This publication was published more than 5 years ago. The state of knowledge may have changed.

Primary care interventions provided to families where children have been subjected to abuse and neglect

A systematic review and assessment including economic and ethical aspects

Reading time approx. 33 minutes Published: Publication type:

SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Published: Report no: 280 Registration no: SBU 2017/71 ISBN: 978-91-88437-22-8


  • A survey sent to the Swedish social and child psychiatry services revealed that the efficacity of only a minority of interventions provided to families where children had been abused and neglected had been scientifically evaluated. A better understanding of how well interventions work would help establish conditions where fewer children are subjected to abuse and neglect.
  • Project Support and Parent Child Interaction Therapy (PCIT) may help reduce abuse and neglect of pre-school aged children.
  • Project Support and PCIT may lead to decreased disruptive behavior among children. PCIT may also improve how the child and parent interact. Interventions aiming at improving attachment behavior among young children for example Attachment and Biobehavioral Catch-up (ABC), may result in the children having less disorganized attachment, which are associated with the development of mental health issues or difficulties with peers later in life.
  • The intervention costs for Project Support are some­­what higher than for PCIT. Project Support may lead to abuse cessation for slightly more children, so the intervention costs per child not exposed to further abuse may be similar for the two interventions.
  • According to SBU’s overall assessment, choice of intervention needs to be based on the child’s and family’s situation, and should take into account, for instance, age, type of abuse, and the effect on the child´s mental health and their relationships with peers. When a new intervention is introduced, it is important to consider the available empirical evidence for that intervention. When planning or initiating an intervention, the child’s legal rights need to be considered.
  • Studies using qualitative methodology indicate that parents experience that interventions can help them find better parenting strategies, but that the interventions do not always match the families’ specific needs. The staff’s ability to express trust and respect for personal integrity was pointed out as important; providing the intervention in a welcoming environment was also seen as important. Parents feel they need support after the intervention has ended. Too few studies evaluated children's experiences to be able to draw any meaningful conclusions.
  • According to reports from user organizations, children and youth who have been in contact with social services feel they did not receive the professional support they needed. They also feel that interventions are provided too late in their lives, and that they are not adequately informed about what kinds of help they are entitled to. These narratives highlight a situation which may be in conflict with children’s rights accord­ing to Swedish law and the Convention on the Rights of the Child.
  • To allow the comparison and synthesis of results from different studies, it is important for researchers to use consistent ways to measure outcomes. This consistency would also help with the interpretation of cost effectiveness. Future studies need more participants and longer follow-up. In addition, plausible negative effects need to be investigated. Children’s rights according to the Convention on the Rights of the Child always needs to be considered when children are involved in research.

Background and objective

Three to nine percent of children in the Nordic countries experience child abuse in their homes, and seven to twelve percent witness violence. The aim of this systematic review was to identify, appraise and synthesize the empirical evidence regarding a) the effectiveness and cost effectiveness of primary care interventions for families where children are exposed to child abuse and neglect and b) experiences of program participation. User perspectives, ethical aspects and children’s rights are included in this assessment.


The systematic review was conducted in accordance with SBU’s methodology ( The interventions should be provided to families where child abuse and neglect had been documented. Quantitative studies should include a control group and have a pre- and post-assessment. Studies evaluating experiences should be based on qualitative interviews. The economic aspects include a systematic review of the literature, estimates of intervention costs for selected manual based interventions, and cost-effectiveness analyses.

Effective interventions

A total of 11,386 abstracts were reviewed. Of these, 35 studies matched the inclusion criteria. Meta-analysis indicates that Project Support and Parent Child Interaction Therapy (PCIT) decreases abuse and neglect and reduces disruptive behavior among children. Attachment and Bio-behavioral Catch-up (ABC) were found to decrease the rates of disorganized attachment among children.

Economic aspects

The intervention costs per family for seven manual based programs varied between SEK 3 800 and 25 700 (Swedish krona year 2016). Treatment of 100 children with PCIT was estimated to cost SEK 1.27 million (of which SEK 0.7 million for social services) versus SEK 1.44 million (SEK 1 million for social services) for Project Support. The intervention costs per child with no further experience of family violence (15 out of 100 children for PCIT and 19 for Project Support) amounted to SEK 85 000 and SEK 76 000. The uncertainty in the effect estimates implies no evident difference in cost-effectiveness of the interventions. The analyses only include short-term costs for implementing the programs.

Parents and children’s experiences

There was a lack of empirical studies evaluating children´s experiences. Parent´s report that interventions may contribute to better parenting strategies, but do not always match the families’ specific needs. Staff’s ability to express trust and show respect for personal integrity, were stated as important as well as the envir­onment in which the intervention took place. Parents state that they need continuous support after intervention participation. According to Swedish organizations representing children who have suffered abuse, children report a lack of support from professionals to process their traumatic experiences. They also feel interventions are delivered too late in their lives and that their voices are not heard during family treatment.


Social- and child psychiatric services use numerous interventions for families were children are exposed to abuse and neglect. Two interventions were shown to be able to decrease child abuse and neglect: Project Support and Parent Child Interaction Therapy (PCIT). It is important to acknowledge that lack of scientific evidence does not mean that an intervention is ineffective, it means that we do not know if it is effective or ineffective. Additionally, interventions that were not proven effective for the population studied in this review, nevertheless can be effective for other populations. For several interventions in this review, Swedish feasibility studies have been conducted.

