We identified factors associated with substantiated recurrent maltreatment in children and families. Individual factors most consistently identified were: the number of previous episodes of maltreatment in the child or family; neglect (as opposed to other types of maltreatment); parental conflict; and parental mental health problems.
A range of other parental, family, and environmental factors were also found to be associated with recurrent maltreatment, albeit less consistently. Those with some suggestion of association with recurrent maltreatment were: parental substance/alcohol abuse; “family stress”; a lack of social support; families with younger children; parental history of abuse; and already being in contact with child protection services.
It was consistently found that the period of greatest risk for maltreatment recurrence occurred directly after the index episode with the risk then gradually declining with time. (This should be interpreted somewhat cautiously however, as most studies did not use survival analysis techniques and so this finding may be somewhat artefactual.) Furthermore, the risk of recurrent maltreatment increased after each maltreatment event, and the time between episodes of maltreatment shortened as the number of maltreatment episodes increased.12,15
It is notable that some factors identified elsewhere5,7
did not emerge as significant risk factors in this review. These include quality of attachment or closeness in the relationship between parent and child, and severity of abuse.
A number of limitations of this review should be considered when interpreting the findings. Firstly, we only selected studies that included cases of substantiated maltreatment. This led to some studies, particularly those including all referrals to child protection services, being excluded. There has been considerable debate about whether it is meaningful to separate studies in this way,13,25
and by doing so we may have introduced an element of bias in that these findings may not reflect accurately the risk factors for all children who are maltreated, rather just those who pass into Child Protection Services. However, the decision to do this does mean that the findings considered here are from studies with clearly verified outcomes. In order to maintain this focus on the child at risk, we also excluded studies which focused specifically on predictors of recidivism in adult offenders. These are reviewed elsewhere.26,27,28
The literature itself is heterogeneous in design, types of abuse studied, populations sampled, risk factors considered, and methods of statistical analysis. Of the studies selected, most were retrospective in design, and several lacked important information about the conduct of the research. Unsurprisingly, given the difficulties in following up families where abuse has occurred, there were significant drop‐out rates. The different populations studied and the wide variations in quality between studies meant that meta‐analysis could not be meaningfully undertaken;9
this limits the extent to which robust conclusions can be drawn.
As with any systematic review, there is a possibility of publication bias (whereby studies with positive results are more likely to be published). We endeavoured to reduce this by contacting researchers in the field to obtain unpublished research. A further criticism sometimes levelled at systematic reviews in this field is that by excluding all but the most methodologically robust studies, important research findings are lost. While there is an omission of some research, this critique also reflects a strength of systematic reviews compared to narrative reviews—the reader can be clear on what basis the studies have been selected, and the review is less prone to other forms of bias, introduced by too much weight being given to the findings of studies which are flawed or weaker in design. In this context systematic reviews should be seen as complementary to narrative reviews, providing a clear and sometimes different view of the literature. Indeed we have also undertaken more narrative reviews of this kind.5,29
A further limitation to be noted is that 15 of the studies in this review were conducted in the United States and the sixteenth in Australia; some caution should therefore be exercised in extrapolating the findings directly to the United Kingdom and other jurisdictions where different services and definitions may prevail. Large differences in demographic factors such as levels of poverty are also important to consider when extrapolating the findings to other settings.
What is already known on this topic
- Child maltreatment is common and can have serious adverse consequences for those affected. Those children who have been maltreated are also at increased risk of further maltreatment
- Competent identification of those at highest risk of further maltreatment is an important part of safe and effective practice, but is a complex and demanding task
What this study adds
- Systematic review of those factors that are associated with an increased risk of recurrent maltreatment
- The most important predictors of recurrent maltreatment are: number of previous episodes of maltreatment; neglect (as opposed to other forms of maltreatment); parental conflict; and parental mental health problems
It is of interest that the findings of the present review accord broadly with previous reviews5,7
that have not restricted themselves to substantiated abuse, or to particular (more robust) study designs. These have linked the following psychosocial risk factors with recurrent maltreatment: neglect; severe maltreatment; multiple types; lack of acknowledgement, or cooperation; younger children; prior history of abuse; parental mental disorder, substance abuse; larger families; young caregivers; step parents; rural families; poor families; domestic violence; and lack of social support. This degree of concordance provides support for the robustness of the present findings.
This study underscores evidence for the existence of a variety of family, child, parental, and environmental indices associated with recurrent child maltreatment. This lends support to the use of multi‐modal assessment approaches, and in turn implies a need for clinicians to use the factors identified as part of a structured approach to the management of risk of recurrence.31 The factors themselves may be identified by different professionals, thus emphasising the need for inter‐professional collaboration to improve the quality and process of assessment and management of risk. Only then can we hope to reduce the likelihood of subsequent maltreatment recurrence in individual cases.