Ojective: 1) Predict prenatally women at high risk for later mistreating their children by abuse, neglect, or non-organic failure-to-thrive. 2) Randomly assign all high-risk women to control or intervention groups, and randomly select a low-risk comparison group. 3) Follow-up for the three forms of maltreatment. 4) By comparison of the incidence of maltreatment between the high-risk control group and the low-risk comparison group, determine the efficacy of prenatal prediction for risk for maltreatment. 5) By comparison of the high-risk intervention group with the high-risk control group, determine the utility of the intervention for preventing the onset of maltreatment. Approach: 2,000 pregnant women attending a prenatal clinic for low-income/indigent patients at Nashville General Hospital will be screened for risk using a second generation interview. From this, 400 high-risk women will be selected and randomly entered into an intervention (a Maternal and Infant Care Project supplemented by psychologically-oriented and educative supportive services for the mother) or a routine care control group. The randomly selected low-risk comparison group also will receive routine care. Children born to mothers in these three groups will be followed through medical records and protective agency reports for occurrence of abuse, neglect, or nonorganic failure-to-thrive. Participants also will be evaluated at intervals over 24 months postpartum using various psychosocial measures. Rationale: Prevention of child maltreatment before it ever begins is preferable to secondary prevention because it may completely avoid physical and psychological damage to the child and it may be easier to accomplish than remediation of maltreatment already begun. Such primary prevention is fiscally feasible only if maltreatment can be predicted efficiently so that intervention may be concentrated upon those families actually in need of additional services. This research attempts to refine prenatal predictive ability for later maltreatment and to determine whether one form of primary intervention for high-risk mothers can prevent, to a practical as well as statistically significant degree, maltreatment from ever being initiated. Data from a variety of psychosocial and developmental measures on the mother and infant also will be used to further evaluate effects of the intervention.
| Brayden, R M; Deitrich-MacLean, G; Dietrich, M S et al. (1995) Evidence for specific effects of childhood sexual abuse on mental well-being and physical self-esteem. Child Abuse Negl 19:1255-62 |
| Christensen, M J; Brayden, R M; Dietrich, M S et al. (1994) The prospective assessment of self-concept in neglectful and physically abusive low income mothers. Child Abuse Negl 18:225-32 |
| Brayden, R M; Altemeier, W A; Dietrich, M S et al. (1993) A prospective study of secondary prevention of child maltreatment. J Pediatr 122:511-6 |
| McLaughlin, F J; Altemeier, W A; Christensen, M J et al. (1992) Randomized trial of comprehensive prenatal care for low-income women: effect on infant birth weight. Pediatrics 89:128-32 |
