Child abuse is one of the worst crimes imaginable, yet one that can be extremely difficult to judge, or to discover. It is always a delicate balancing act for governments and civil service agencies to know how far they can intrude into peoples’ private lives without invading their privacy and transgressing their human rights. If it were possible to profile families most at risk of child abuse, would it even be desirable to do so?
This is the question being asked this month by the U.S. Preventive Services Task Force (USPSTF). The agency is known for its sometimes controversial methodology while undertaking research into how to prevent social problems before they happen. They previously caused outrage in the U.S. after making recommendations to reduce cancer screening to enhance statistical effectiveness. The topic currently under review is the role of doctors in intervening in family issues. The task force has enlisted researchers from Oregon Health & Science University to help them deconstruct a decade’s worth of studies on the topic of family wellbeing.
So far, they have established that cases of child maltreatment are difficult to detect when they don’t take an obvious form; for example, in cases of extreme physical abuse. Most children show no immediate signs of abuse, and it is difficult to find a failsafe method of helping the 700,000 children per year thought to be the victims of parental abuse. The main question raised so far is the efficacy of home visits over observation in a clinical setting. Past research strongly suggests that home visits give doctors a better insight into the nature of a family and increase the likelihood of them locating the children most in need.
This being the case, a controversial issue remains. How should doctors determine which families should be visited at home? The danger is that this might turn out to be another exercise in discriminatory profiling, where single mothers and low-income families are targeted as suspected abusers. A previous study, published in the Journal of the American Medical Association (JAMA) found that home visits can reduce child abuse cases by up to fifty per cent, so the potential gain of a screening procedure should not be easily dismissed. This important wellness issue looks set to form part of a civil rights debate in the US, with the desirability of screening and domestic intervention by the state under intense political scrutiny.
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