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Silovsky, J. F., Bard, D., Chaffin, M., Hecht, D., Burris, L., Owora, A., Beasley, L., Doughty, D., & Lutzker, J. (2011). Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Services Review, 33, 1435-1444.

Model(s) Reviewed: SafeCare Augmented
Manuscript screening details
Screening decision Screening conclusion HomVEE procedures and standards version
Passes screens Eligible for review Version 1
Study design details
Rating Design Attrition Baseline equivalence Compromised randomization Confounding factors Valid, reliable measure(s)
High Randomized controlled trial Low Established on race, SES, and baseline outcomes None None Not assessed in manuscripts reviewed before 2021
Notes:

In 2020, HomVEE updated findings from this review to move findings from the Social Provision Scale from the Family Economic Self-Sufficiency domain to the Maternal Health domain because ACF determined that HomVEE should place outcomes measuring social support for the mother in the Maternal Health domain. Similarly, based on ACF determination in 2021, HomVEE placed the finding about referral to child welfare for domestic violence in the Reductions in Juvenile Delinquency, Family Violence, and Crime domain, updated from its earlier placement in the Reductions in Child Maltreatment domain. 

In a general review of the HomVEE website in 2018, it was determined that two outcomes did not meet the original review criteria requiring that all reports of child maltreatment be substantiated: post-enrollment referral to child welfare and post-enrollment referral to child welfare for neglect. Those two outcomes are no longer included in the review.

Study characteristics
Study participants Eligible families had a caregiver at least 16 years of age, at least one child aged 5 or younger, and at least one of the following risk factors: parental substance abuse, mental health issues, or intimate partner violence (IPV). Eligible participants who consented to be a part of the study completed the baseline assessment and were randomized to the intervention or control condition. African Americans and American Indians were over-represented relative to their rates in the general population for the county. In the treatment group, the sample was 74 percent white, 14 percent African American, 4 percent Latino, 7 percent American Indian or Alaska Native, and 1 percent Asian.
Setting The study took place in a rural county in the American Southwest, with a population of fewer than 100,000 people and fewer than 30,000 households.
Intervention services SafeCare Augmented (SC+) consists of SC and two additional components: (1) motivational interviewing (MI) (not described) and (2) training of home visitors on identification and response to risk factors of substance abuse, depression, IPV, and impending child maltreatment. For this study, SC+ was adapted for use in a rural setting, including selection of providers who are established in the community and knowledgeable about local resources.
Comparison conditions The comparison group received standard home-based mental health services, including individual and family therapy and case management services.
Subgroups examined This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report).
Subgroups are not listed for manuscripts reviewed before 2021.
Funding sources Not specified.
Author affiliation John R. Lutzker, a study author, is a developer of SafeCare.
Peer reviewed Peer reviewed status is not listed for manuscripts reviewed before 2021.

Findings that rate moderate or high

Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High FRS-R
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 149.70 Mean = 141.20 Mean difference = 8.50 HomVEE calculated = 0.40 Not statistically significant, p ≥ 0.05
High FRS-R
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 136.00 Mean = 138.60 Mean difference = -2.60 HomVEE calculated = -0.11 Not statistically significant, p ≥ 0.05
Linkages and referrals
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Referrals/linkages to additional services
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Unadjusted proportion = 0.50 Unadjusted proportion = 0.00 Mean difference = 0.50 Not available Statistically significant, p < 0.05
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High BDI-2
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 14.90 Mean = 15.40 Mean difference = -0.05 HomVEE calculated = -0.05 Not statistically significant, p ≥ 0.05
High BDI-2
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 15.50 Mean = 11.20 Mean difference = 4.30 HomVEE calculated = 0.31 Not statistically significant, p ≥ 0.05
High DIS alcohol module
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High DIS alcohol module
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High DIS drug module
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High DIS drug module
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High SPS
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 40.10 Mean = 38.80 Mean difference = 1.30 HomVEE calculated = 0.24 Not statistically significant, p ≥ 0.05
High SPS
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 41.00 Mean = 40.20 Mean difference = 0.80 HomVEE calculated = 0.14 Not statistically significant, p ≥ 0.05
Reductions in child maltreatment
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High CAPI
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 166.50 Mean = 170.80 Mean difference = -4.30 HomVEE calculated = -0.04 Not statistically significant, p ≥ 0.05
High CAPI
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 168.60 Mean = 128.30 Mean difference = 40.30 HomVEE calculated = 0.38 Not statistically significant, p ≥ 0.05
High CTS-PC, nonviolent discipline
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 52.00 Mean = 51.60 Mean difference = 0.40 HomVEE calculated = 0.01 Not statistically significant, p ≥ 0.05
High CTS-PC, nonviolent discipline
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 55.20 Mean = 50.50 Mean difference = 4.70 HomVEE calculated = 0.16 Statistically significant, p < 0.05
High CTS-PC, physical assault
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High CTS-PC, physical assault
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High CTS-PC, psychological aggression
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High CTS-PC, psychological aggression
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
High Referral to child welfare where child was removed from the home
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 716 days 105 families Not reported Not reported Not reported Not available Not statistically significant, p ≥ 0.05
Reductions in juvenile delinquency, family violence, and crime
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High CTS2 victimization, negotiation
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 53.60 Mean = 50.00 Mean difference = 3.60 HomVEE calculated = 0.08 Statistically significant, p < 0.001
High CTS2 victimization, negotiation
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 51.10 Mean = 54.30 Mean difference = -3.20 HomVEE calculated = -0.08 Not statistically significant, p ≥ 0.05
High CTS2 victimization, partnered
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 17 months 105 families Mean = 0.62 Mean = 0.72 Mean difference = -0.10 HomVEE calculated = -0.28 Not statistically significant, p ≥ 0.05
High CTS2 victimization, partnered
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 10 months 105 families Mean = 0.48 Mean = 0.76 Mean difference = -0.28 HomVEE calculated = -0.75 Not statistically significant, p ≥ 0.05
High Referral to child welfare for domestic violence
FavorableUnfavorable or ambiguousNo Effect
Rural Southwest 716 days 105 families Unadjusted proportion = 0.00 Unadjusted proportion = 0.12 Mean difference = -0.12 Not available Statistically significant, p < 0.05