This section highlights interventions that may be advantageous for maltreated children between birth and the age of 3 years. Although not tested exclusively with maltreated children, these treatments show promise because existing research either included mixed populations of both maltreated and nonmaltreated children or included populations with individual and family characteristics that were similar to maltreated populations.
As discussed in Part 1 of this literature review, there is a strong relationship between maltreatment and developmental delays. Prevention programs and early childhood education programs that focus on improving academic achievement and well-being of populations considered at risk (e.g., young, single, and poor parents, infants with low birth weight) may also have clinical utility for maltreated children. These treatments hospital-based prevention programs (Kleberg, Westrup, Stjernqvist, & Lagercrantz, 2002; Ment et al., 2003), The Infant Health Development Program (IHDP, 1990), the Prenatal Early Infancy Project (Olds, Henderson, & Kitzman, 1994), the Child Abecedarian Project (Campbell et al., 2001), the Chicago Child-Parent centers (Reynolds et al., 2003), state funded preschools (Gilliam & Zigler, 2000), and Early Head Start programs (Love et al., 2005) have had treatment effects that have ranged from small to large. Specifically, children receiving the intervention demonstrated higher IQ and achievement scores as well as lower rates of developmental delay, need for special education, and need for remediation than children from similar backgrounds who did not receive the intervention. Despite improvement (i.e., differences between control group and treatment group) signaling success, the overall cognitive performance of children receiving intervention still usually places them in the below-average-to-average range (Campbell et al., 2001; Love et al., 2005; Ment et al., 2003).
The effectiveness of large, community-based systems such as state-funded preschools and Early Head Start was found to be lower and to diminish faster over time than smaller model programs because model programs use consistent protocols and more sophisticated intervention science (Barnett, 1995; Guralnick, 2005; Reynolds, 1994). The superior effectiveness of model programs versus large, community-based programs can be partially explained by differences in populations (risk), program quality, adherence to therapeutic elements, quality of elementary and high schools attended after intervention ended, and attendance and participation in intervention programs (Gilliam & Zigler, 2000; Hill, Brooks-Gunn, & Waldfogel, 2003; Ou, 2005). Further research suggests that children with the most severe risks and cognitive deficits compared with children who start out with less severe deficits may receive more benefit and improved cognitive functioning across all such model and community-based programs (Bradley, Burchinal, & Casey, 2001; Kolko, Baumann, & Caldwell, 2003; Lawrence & Blair, 2003). Thus, in some cases, maltreated children may gain valuable cognitive and developmental skills from these prevention and early childhood programs, reducing the risk of developmental delays or decreasing their severity. When maltreated children have serious emotional and behavior problems (e.g. delusions, sexualized behavior, or dangerous aggressive behavior) however, they may be better served in a therapeutic daycare or preschool or in a home-based program.
Finally, young maltreated children often display medical problems or health risks. Regardless of whether the health concern is directly related to the abuse and neglect, these children need medical attention and various health interventions. Beneficial health and medical interventions may include education about general hygiene; nutrition; and basic child care; and how to obtain nutritional assistance and supplements, immunizations, medical and therapeutic assistance for minor and chronic conditions, or some combination. Because of growing appreciation that health and well-being is related to many important domains of functioning, including school readiness and cognitive development, health components have been integrated into prevention and early intervention programs. For example, the Abecederian Project (Campbell et al., 2001) assessed whether dietary differences could explain differences in cognitive development by giving infants in the treatment group healthy meals at the center and giving infants in the control group iron-fortified formula. Within the Chicago Child-Parent Centers (Reynolds et al., 2003) the treatment included preschoolers' receiving health screenings, nursing services, and free or reduced-price meals (Ou, 2005). These projects showed success in improving preschooler's educational attainment; however, because of the comprehensive nature of these programs, it is difficult to isolate the benefits of the physical health component. Furthermore, because these projects were interested in improving cognitive development of at-risk children, the effects on general health and medical conditions were not measured.
Still other programs are designed to promote health and nutrition in at-risk populations. The Prevention-Oriented System for Child Health Project (PORSCHE) is a nurse-run home visitation program designed to improve nutritional status of at-risk children younger than the age of 5 (Worobey, Pisuk, & Decker, 2004). Risk could include poverty status along with one other risk factor, including a child with iron deficiency or lead burden, parents with history of maltreatment, inappropriate parent-child interactions, or a teenage parent with poor social support. The program focused on improving the child's caloric intake, hand washing, increasing iron intake, using vitamins for supplementing the diet, avoiding dehydration, eating more healthy snacks, and reducing lead consumption (through avoiding high-fat moist snacks, which grab paint particles when placed on the counter or floor). Although the study had no control group, after 6 months of program participation, children's caloric intake met recommended daily allowances; children received adequate amounts of calcium, iron, and zinc; and children's levels of physical activity increased. The PORSCHE program, however, was not related to changes in cognitive development. Similar health programs for infants and young children are currently being evaluated (Coleman, Horodynski, Contreras, & Hoerr, 2005). Of particular interest (because of its inclusion in an already comprehensive child education program) is the Hip Hop to Health Jr. program, an obesity prevention program recently under way with Head Start children; that is, baseline characteristics have been collected and the intervention has started (Stolley et al., 2003). It appears that young maltreated children at risk for diet and health-related problems may receive help through these federal and community-based programs.