Included/excluded studies and search strategies

The full report in Swedish

The full report Öppenvårdsinsatser för familjer där barn utsätts för våld och försummelse


  1. Kloppen K, Mæhle M, Kvello Ø, Haugland S, Breivik K. Prevalence of Intrafamilial Child Maltreatment in the Nordic countries: A Review. Child Abuse Rev 2015;24:51-66.
  2. Teicher MH, Samson JA, Anderson CM, Ohashi K. The effects of childhood maltreatment on brain structure, function and connectivity. Nat Rev Neurosci 2016;17:652-66.
  3. Fergusson DM, Boden JM, Horwood LJ. Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse Negl 2008;32:607-19.
  4. Leiter J. School performance trajectories after the advent of reported maltreatment. CYSR Child Youth Serv Rev 2007;29:363-82.
  5. Thornberry TP, Ireland TO, Smith CA. The importance of timing: the varying impact of childhood and adolescent maltreatment on multiple problem outcomes. Dev Psychopathol 2001;13:957-79.
  6. Grip K. The damage done : children exposed to intimate partner violence and their mothers - towards empirically based interventions in order to reduce negative health effects in children. Göteborgs, universitet Psykologiska, institutionen 2012.
  7. Koenen KC, Moffitt TE, Caspi A, Taylor A, Purcell S. Domestic violence is associated with environmental suppression of IQ in young children. Dev Psychopathol 2003;15:297-311.
  8. Kuhlman KR, Howell KH, Graham-Bermann SA. Physical Health in Preschool Children Exposed to Intimate Partner Violence. J Fam Viol 2012;27:499-510.
  9. Howarth E, Moore THM, Welton NJ, Lewis N, Stanley N, MacMillan H, et al. IMPRoving Outcomes for child­ren exposed to domestic ViolencE (IMPROVE): an evidence synthesis. Public Health Res 2016;4.
  10. Graham-Bermann SA, Howell KH, Miller LE, Lilly MM, Lilly MM. Traumatic Events and Maternal Education as Predictors of Verbal Ability for Preschool Children Exposed to Intimate Partner Violence (IPV). J Fam Viol 2010;25:383-92.
  11. Gustafsson HC, Coffman JL, Harris LS, Langley HA, Ornstein PA, Cox MJ. Intimate partner violence and children’s memory. J Fam Psychol 2013;27:937-44.
  12. Hungerford A, Wait SK, Fritz AM, Clements CM. Exposure to intimate partner violence and children’s psychological adjustment, cognitive functioning, and social competence: A review. Aggress Violent Behav 2012;17:373-82.
  13. Hamby S, Finkelhor D, Turner H. Teen dating violence: Co-occurrence with other victimizations in the National Survey of Children’s Exposure to
  14. Violence (NatSCEV). Psychol Violence 2012;2:111-24.
  15. Boy A, Salihu HM. Intimate partner violence and birth outcomes: a systematic review. Int J Fertil Womens Med 2004;49.
  16. Donovan BM, Spracklen CN, Schweizer ML, Ryckman KK, Saftlas AF. Intimate partner violence during pregnancy and the risk for adverse infant outcomes: a systematic review and meta-analysis. BJOG 2016;123:1289-99.
  17. Hill A, Pallitto C, McCleary-Sills J, Garcia-Moreno C. A systematic review and meta-analysis of intimate partner violence during pregnancy and selected birth outcomes. Int J Gynaecol Obstet 2016;133:269-76.
  18. Socialstyrelsen. Socialtjänstens behov av kunskapsunderlag. En kartläggning. 2015; Artikelnummer: 2015-2-49. Available from:
  19. UNICEF. Handbok om Barnkonventionen Stockholm: UNICEF Sverige. ISBN 978-91-633-1689-0. 2008.
  20. Rikshandboken Barnhälsovård - webbaserad hand- och metodbok för barnhälsovården. Available from:
  21. Finkelhor D. Childhood victimization: violence, crime and abuse in the lives of young people. New York, Oxford University Press; 2008.
  22. Gilbert R, Fluke J, O’Donnell M, Gonzalez-Izquierdo A, Brownell M, Gulliver P, et al. Child maltreatment: variation in trends and policies in six developed countries. Lancet 2012;379:758-72.
  23. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S. Burden and consequences of child maltreatment in high-income countries. Lancet 2009;373:68-81.
  24. Janson S, Jernbro C, Långberg B, Allmänna b. Kroppslig bestraffning och annan kränkning av barn i Sverige : en nationell kartläggning 2011. Stockholm, Stiftelsen Allmänna barnhuset; 2011.
  25. Lucas S, Jernbro C. Försummelse av barn – ett försummat problem. [Neglect of Children--a neglected problem]. Lakartidningen 2014;111:2102-4.
  26. Campbell JA, Walker RJ, Egede LE. Associations Between Adverse Childhood Experiences, High-Risk Behaviors, and Morbidity in Adulthood. Am J Prev Med 2016;50:344-52.
  27. Cater AK, Andershed AK, Andershed H. Youth victimization in Sweden: preva­lence, characteristics and relation to mental health and behavioral problems in young adulthood. Child Abuse Negl 2014;38:1290-302.
  28. Krug EG, WHO. World report on violence and health. Geneva, World Health Organization; 2002.
  29. WHO. Investing in children: the European child maltreatment prevention action plan 2015–2020. In. World Health Organisation, Copenhagen; 2014.
  30. Jernbro C, Janson S. Våld mot barn 2016 – En nationell kartläggning. Stockholm: Stiftelsen Allmänna Barnhuset. 2017.
