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a cognitive approach to child abuse prevention.pdf

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A Cognitive Approach to Child Abuse Prevention Daphne Blunt Bugental and Patricia Crane Ellerson University of California, Santa Barbara Eta K. Lin Lake Tahoe Community College Bonnie Rainey State University of New York at Stony Brook Anna Kokotovic Child Abuse Listening and Mediation Nathan O’Hara Santa Barbara County Public Health This investigation tested the incremental utility of cognitive retraining as a component within a program designed to prevent child maltreatment. High-risk families ( N 96) were randomly assigned to a control condition, home visitation modeled after the Healthy Start program (unenhanced home visitation), or home visitation that included a cognitive component (enhanced home visitation). Mothers were identified late during pregnancy or soon after birth, and their participation continued for 1 year. Lower levels of harsh parenting were found among mothers in the enhanced home visitation condition than among those in the unenhanced home visitation or control conditions. Prevalence of physical abuse (percentage of mothers who were abusive) during the first year was 26% in the control condition, 23% in the unenhanced home visitation condition, and 4% in the enhanced home visitation condition. Benefits were greatest in families that included a medically at-risk child. A linear pattern of benefits was found for child health; as program features were added, benefits for child health increased. In recent years, the issue of child maltreatment has re- ceived increasing attention in both the scientific and public domains. Much of the attention it has received follows from its continuing pervasiveness and severity. Thousands of infants and children come to the attention of medical pro- fessionals every year as a result of the injuries or other types of harm they have experienced at the hands of their parents. Within the United States, approximately 3 million suspected cases of child maltreatment are reported in a year’s time. On the basis of cases offically reported by child protective service agencies (and thus a clear underestimate), over 1,000 children die annually as a result of abuse or neglect (Na- tional Center on Child Abuse and Neglect data system, U.S. Department of Health and Human Service’s Administration for Children and Families, Children’s Bureau, 1995 1 ). Physical abuse of the young is not only a severe public health problem and a source of national shame, it is also a perplexity. Abusers often describe their children as engag- ing in aversive behaviors intentionally and perceive them- selves as victims (Bugental, Blue, & Cruzcosa, 1989; Lar- rance & Twentyman, 1983). Within this interpretive bias lies an important key to prevention efforts. In the program described here, efforts were made to test the effectiveness of a cognitively based home visitation program directed to- ward preventing child maltreatment among at-risk parents.
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