This annual report - Taranaki District Health Board

in one Cochrane review [274] (see page 344). Intensive advocacy (12 hours or moreduration) was associated with a reduction in physical abuse more than one to two yearsafter the intervention for women already in refuges, and brief advocacy was associatedwith an increase in the use of safety behaviours by abused women. However, the findingsfor the good quality study which took place in an antenatal setting were more equivocal.Brief 30 minute sessions of advocacy were not associated with any reduction in severeabuse (measured at 16 to 34 weeks post-intervention: change-score SMD 0.09, 95% CI -0.29 to 0.46) but a significant reduction in minor abuse was observed (change-score SMD-0.45, 95% CI -0.83 to -0.07). Significant improvements in emotional abuse and postnataldepression were also observed in this Hong Kong based study. It is not known whetherthese benefits were sustained over time.PreventionCare provided to pregnant women that have lost custody of a child through a care andprotection intervention represents an opportunity address the prevention of abuse ofsubsequent children. Kerslake Hendricks and Stevens reviewed the international literatureexamining what can be done to assist such families so that subsequent children are not atrisk, and prevent subsequent children coming into families while parents are stilladdressing complex problems [275]. A companion document examined the issue from aMāori perspective, recognising that Māori children belong to whānau, hapū and iwi andresponsibility for raising children is shared beyond the immediate family [276]. No studiesassessing interventions during pregnancy were identified in the review. Two studiesidentified an association between a lack of antenatal care and children being removedfrom their parents but were unable to identify whether antenatal care was associated withthe prevention of initial or repeat maltreat. Overall the review found that becoming aware ofsubsequent children entering families where children have previously been removed ischallenging. No evidence was identified to demonstrate the effectiveness of systems toimprove identification and referral pathways, including alert systems, mandatory reporting,improved interagency relationships and information sharing, and public and professionaleducation. One small-scale study focusing on families who had previously had childrenremoved found that neglect was a key characteristic but further research on identifying andaddressing neglect is needed. While the evidence base for interventions was mixed thereport makes a number of recommendations regarding effective practice, includingmultiagency assessments, tailored interventions to meet individual family needs, and multicomponentprogrammes that address parenting issues and systemic problems such ashousing and poverty. The review recommends that engaging more fully with extendedfamily and communities to support at-risk families, including during the prenatal period,should be considered. The authors suggest that more information about the reasons whyinitial and subsequent children have been removed would be useful to help develop andtarget assistance for these families and further research on effective interventions isneeded.Similarly, in their ‘review of reviews’ Bull et al. found that review-level studies of homevisiting aimed at prevention of child abuse presented an incomplete and complex picture[250]. Where positive effects have been found, they tended to be in measures of parentingrather than in direct measures of abuse. Methodological problems with measuring childabuse in the trials presented a serious risk of outcome report and surveillance bias,threatening the validity of studies. A meta-analysis (including 19 controlled studies)published in 1999 found that universal, population based early intervention home visitingprogrammes were likely to be more effective in the prevention of maltreatment thanscreening-based programmes [277]. A further review published in 2009 assessed theeffectiveness of early childhood interventions in the primary prevention of childmaltreatment [278]. Fifteen controlled studies assessing 14 programmes, completed from1990 to 2007, were included. Most of the programmes intervened from birth to age three(seven programmes began antenatally for some participants and two began antenatally forall participants) through home visits (10 interventions), parent education classes, or theprovision of health services. Most of the studies evaluated effects during or immediatelyafter the intervention, although two (Nurse–Family Partnership (NFP) and Child ParentIn-Depth Topic: Adversity in Pregnancy - 302