  31. Durrant JE, Ensom R. Twenty-Five Years of Physical Punishment Research: What Have We Learned? J Korean Acad Child Adolesc Psychiatry 2017;28:20-24.
  32. Berger LR, Waldfogel J. Economic Determinants and Consequences of Child Maltreatment. OECD Social Employment and Migration Working Papers, No. 111, OECD Publishing, Paris 2011.
  33. Dalziel K, Segal L. Home visiting programmes for the prevention of child maltreatment: cost-effectiveness of 33 programmes. Arch Dis Child 2012;97:787-98.
  34. Cohen MA, Piquero AR, Jennings WG. Estimating the costs of bad outcomes for at-risk youth and the benefits of early childhood interventions to reduce them. Crim Justice Policy Rev 2010;21:391-434.
  35. WSIPP, Washington State Institute for Public Policy. Available from:
  36. Currie J, Widom CS. Long-term consequences of child abuse and neglect on adult economic well-being. Child Maltreat 2010;15:111-20.
  37. Corso PS, Edwards VJ, Fang X, Mercy JA. Health-related quality of life among adults who experienced maltreatment during childhood. Am J Public Health 2008;98:1094-100.
  38. Socialstyrelsen. Anmälningar till socialtjänsten om barn och unga – En undersökning om omfattning och regionala skillnader. Stockholm, Socialstyrelsen; 2012.
  39. Socialstyrelsen. Statistik om social­tjänst­insatser till barn och unga 2014. 2015.
  40. Gypen L, Vanderfaeillie J, De Maeyer S, Belenger L, Van Holen F. Outcomes of children who grew up in foster care: Systematic-review. Child Youth Serv Rev 2017;76:74-83.
  41. SBU. Insatser för bättre psykisk och fysisk hälsa hos familjehemsplacerade barn. Stockholm: Statens beredning för medicinsk och social utvärdering (SBU); 2017. ISBN 978-91-88437-07-5.
  42. Wiklund S, Sjöblom Y. När samhället träder in: barn, föräldrar och social barnavård. Lund: Studentlitteratur; 2012.
  43. Forkby T, Institutionen för socialt a. Ungdomsvård på hemmaplan idéerna, framväxten, praktiken. Göteborg: Institutionen för socialt arbete, Göteborgs universitet; 2005.
  44. Zubrick SR, Ward KA, Silburn SR, Lawrence D, Williams AA, Blair E, et al. Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prev Sci 2005;6:287-304.
  45. Farmer ERG. Using Research to Develop Practice in Child Protection and Child Care. In: Domestic Violence and Child Protection: Directions for Good Practice: Jessica Kingsley; 2006. p 124-36.
  46. Steinsvåg PØ. Få slut på våldet – Om säkerhetsarbete för barn. In: Barn som upplever våld: nordisk forskning och praktik. Stockholm: Gothia; 2007.
  47. Wathen CN, MacMillan HL. Children’s exposure to intimate partner violence: Impacts and interventions. Paediatr Child Health 2013;18:419-22.
  48. SBU. Utvärdering av metoder i hälso- och sjukvården: En handbok. 2 uppl. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2014.
  49. Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Book Series 2008.
  50. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.
  51. Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gulmezoglu M, et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). PLoS Med 2015;12:e1001895.
  52. Barnrättsbyrån. Barnens röster – En utvärdering av Barnrättsbyråns arbete med barn och unga. 2016.
  53. Maskrosbarn. Jag är bara en påse med pengar: en rapport av Maskorsobarn
  54. om ungdomars upplevelse av insatser från socialtjänsten. In. Maskrosbarn, Stockholm; 2016.
  55. Hughes JR, Gotflieb LN. The effects of the Webster-Stratton parenting program on maitreating families: fostering strengths. Child Abuse Negl 2004;28:1081-97.
  56. Jacobsen SL, McKinney CH, Holck U. Effects of a dyadic music therapy intervention on parent-child interaction, parent stress, and parent-child relationship in families with emotionally neglected children: a randomized controlled trial. J Music Ther 2014;51:310-32.
  57. Dozier M, Dozier D, Manni M. Recognizing the special needs of infants’ and toddlers’ foster parents: Development of a relational intervention. Zero Three Bulletin 2002;22:7-13.
  58. Dozier M, Lindhiem O, Ackerman J. Attachment and biobehavioral catch-up. In: L. Berlin, Y. Ziv, L. Amaya-Jackson, & M. T. Greenberg (Eds.), Enhancing early attachments. New York: Guilford; 2005. p 178-94.
  59. Lieberman AF, Compton NC, Van Horn P, Ghosh Ippen C. Losing a parent to death in the early years: Guidelines for the treatment of traumatic bereavement in infancy. Washington D.C.: Zero Three Press. 2003.
  60. Lieberman AF, Van Horn P. Don’t hit my mommy: A manual for child parent psychotherapy with young witnesses of family violence. Zero Three Press: Washington, D.C. 2004.
  61. Lieberman AF, Van Horn P. Psycho­therapy with infants and young children: Repairing the effects of stress and trauma on early attachment. New York: The Guilford Press. 2008.
  62. Graham-Bermann SA. Evaluating interventions for children exposed to family violence. J Aggress Maltreat Trauma 2000;4:191-216.
