There is additional evidence of fair quality to strengthen the 1993 recommendation to exclude screening procedures for predicting whether children will experience or adults will commit child maltreatment. There is further evidence to strengthen the earlier recommendation of a referral for home visitation during the perinatal period through infancy for first-time mothers of low socioeconomic status, single parenthood or teenaged parenthood to prevent child abuse and neglect. The strongest evidence is for home visitation by nurses, but the most important factor is to maintain the elements of the original prevention program described by Olds and colleagues when it is disseminated. Unfortunately, most home visitation programs that have been developed in Canada bear little resemblance to the model shown to be effective by Olds and colleagues. If such a program is not available in the community, physicians and allied health professionals can advocate for the development of such a program. The eligibility criteria for the Elmira and Memphis studies were demographically based and did not involve any active screening strategy. Presumably most primary care physicians are familiar with the age, socioeconomic and marital status of their patients. Olds and Kitzman advocated targeting communities with high rates of poverty and of single and teenaged parenthood. Making this program widely available in such communities could reduce the problem associated with labelling a person as in need of the program.
There is no good evidence to include or exclude a referral for a comprehensive health care program, a parent education and support program or a combined service program that includes case management, education and psychotherapy in the prevention of child maltreatment. These interventions may be beneficial for other reasons and should be assessed on an individual basis.
There is no new evidence to justify a change in the recommendations regarding programs for the prevention of sexual abuse and victimization. As outlined in the 1993 update, health professionals making recommendations regarding such programs during a periodic health examination must do so on other grounds.