Preventing child abuse and neglect with parent training: evidence and opportunities.

Researchers have identified four common co-occurring parental risk factors-substance abuse, mental illness, domestic violence, and child conduct problems-that lead to child maltreatment. The extent to which maltreatment prevention programs must directly address these risk factors to improve responsiveness to parenting programs or can directly focus on improving parenting skills, says Richard Barth, remains uncertain. Barth begins by describing how each of the four parental issues is related to child maltreatment. He then examines a variety of parent education interventions aimed at preventing child abuse. He cautions that many of the interventions have not been carefully evaluated and those that have been have shown little effect on child maltreatment or its risk factors. Although some argue that parent education cannot succeed unless family problems are also addressed, much evidence suggests that first helping parents to be more effective with their children can address mental health needs and improve the chances of substance abuse recovery. Barth recommends increased public support for research trials to compare the effectiveness of programs focused on parenting education and those aiming to reduce related risk factors. Child welfare services and evidence-based parent training, says Barth, are in a period of transformation. Evidence-based methods are rapidly emerging from a development phase that has primarily involved local and highly controlled studies into more national implementation and greater engagement with the child welfare system. The next step is effectiveness trials. Citing the importance and success of multifaceted campaigns in public health policy, Barth discusses a multifaceted parenting campaign that has demonstrated substantial promise in several large trials. The goal of the Triple P-Positive Parenting Program is to help parents deal with the full gamut of children's health and behavioral issues. The campaign includes five levels of intervention, each featuring a different means of delivery and intensity of service. More broadly, Barth suggests that the evidence-based Triple P approach offers a general framework that could be used to guide the future evolution of parenting programs.