  63. Graham-Bermann SA, Follett C. Fostering resilience in young children exposed to violence. Department of Psychology, University of Michigan. 2001.
  64. Graham-Bermann SA, Halabu H. Fostering resilient coping in children exposed to violence: Cultural considerations. In: Jaffe PG, Baker LL, Cunningham A (Eds.) Protecting children from domestic violence. (pp. 71-88). New York: Guilford Press. 2004.
  65. Runyon MK, Deblinger E, Ryan EE, Thakkar-Kolar R. An overview of child physical abuse: developing an integrated parent-child cognitive-behavioral treatment approach. Trauma Violence Abuse 2004;5:65-85.
  66. Runyon MK, Deblinger E, Schroeder CM. Pilot Evaluation of Outcomes of Combined Parent-Child Cognitive-Behavioral Group Therapy for Families at Risk for Child Physical Abuse. Cogn Behav Pract 2009;16:101-18.
  67. Swenson CC, Penman JE, Henggeler SW, Rowland MD. Multisystemic Therapy for Child Abuse and Neglect, revised edition. Charleston, SC: Family Services Research Center, National Institute of Mental Health, and Connecticut Department of Children and Families. 2011.
  68. Swenson CC, Schaeffer CM. Multisystemic Therapy for Child Abuse and Neglect. In A. Rubin & D. Springer (Eds.), Programs and Interventions for Maltreated Children and Families at Risk (pp. 31-42). Hoboken, NJ: Wiley. 2011.
  69. Swenson CC, Schaeffer CM, Tuerk EH, Henggeler SW, Tuten M, Panzarella P, et al. Adapting Multisystemic Therapy for co-occurring child maltreatment and parental substance abuse: The building stronger families project. J Emot Behav Disord Youth, W, 2009:3-8.
  70. Eyberg S. Parent-Child Interaction Therapy: Integration of Trditional and Behavioral Concerns. Child Fam Behav Therapy 1988;10:33-46.
  71. Jouriles EN. Reducing Conduct Problems Among Children of Battered Women. J Consult Clin Psychol 2001;69:774-85.
  72. Deblinger E, Cohen J, Mannarino A. Child and Parent Trauma-Focused Cognitive Behavioral Therapy Treat­ment Manual. Pittsburgh, Pa: Allegheny General Hospital Center for Traumatic Stress in Children and Adolescents. 2003.
  73. Cohen JA, Mannarino AP, Deblinger E. Treating Trauma and Traumatic Grief in Children and Adolescents. New York, The Guilford; 2006.
  74. Saunders DG. Procedures for adjusting self-reports of violence for social desirability bias. J Interpers Violence 1991;6:336-44.
  75. Azrin NH, Donohoe B, Basalel BA, Kogan ES, Acierno R. Youth drug abuse treatment: A controlled outcome study. J Child Adolesc Subst Abuse 1994;3:1-14.
  76. Briere J, Par. Trauma symptom checklist for children (TSCC). Odessa, FL: PAR.; 1996.
  77. Briere J, Johnson K, Bissada A, Damon L, Crouch J, Gil E, et al. Trauma Symptom Checklist for Young Children (TSCYC): Reliability and Association With Abuse Exposure in a Multi-Site Study. Child Abuse Negl 2001;25:1001-14.
  78. Achenbach TM. Manual for the ASEBA preschool forms & profiles: an integrated system of multi-informant assessment. Burlington, Vt., ASEBA; 2000.
  79. Goodman R. The Strengths and Difficulties Questionnaire: A Research Note. J Child Psychol Psychiat 1997;38:581-6.
  80. Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997;36:980-8.
  81. Reynolds CR, Kamphaus RW. BASC : Behavior Assessment System for Children: manual. Circle Pines, MN, American Guidance Service, Inc.; 1992.
  82. Eyberg SM, Pincus D. ECBI & SESBI-R: Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory-Revised : professional manual. Odessa, FL, Psychological Assessment Resources; 1999.
  83. Briggs-Gowan MJ, Carter ASC, Psychological C. BITSEA : brief infant-toddler social and emotional assessment. San Antonio, TX, PsychCorp; 2006.
  84. Scheeringa MS, Zeanah CH, Myers L, Putnam FW. New findings on alternative criteria for PTSD in preschool children. J Am Acad Child Adolesc Psychiatry 2003;42:561-70.
  85. Bimler D, Kirkland J. Unifying Versions and Criterion Sorts of the AQS with a Spatial Model. Canadian Journal of Infancy and Early Childhood 2002;9:2-18.
  86. Abidin RR. Parenting Stress Index : manual (PSI). Charlottesville, Va., Pediatric Psychology Press; 1983.
  87. Blake DD, Weathers FW, Nagy LM, Kaloupek DG, Gusman FD, Charney DS, et al. The development of a Clinician-Administered PTSD Scale. J Trauma Stress Journal of Traumatic Stress 1995;8:75-90.
  88. Lovibond SH, Lovibond PF, Psychology Foundation of A. Manual for the depression anxiety stress scales. Sydney, N.S.W., Psychology Foundation of Australia; 1995.
  89. Derogatis LR, Lipman RS, Covi L. SCL-90: an outpatient psychiatric rating scale--preliminary report. Psychopharmacol Bull 1973;9:13-28.
  90. Straus MA, Hamby SL, Finkelhor D, Moore DW, Runyan D. Identification of Child Maltreatment With the Parent-Child Conflict Tactics Scales: Develop­ment and Psychometric Data for a National Sample of American Parents. Child Abuse Negl 1998;22:249-70.
  91. Milner JS. The child abuse potential inventory: manual. Dekalb, Psytec; 1987.
  92. Shelton KK, Frick PJ, Wootton J. Assessment of parenting practices in families of elementary school-age children. J Clin Child Adolesc Psychol 1996;25:317-29.
