Psychosocial Interventions for Edge of Care Families in the Early Years: A Systematic Review and Meta-Analysis.

Abstract

Despite the recognized need for early interventions to prevent maltreatment and family separation in families involved with child protection services (CPS), evidence for children aged 0 to 5 years remains scarce and inconclusive. This systematic review and meta-analysis aimed to evaluate the effectiveness of psychosocial interventions delivered to these families in reducing the risk of harm, improving parenting quality, and supporting parental functioning. The review included families with children aged 0 to 5 years engaged with CPS and deemed at risk of entering the care system. A systematic search of databases (e.g., PubMed, CINAHL, PsychINFO) was conducted for randomized controlled trials (RCTs) from 1990 to 2024. Eligible studies were assessed for risk of bias using the Revised Cochrane Risk-of-Bias Tool. Meta-analyses used random effects models to estimate standardized mean differences (SMD) or odds ratios (OR). Narrative synthesis was provided for outcomes not appropriate to include in meta-analyses. Fifteen RCTs (n = 2,232 families) were included. Interventions did not demonstrate consistent effects on reducing subsequent maltreatment, as measured by official records (OR = 0.88, 95% CI [0.75, 1.02]) or parent-reported risk of harm (SMD = -0.07, [-0.25, 0.11]). However, significant improvements were observed in parental sensitivity (SMD = 0.53, [0.30, 0.76]), attachment organization (OR = 2.17, [1.64, 2.87]), and parental functioning (SMD = -0.21, [-0.36, -0.06]). In conclusion, psychosocial interventions show promise in improving parenting among edge-of-care families but lack consistent evidence for reducing maltreatment risk. Future research should prioritize larger trials with standardized outcome measures to strengthen this evidence base.