The effect of family-based therapy on child physical abuse and neglect: a narrative systematic review

Abstract

AbstractFamily-based therapy is a common front-line strategy to prevent child maltreatment in high-risk families. This review aimed to systematically assess the evidence of the effect of family-based therapy programs on child maltreatment outcomes. CINAHL, Scopus and PsycINFO were systematically searched to March 25, 2023. Outcome data were extracted for child protection reports and out-of-home care (OOHC) placements from administrative data, and parent- or child-reported maltreatment risk. 12 RCTs and two observational studies of 8,410 screened were included. All 14 studies had high risk of bias. Sample sizes ranged from 43 in an RCT to 3875 families in an observational study. In seven studies with child protection report risk estimates, five studies (3 RCTs, 2 observational) showed results in favor of the intervention (risk differences (RD) of 2.0–41.1 percentage points) and two RCTs in favor of the comparison (RD, 2.0–8.6 percentage points). In the four studies with OOHC risk estimates, three studies (2 RCTs, 1 observational) showed results in favor of the intervention (RD, 0.9–17.4 percentage points) and one observational study showed results in favor of the comparison (RD, 1.5 percentage points). Most studies had ≤ 100 participants, did not estimate main causal effects, and had high risk of bias. Thus, although family-based therapy programs may reduce child maltreatment, the high risk of bias, typically small sample sizes (> 62% of studies had sample sizes < 100), and inconsistent results across studies means it is currently unclear whether family-based therapy interventions achieve better child maltreatment outcomes, compared with usual care services.