  93. Campis LK, Lyman RD, Prentice-Dunn S. The Parental Locus of Control Scale: Development and Validation. J Clin Child Psychol 1986;15:260-67.
  94. Sharp ME. A multiple rater validation of the parenting dimensions inventory (PDI); 1988.
  95. Eyberg SM, Robinson EA. Dyadic parent-child interaction coding system : a manual. [Washington, D.C.], American Psychological Association; 1981.
  96. Pederson DR, Moran G. A Categorical Description of Infant-Mother Relationships in the Home and Its Relation to Q-Sort Measures of Infant-Mother Interaction. Monogr Soc Res Child Dev 1995;60.
  97. Matas L, Arend RA, Sroufe LA. Continuity of adaptation in the second year: The relationship between quality of attachment and latercompetence. Child Dev 1978;49:547-56.
  98. Ainsworth MDS, Bell SM. Attachment, Exploration, and Separation: Illustrated by the Behavior of one-year olds in a strange situation. Child Dev 1970;41:49-67.
  99. NICHD Early Child Care Research Network. Child-care and family predictors of preschool attachment and stability from infancy. Dev Psychol 2001;37:847-62.
  100. Moss E, Dubois-Comtois K, Cyr C, Tarabulsy GM, St-Laurent D, Bernier A. Efficacy of a home-visiting intervention aimed at improving maternal sensitivity, child attachment, and behavioral outcomes for maltreated children: a randomized control trial. Dev Psychopathol 2011;23:195-210.
  101. Dubois-Comtois K, Cyr C, Tarabulsy GM, St-Laurent D, Bernier A, Moss E. Testing the limits: Extending attachment-based intervention effects to infant cognitive outcome and parental stress. Dev Psychopathol 2017;29:565–74.
  102. Bernard K, Dozier M, Bick J, Lewis-Morrarty E, Lindhiem O, Carlson E. Enhancing attachment organization among maltreated children: Results of a Randomized Clinical Trial. Child Dev 2012;83:623–36.
  103. Lind T, Bernard K, Ross E, Dozier M. Intervention effects on negative affect of CPS-referred children: results of a randomized clinical trial. Child Abuse Negl 2014;38:1459-67.
  104. Oxford ML, Spieker SJ, Lohr MJ, Fleming CB. Promoting First Relationships®. Child Maltreat 2016;21:267-77.
  105. Lieberman AF, Ghosh Ippen C, Van Horn P. Child-parent psychotherapy: 6-month follow-up of a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2006;45:913-8.
  106. Lieberman AF, Van Horn P, Ippen CG. Toward evidence-based treatment: child-parent psychotherapy with preschoolers exposed to marital violence. J Am Acad Child Adolesc Psychiatry 2005;44:1241-8.
  107. Stronach EP, Toth SL, Rogosch F, Cicchetti D. Preventive interventions and sustained attachment security in maltreated children. Dev Psychopathol 2013;25:919-30.
  108. Cicchetti D, Rogosch FA, Toth SL. Fostering secure attachment in infants in maltreating families through preventive interventions. Dev Psychopathol 2006;18:623-49.
  109. Toth SL, Sturge-Apple ML, Rogosch FA, Cicchetti D. Mechanisms of change: Testing how preventative interventions impact psychological and physiological stress functioning in mothers in neglectful families. Dev Psychopathol 2015;27:1661-74.
  110. Graham-Bermann SA, Lynch S, Banyard V, DeVoe ER, Halabu H. Community-based intervention for children exposed to intimate partner violence: An efficacy trial. J Consult Clin Psychol 2007;75:199-209.
  111. Graham-Bermann SA, Miller LE. Intervention to reduce traumatic stress following intimate partner violence: An efficacy trial of the Moms’ Empower­ment Program (MEP). Psychodyn Psychiatry 2013;41:329-49.
  112. Graham-Bermann SA, Miller-Graff L. Community-based intervention for women exposed to intimate partner violence: A randomized control trial. J Fam Psychol 2015;29:537-47.
  113. Overbeek MM, de Schipper JC, Lamers-Winkelman F, Schuengel C. Effectiveness of specific factors in community-based intervention for child-witnesses of interparental violence: a randomized trial. Child Abuse Negl 2013;37:1202-14.
  114. Grogan-Kaylor A, Galano MM, Howell KH, Miller-Graff L, Graham-Bermann SA. Reductions in Parental Use of Corporal Punishment on Pre-School Children Following Participation in the Moms’ Empowerment Program. J Interpers Violence 2016;9:9.
  115. Runyon MK, Deblinger E, Steer RA. Group cognitive behavioral treatment for parents and children at-risk for physical abuse: An initial study. Child Fam Behav Therapy 2010;32:196-218.
  116. Swenson CC, Schaeffer CM, Henggeler SW, Faldowski R, Mayhew AM. Multisystemic Therapy for Child Abuse and Neglect: a randomized effectiveness trial. J Fam Psychol 2010;24:497-507.
  117. Chaffin M, Funderburk B, Bard D, Valle LA, Gurwitch R. A combined motivation and parent-child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial. J Consult Clin Psychol 2011;79:84-95.
  118. Chaffin M, Silovsky JF, Funderburk B, Valle LA, Brestan EV, Balachova T, et al. Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. J Consult Clin Psychol 2004;72:500-10.
