Social Policy Report: The Biological Embedding of Child Abuse and Neglect Implications for Policy and Practice

This Social Policy report focuses on United States (US)-based research on child well-being and the threat of child abuse and neglect or child maltreatment in the early years of child development. It was gathered based upon the proceedings of an expert panel meeting of US agencies to encourage "the translation of science leading to innovative approaches to addressing the needs of children who experience maltreatment..." with the goal of seeking long-term evidence-based interventions for children exposed to abuse.

The issue includes the following research:

• The Biological Embedding of Child Abuse and Neglect Implications for Policy and Practice - Sara R. Jaffee and Cindy W. Christian - "In addition to providing comprehensive research linking maltreatment to change in children’s neurodevelopmental behavior and functioning, the authors, Jaffee and Christian, call attention to interventions that can prevent child abuse and support children who are maltreated, highlighting the importance of comprehensive and integrated services for these children."

and four commentaries:

• The Biological Embedding of Child Abuse and Neglect Implications for Policy and Practice - Cheryl Anne Boyce, Valerie Maholmes, and Cathy Spatz Widom - "Boyce, Maholmes, and Widom stress the importance of translational research with the goal of seeking long-term evidence-based interventions for children exposed to abuse."
• Neuroscience and Child Maltreatment: The Role of Epigenetics in Risk and Resilience in Maltreated Children - Catherine Ann Orr and Joan Kaufman - "Orr and Kaufman remind us of the importance of new discoveries in the field of epigenetics in uncovering the resiliency of children who experience abuse and the implications for interventions."
• Neuroscience Enhanced Child Maltreatment Interventions to Improve Outcomes - Mary Dozier and Philip A. Fisher - "Dozier and Fisher highlight current neuroscience evidence with their review of one strategy to address maltreatment is by helping caregivers support the biobehavioral regulation of children who have experienced abuse."
• A Call to Action Promoting Effective Interventions for Children in Child Welfare Using Neuroscience - Bryan Samuels and Caryn Blitz - "Samuels and Blitz provide insight on how the child welfare system can be strengthened to support children who experience maltreatment and the importance of neuroscience to inform child welfare practice."

For maltreated and abused children, due to periods of brain or neural plasticity (refers to changes in neural pathways and synapses which are due to changes in behavior, environment and neural processes, as well as changes resulting from bodily injury - Wikipedia), interventions that involve communication, including behaviour change, are described as being possibly effective in periods occurring from childhood into adulthood. One set of interventions described in a commentary are directed at enhancing the parent’s capacities to help the child develop regulatory capabilities (including regulating their emotions and behavior). "We emphasize that we are asking the parent to provide not only competent care, but indeed therapeutic care."

The Attachment and Biobehavioral Catch-Up (ABC) intervention for infants and young children targets biological and behavioral regulatory challenges these children face "by helping parents: (a) behave in nurturing ways when children are distressed, (b) follow their children’s lead when children are not distressed, and (c) avoid behaving in frightening ways." The ABC intervention is implemented through ten sessions in homes with parent and child present. "Key components of the intervention involve providing very clear feedback to parents regarding nurturance and following their child’s lead (i.e., making "in the moment" comments at a very high rate), and providing specific video-feedback regarding intervention targets (i.e., carefully reviewing brief video-clips in which the parent nurtured the child or followed the child’s lead). Through a randomized clinical trial, the intervention was found effective in enhancing children’s physiological regulation." The evidence of effectiveness included measurement of cortisol regulation (a steroid hormone released in response to stress) effects on the brain, as well as improved mother responses, both measured several months after the intervention and after three years.

The Multidimensional Treatment Foster Care for Preschoolers (MTFC-P) helps parents learn effective behaviour management practices. Foster parents and birth parents receive training to communicate a consistency that provides a highly predictable environment. As was found through randomised trials for the ABC intervention with younger children, "MTFC-P affects cortisol regulation."

The research on neural plasticity shows that there is both damage from maltreatment and, with the right interventions, degrees of reversal of damage "such that the child develops a healthier and more normative response to stress." The fact that there is plasticity also in the adult brain supports retraining of caregivers - "Enhanced Triple P Positive Parenting Program, Combined Parent-Child Cognitive Behavioral Therapy, and Parent-Child Interaction Therapy are just a few examples of evidence-based interventions that have demonstrated effectiveness with parents who have previously abused or neglected their children. Core components shared by these interventions include parent psychoeducation on the negative impacts of violence, child development and appropriate expectations; coping skills training; coaching on child behavior management strategies and alternative methods of conflict resolution; skills to establish or strengthen nurturing relationships of parents with their children; and joint sessions with parents and children for skills practice." 

These commentaries and the call to action note that there is a need for more availability of evidence-based "psychosocial treatments that meet the complex needs of children who have experienced maltreatment," including scaling those treatments (and decommissioning those ineffective interventions) to the existing need and building capacity for implementation, based upon government-level policymaking.