is 

the norm. Those engaged in developing 

and implementing comprehensive, 

prevention systems need to consider how 

they might best draw on both of these 

resources.

Identifying and testing a range of innovations 

that address all of these concerns and 

alternatives is important. Equally challenging, 

however, is how these efforts are woven 

together into effective prevention systems 

at local, State, and national levels. Just 

as the appropriate service focus will vary 

across families, the appropriate collaborative 

partnerships and institutional alignments 

will differ across communities. In some 

cases, public health services will provide 

the most fruitful foundation for crafting 

effective outreach to new parents. In other 

communities, the education system or faith 

community will offer the most promising 

approach. And once innovations are 

established, they will require new partnerships, 

systemic reforms, or continuous refinement if 

they are to remain viable and relevant to each 

subsequent cohort of new parents and their 

children.

Preventing child abuse is not simply a matter 

of parents doing a better job, but rather it 

is about creating a context in which “doing 

better” is easier. Enlightened public policy 

and the replication of high-quality publicly 

supported interventions are only part of what 

is needed to successfully combat child abuse. 

It remains important to remind the public 

that child abuse and neglect are serious 

threats to a child’s healthy development and 

that overt violence toward children and a 

persistent lack of attention to their care and 

supervision are unacceptable. Individuals have 

the ability to accept personal responsibility for 

reducing acts of child abuse and neglect by 

providing support to each other and offering 

protection to all children within their family 

and their community. As sociologist Robert 

Wuthnow has noted, every volunteer effort or 

act of compassion finds its justification not in 

offering solutions for society’s problems but 

in offering hope “both that the good society 

we envision is possible and that the very act 

of helping each other gives us strength and 

a common destiny” (Wuthnow, 1991: 304). 

When the problem is owned by all individuals 

and communities, prevention will progress, 

and fewer children will remain at risk. 

Conclusion
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Suggested Citation:

Child Welfare Information Gateway. (2011). Child maltreatment prevention: Past, present, and 

future. Washington, DC: U.S. Department of Health and Human Services, Children’s Bureau.