  119. Thomas R, Zimmer-Gembeck MJ. Parent-child interaction therapy: an evidence-based treatment for child maltreatment. Child Maltreat 2012;17:253-66.
  120. Terao SY. Treatment Effectiveness of Parent Child Interaction Therapy with Physically abusive Parent-Child Dyads. 1999.
  121. McDonald R, Jouriles EN, Skopp NA. Reducing conduct problems among children brought to women’s shelters: Intervention effects 24 months following termination of services. J Fam Psychol 2006;20:127-36.
  122. Jouriles EN, McDonald R, Rosenfield D, Stephens N, Corbitt-Shindler D, Miller PC. Reducing conduct problems among children exposed to intimate partner violence: a randomized clinical trial examining effects of Project Support. J Consult Clin Psychol 2009;77:705-17.
  123. Jouriles EN, McDonald R, Rosenfield D, Norwood WD, Spiller L, Stephens N, et al. Improving parenting in families referred for child maltreatment: a ran­domized controlled trial examining effects of Project Support. J Fam Psychol 2010;24:328-38.
  124. Broberg A, Hultmann O, Axberg U. Förekomst, bedömning och behandling inom barn- och ungdomspsykiatrin (BUP) av patienter som utsatts för våld i familjen. Bilaga till slutrapport till FORTE avseende FAS-projekt nr 2011-0350. Göteborgs universitet: Psykologiska institutionen; 2016.
  125. Cohen JA, Mannarino AP, Iyengar S. Community treatment of posttraumatic stress disorder for children exposed to intimate partner violence: a randomized controlled trial. Arch Pediatr Adolesc Med 2011;165:16-21.
  126. Donohue B, Azrin NH, Bradshaw K, Van Hasselt VB, Cross CL, Urgelles J, et al. A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse. J Consult Clin Psychol 2014;82:706-20.
  127. Sanders MR, Pidgeon AM, Gravestock F, Connors MD, Brown S, Young RW. Does parental attributional retraining and anger management enhance the effects of the Triple P-Positive Parenting Program with parents at risk of child maltreatment? Behav Therapy 2004;35:513-35.
  128. Guterman NB, Tabone JK, Bryan GM, Taylor CA, Napoleon-Hanger C, Banman A. Examining the effectiveness of home-based parent aide services to reduce risk for physical child abuse and neglect: six-month findings from a randomized clinical trial. Child Abuse Negl 2013;37:566-77.
  129. MacMillan HL, Thomas BH, Jamieson E, Walsh CA, Boyle MH, Shannon HS, et al. Effectiveness of home visitation by public-health nurses in prevention of the recurrence of child physical abuse and neglect: a randomised controlled trial Lancet 2005;365:1786-93.
  130. McFarlane JM, Groff JY, O’Brien JA, Watson K. Behaviors of children following a randomized controlled treatment program for their abused mothers. Issues Compr Pediatr Nurs. 2005;28:195-211 17p.
  131. Cossar J, Brandon M, Jordan P. ’You’ve got to trust her and she’s got to trust you’: children’s views on participation in the child protection system. Child Fam Soc Work 2014;21:103-12.
  132. McManus E, Belton E, Barnard M, Cotmore R, Taylor J. Recovering from domestic abuse, strengthening the mother-child relationship: Mothers’ and children’s perspectives of a new intervention. Child Care Pract 2013;19:291-310.
  133. Cossar J, Brandon M, Jordan P. ’Don’t make assumptions’: Children’s and young people’s views of the child protection system and messages for change, Office of the Children’s Commissioner; 2011.
  134. Petra M, Kohl P. Pathways Triple P and the child welfare system: A promising fit. Child Youth Serv Rev 2010;32:611-8.
  135. Bolen MG, McWey LM, Schlee BM. Are at-risk parents getting what they need? Perspectives of parents involved with child protective services. Clin Soc Work J 2008;36:341-54.
  136. Kelleher L, Cleary M, Jackson D. Compulsory participation in a child protection and family enhancement program: mothers’ experiences. Contemp Nurse 2012;41:101-10.
  137. Kinsworthy S, Garza Y. Filial therapy with victims of family violence: A phenomenological study. J Fam Violence 2010;25:423-29.
  138. Källström Cater Å, Grip K. Kids Club i Sverige. Resultat från en förstudie av en metod för att stödja barn som upplevt våld mot mamma. Working Papers and Repots Social work, Örebro universitet 2014;4.
  139. Rizo CF, Reynolds A, Macy RJ, Ermentrout DM. Parenting and Safety Program for System-Involved Female Survivors of Intimate Partner Violence: A Qualitative Follow-up Study. J Fam Violence 2016;31:833-48.
  140. Lewis EM, Feely M, Seay KD, Fedoravicis N, Kohl PL. Child Welfare Involved Parents and Pathways Triple P: Perceptions of Program Acceptability and Appropriateness. J Child Fam Stud 2016;25:3760-70.
  141. Gockel A, Russell M, Harris B. Recreating Family: Parents Identify Worker-Client Relationships as Paramount in Family Preservation Programs. Child Welfare 2008;87:91-113.
  142. Bundy-Fazioli K, DeLong Hamilton TA. A Qualitative Study Exploring Mothers’ Perceptions of Child Neglect. Child Youth Serv 2013;34:250-266 17p.
