Adolescents at risk for mistreating their children. Part II: A home- and clinic-based prevention program.
OBJECTIVE
To determine if adding an intensive home visitation component to a comprehensive adolescent-oriented maternity program prevents child abuse and neglect.


METHODS
We studied 171 participants in a comprehensive, adolescent-oriented maternity program who were deemed to be at high risk for child abuse and neglect. Half were randomly assigned to receive in-home parenting instruction. Major disruptions of primary care-giving by the adolescent mother were classified hierarchically as abuse, neglect, and abandonment.


RESULTS
Compliance with home visits varied in relation to the support the teenage mothers received from their families and the fathers of their babies (p < .0001). There were no significant treatment group differences in the pattern of health care utilization, the rate of postpartum school return, repeat pregnancies, or child abuse and neglect. The incidence of maltreatment rose in tandem with the predicted risk status of the mother. Ultimately, 19% of the children were removed from their mother's custody.


CONCLUSIONS
Prediction efforts were effective in identifying at-risk infants, but this intensive home- and clinic-based intervention did not alter the incidence of child maltreatment or maternal life course development. A parenting program that was more inclusive of the support network might be more popular with teenagers and therefore more effective. Our findings also emphasize the importance of including counseling specifically designed to prevent teenagers from abandoning their children.
Stevens-Simon
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C
Division of Adolescent Medicine, University of Colorado Health Sciences Center, The Children's Hospital, Denver 80218, USA.
Nelligan
D
D
Kelly
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L
D000293:Adolescent; D002649:Child Abuse / Q000517:prevention & control*; D003120:Colorado / Q000453:epidemiology; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000523:psychology*; D008427:Maternal Health Services / Q000458:organization & administration*; D009035:Mothers / Q000523:psychology*; D016487:Parenting / Q000523:psychology*; D011181:Postnatal Care; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology* / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000145:classification*; D013315:Stress, Psychological / Q000150:complications / Q000517:prevention & control*