Prevention of child maltreatment and family support — formative SAQs

SAQ 1 (10 marks)

A 19-year-old first-time mother is seen at the antenatal clinic at 14 weeks' gestation. She left school at 16, is in casual employment, and lives in private rental she describes as unstable. Her partner left last month, she has no family nearby, and she scores positive on a screen for depressive symptoms. There are no current concerns about the pregnancy and no suggestion of maltreatment. ^[2]

Question: Outline the stepped (universal to intensive) prevention and family-support pathway you would offer this family, and justify each step with the relevant evidence. (10 marks) ^[1]

Model answer

Framing (1 mark). Prevention matches the intensity of support to risk: universal support for all families, targeted (secondary) support for at-risk families, and intensive (tertiary) support after harm. Frame the encounter as support, not surveillance; do not conflate disadvantage with evidence of maltreatment. ^[1]

Universal level (2 marks). Offer the universal package: enrolment in the medical home and well-child schedule; population-level parenting support (Triple P at scale reduced substantiated maltreatment and out-of-home entries); and address structural drivers — income, housing and food support, and alcohol and safe-environment policy. ^[3]

Targeted level (4 marks). This family has identified risk factors (young, first-time, single, unstable housing, depressive symptoms, social isolation), so offer structured nurse home visiting beginning in pregnancy and continuing through the child's second year — the Nurse-Family Partnership, whose fifteen-year randomised-trial follow-up showed fewer verified maltreatment reports and fewer child injuries than controls, alongside maternal life-course benefit. In parallel, treat the modifiable drivers: mental-health assessment and treatment for the depressive symptoms, housing support, and connection to social and community supports. Engage the mother as the buffering-adult partner. ^{[2] [12]}

Intensive level (1 mark). Tertiary prevention is reserved for after harm; it is not needed now. State the boundary clearly: if a contact surfaces a reasonable belief of current significant harm, switch to the recognition-to-response bundle (stabilise, examine, document, report). ^[1]

Stance, ACE-informed practice and safety-net (2 marks). Use an ACE-informed (not ACE-scored) stance — ask about adversity to understand and offer support, not to calculate a triage number, because the ACE score is a population risk marker, not an individual test. Document a written family-needs plan with strengths, needs, agreed supports and a review date; engage primary care, early-childhood services and education; and give a clear re-contact pathway so the family returns if circumstances change. ^[5]