  143. Fuller TL, Paceley MS, Schreiber JC. Differential Response family assessments: listening to what parents say about service helpfulness. Child Abuse Negl 2015;39:7-17.
  144. Reimer EC. Relationship-based practice with families where child neglect is an issue: Putting relationship development under the microscope. Australian Social Work 2013;66:455-70.
  145. Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M. Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years (Review). Evid Based Child Health Cochrane Review Journal 2012;2:318-692.
  146. Sampaio F, Enebrink P, Mihalopoulos C, Feldman I. Cost-effectiveness of four parenting programs and bibliotherapy for parents of children with conduct problems. J Ment Health Policy Econ 2016;19:201-12.
  147. Sloan S, Winter K, Lynn F, Gildea A, Connolly P. The impact and cost effectiveness of Nuture Groups in Primary Schools in Northern Ireland. Belfast: Centre for Effective Education, Queens University Belfast. 2016.
  148. Dalziel K, Dawe S, Harnett PH, Segal L. Cost‐effectiveness analysis of the Parents under Pressure programme for methadone‐maintained parents. Child Abuse Rev 2015;24:317-31.
  149. Mihalopoulos C, Magnus A, Lal A, Dell L, Forbes D, Phelps A. Is implementation of the 2013 Australian treatment guidelines for posttraumatic stress disorder cost-effective compared to current practice? A cost-utility analysis using QALYs and DALYs. Aust N Z J Psychiatry 2015;49:360-76.
  150. The California Evidence-Based Clearinghouse for Child Welfare (CEBC), [cited 2018 Feb 22]. Available from:
  151. Svedin CG, Nilsson D, Kjellgren C, Thulin J. Slutrapport KIBB-projektet Kognitiv Integrerad Behandling vid Barnmisshandel 2013-2015; 2015.
  152. Almqvist K, Draxler H. Project support: En genomförbarhetsstudie av ett individuellt föräldrastöd i socialtjänsten för våldsutsatta föräldrar. Karlstad University studies, Karlstad; 2016. Forsknings­rapport 2016:26.
  153. Broberg A, Hultmann O, Axberg U. Förekomst, bedömning och behandling inom barn- och ungdomspsykiatrin (BUP) av patienter som utsatts för våld i familjen. Bilaga till slutrapport till FORTE avseende FAS-projekt nr. 2011-0350. Psykologiska institutionen Göteborgs universitet 2016.
  154. Ungar WJ. Economic evaluation in child health. Oxford; Oxford University Press; 2010.
  155. Ericastiftelsen. [cited 2017 Nov 11]. Available from:
  156. Stiftelsen Allmänna Barnhuset, [cited July 13 2017]. Available from:
  157. Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol 1997;50:683-91.
  158. Kiefer C, Sturtz S, Bender R. Indirect comparisons and network meta-analyses. Dtsch Arztebl Int 2015;112:803-8.
  159. Wertheim EH, Donnoli M. Do offender and victim typical conflict styles affect forgiveness? International Journal of conflict management 2012;23:4-23.
  160. Janson S. Kapitel 14: Att bevaka barns rätt till en god hälsa. In: Cederborh A-C, Warnling-Nerep W, editors. In: Barnrätt - en antologi. Stockholm: Norstedts Juridik AB; 2014.
  161. Taket A. Health equity, social justice and human rights. Routledge/Taylor and Francis Group, London and New York; 2012.
  162. Groh AM, Fearon RP, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Steele RD, Roisman GI. The significance of attachment security for children’s social competence with peers: a meta-analytic study. Attach Hum Dev 2014;16:103-36.
  163. Fearon RP, Bakermans-Kranenburg MJ, van Ijzendoorn MH, Lapsley AM, Roisman GI. The significance of insecure attachment and disorganization in the development of children’s externalizing behavior: a meta-analytic study. Child Dev 2010;81:435-56.
  164. Groh AM, Roisman GI, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Fearon RP. The significance of insecure and disorganized attachment for children’s internalizing symptoms: a meta-analytic study. Child Dev 2012;83:591-610.
  165. Kaminski JW, Valle LA, Filene JH, Boyle CL. A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol 2008;36:567-89.
  166. McIntosh E, Barlow J, Davis H, Stewart-Brown S. Economic evaluation of an intensive home visiting programme for vulnerable families: a cost-effectiveness analysis of a public health intervention. J Public Health (Oxf) 2009;31:423-33.
  167. Gospodarevskaya E, Segal L. Cost-utility analysis of different treatments for post-traumatic stress disorder in sexually abused children. Child Adolesc Psychiatry Ment Health 2012;6:15.
  168. Macdonald G, Livingstone N, Hanratty J, McCartan C, Cotmore R, Cary M, et al. The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis. Health Technol Assess 2016;20:1-508.
  169. Dartington Social Research Unit, Investing in children. [Cited 2018 Feb]Available from:
  170. Kazantzis N, Whittington C, Dattilo F. Meta‐analysis of homework effects in cognitive and behavioral therapy: a repli­cation and extension. Clin Psychol Sci Prac 2010:17:144-56.
  171. Norcross JC, Wampold BE. Evidence-based therapy relationships: research conclusions and clinical practices. Psychotherapy (Chic) 2011;48:98-102.
  172. Shirk SR, Karver M. Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review. J Consult Clin Psychol 2003;71:452-64.
  173. Cater AK. Children’s Descriptions of Participation Processes in Interventions for Children Exposed to Intimate Partner Violence. Child Adolesc Social Work J 2014;31:455-73.
  174. Pernebo K, Almqvist K. Young children’s experiences of participating in group treatment for children exposed to intimate partner violence: A qualitative study. Clin Child Psychol Psychiatry 2016;21:119-32.
  175. Löfholm CA, Olsson T, Sundell K, Hansson K. Multisystemic therapy with conduct-disordered young people: stability of treatment outcomes two years after intake. Evidence & Policy: A Journal of Research, Debate and Practice Evid Policy: A Journal of Research, Debate and Practice 2009;5:373-97.
  176. Howarth E, Moore TH, Shaw AR, Welton NJ, Feder GS, Hester M, et al. The Effectiveness of Targeted Interventions for Children Exposed to Domestic Violence: Measuring Success in Ways that Matter to Children, Parents and Professionals. Child abuse rev 2015;24:297-310.
  177. Annerbäck EM, Wingren G, Svedin CG, Gustafsson PA. Prevalence and characteristics of child physical abuse in Sweden - findings from a population-based youth survey. Acta Paediatr 2010;99:1229-36.
  178. Jernbro C, Tindberg Y, Lucas S, Janson S. Quality of life among Swedish school children who experienced multitype child maltreatment. Acta Paediatr 2015;104:320-5.
  179. Luborsky L, Diguer L, Seligman DA, Rosenthal R, Krause ED, Johnson S, et al. The Researcher’s Own Therapy Allegiances: A Wild Card in Compari­sons of Treatment Efficacy. CPSP Clinical Psychology: Science and Practice 1999;6:95-106.
  180. SBU. Program för att förebygga psykisk ohälsa hos barn. En systematisk littera­turöversikt. Stockholm: Statens beredning för medicinsk utvärdering (SBU); 2010. SBU-rapport 202. ISBN 978-91-85413-38-6.
  181. SBU. Program för ungdomar med antisocial problematik inom institutionsvård. En systematisk litteraturöversikt. Stockholm: Statens beredning för medicinsk och social utvärdering (SBU) 2016; SBU-rapport nr 252. ISBN 978-91-85413-00-0.
  182. Kjellgren C, Nilsson D, Thulin J. Implemen­tering av en strukturerad behandlingsmodell vid barnmisshandel – ett tioårs­perspektiv. Socialmedicinsk tidskrift 4/2017 2017.
  183. Broberg A, Almqvist K, Appell P, Axberg U, Cater As, Draxler H, et al. Utveckling av bedömningsinstrument och stöd­insatser för våldsutsatta barn. 2015.
  184. Källström Cater Å, Grip K. KIDS CLUB I SVERIGE. Resultat från en förstudie av en metod för att stödja barn som upplevt våld mot mamma. In. Örebro Universitet.
  185. Nilsson D, Svedin CG. KUNSKAPSÖVERSIKT om stöd och behandling för barn som utsatts för sexuella övergrepp och fysisk miss­handel. In. Barnafrid Linköpings universitet, Stiftelsen Allmänna Barnhuset, Stockholm 2017; 2017.
  186. Cicchetti D, Valentino K. An ecological transactional perspective on child maltreatment: Failure of the average expectable environment and its influence upon child development. In D. Cicchetti, & D. J. Cohen (Eds.), Developmental psychopathology (2 ed., Vol. 3, pp. 129-201). New York, NY: Wiley. 2006.
  187. Jensen TK, Holt T, Ormhaug SM, Egeland K, Granly L, Hoaas LC, et al. A randomized effectiveness study comparing trauma-focused cognitive behavioral therapy with therapy as usual for youth. J Clin Child Adolesc Psychol 2014;43:356-69.
  188. Silverman WK, Ortiz CD, Viswesvaran C, Burns BJ, Kolko DJ, Putnam FW, et al. Evidence-based psychosocial treatments for children and adolescents exposed to traumatic events. J Clin Child Adolesc Psychol 2008;37:156-83.
  189. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med 2009;36:452-7.
  190. Statens Folkhälsoinstitut. Socialtjänstens insatser för barn och ungdomar i risk­situationer: kartläggning av selektiv prevention i 25 kommuner. In; 2012.
  191. Dean F, Karen B, Allison M, Melissa Van D. Statewide Implementation of Evidence-Based Programs. Except Child 2013;79:213-30.
  192. Wilson SJ, Lipsey MW. School-Based Interventions for Aggressive and Disruptive Behavior:Update of a Meta-Analysis. AMEPRE Am J Prev Med: Supplement 2007;33:S130-S143.
  193. Casillas KL, Fauchier A, Derkash BT, Garrido EF. Implementation of evidence based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse Negl 2016;53:64-80.
  194. Fixsen DL, Blase KA, Naoom SF, Wallace F. Core Imple­mentation Components. Research On Social Work Practice 2009;19:531-40.
  195. Beck AT, Steer RA, Brown GK (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Project group


  • Ulf Axberg
  • Anders Broberg
  • Pia Enebrink
  • Staffan Janson
  • Stefan Wiklund


  • Lina Leander, Project Manager
  • Agneta Brolund, Information Specialist
  • Christel Hellberg, Assistant Project Manager
  • Pia Johansson, Health Economist
  • Naama Kenan Modén, Assistant Project Manager
  • Agneta Petersson, Assistant Project Manager
  • Anneth Syversson, Project Administrator
Page published