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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
Study Screening Details
Screening Decision Screening Conclusion
Study Passes Screens Study Passes Screens
Study Design Details
Rating Design Attrition Baseline Equivalence Reassignment Confounding Factors
High Randomized controlled trial Low Established on race, SES, and baseline outcomes None None
Notes:

footnote447

Submitted by user on Fri, 03/15/2019 - 14:29

In a general review of the <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr> website in 2018, it was determined that three outcomes did not meet the original review criteria requiring that all reports of child maltreatment be substantiated: post-enrollment referral to child welfare, post-enrollment referral to child welfare for domestic violence, and post-enrollment referral to child welfare for neglect. Those three 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.
Home Visiting 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.
Staff Characteristics and Training The providers of SC+ were trained and observed for fidelity to the model by monitors certified by the national developers. A member of the Motivational Interviewing Network of Trainers provided initial and ongoing MI training. Local experts in IPV, substance abuse, and mental health consulted with the SC+ team.
Funding Sources Not specified.
Author Affiliation John R. Lutzker, a study author, is a developer of SafeCare.

Study Effects Details

Outcome domain: Maternal Health Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
High BDI-2
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Mean = 14.90 Mean = 15.40 Mean difference = -0.05 HomeVEE calculated = -0.05 Not statistically significant, p > 0.05 Primary
High BDI-2
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Mean = 15.50 Mean = 11.20 Mean difference = 4.30 HomeVEE calculated = 0.31 Not statistically significant, p > 0.05 Primary
High DIS alcohol module
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High DIS alcohol module
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High DIS drug module
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High DIS drug module
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
Outcome domain: Reductions in Child Maltreatment Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
High CAPI
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Mean = 166.50 Mean = 170.80 Mean difference = -4.30 HomeVEE calculated = -0.04 Not statistically significant, p > 0.05 Primary
High CAPI
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Mean = 168.60 Mean = 128.30 Mean difference = 40.30 HomeVEE calculated = 0.38 Not statistically significant, p > 0.05 Primary
High CTS-PC, nonviolent discipline
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Mean = 55.20 Mean = 50.50 Mean difference = 4.70 HomeVEE calculated = 0.16 Statistically significant, p < 0.05 Secondary
High CTS-PC, nonviolent discipline
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Mean = 52.00 Mean = 51.60 Mean difference = 0.40 HomeVEE calculated = 0.01 Not statistically significant, p > 0.05 Secondary
High CTS-PC, physical assault
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High CTS-PC, physical assault
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High CTS-PC, psychological aggression
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High CTS-PC, psychological aggression
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Secondary
High Post-enrollment referral to child welfare where child was removed from the home
FavorableUnfavorableNo Effect
Rural Southwest 716 days 105 families Not reported Not reported Not Reported Not available Not statistically significant, p > 0.05 Primary
Outcome domain: Reductions in Juvenile Delinquency, Family Violence, and Crime Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
High CTS2 victimization, negotiation
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Mean = 53.60 Mean = 50.00 Mean difference = 3.60 HomeVEE calculated = 0.08 Statistically significant, p < 0.001 Secondary
High CTS2 victimization, negotiation
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Mean = 51.10 Mean = 54.30 Mean difference = -3.20 HomeVEE calculated = -0.08 Not statistically significant, p > 0.05 Secondary
High CTS2 victimization, partnered
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families % = 62.00 % = 72.00 Difference = -10.00 HomeVEE calculated = -0.28 Not statistically significant, p > 0.05 Secondary
High CTS2 victimization, partnered
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families % = 48.00 % = 76.00 Difference = -28.00 HomeVEE calculated = -0.75 Not statistically significant, p > 0.05 Secondary
Outcome domain: Family Economic Self-Sufficiency Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
High FRS-R
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Mean = 149.70 Mean = 141.20 Mean difference = 8.50 HomeVEE calculated = 0.40 Not statistically significant, p > 0.05 Secondary
High FRS-R
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Mean = 136.00 Mean = 138.60 Mean difference = -2.60 HomeVEE calculated = -0.11 Not statistically significant, p > 0.05 Secondary
High SPS
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families Mean = 40.10 Mean = 38.80 Mean difference = 1.30 HomeVEE calculated = 0.24 Not statistically significant, p > 0.05 Secondary
High SPS
FavorableUnfavorableNo Effect
Rural Southwest 17 months 105 families Mean = 41.00 Mean = 40.20 Mean difference = 0.80 HomeVEE calculated = 0.14 Not statistically significant, p > 0.05 Secondary
Outcome domain: Linkages and Referrals Outcome Effects
Rating Outcome Measure Effect Sample Timing of Follow-up Sample Size Program Group Comparison Group Group Difference Effect size Statistical significance Outcome Type
High Referrals/linkages to additional services
FavorableUnfavorableNo Effect
Rural Southwest 10 months 105 families = 0.50 = 0.00 Difference = 0.50 Not available Statistically significant, p < 0.05 Primary

Study Outcome Measure Summary

Outcome Domain: Maternal Health Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
High

BDI-2

The Beck Depression Inventory 2(BDI-2) is a 21-item multiple-choice instrument designed to measure symptoms of depression.

Parent/caregiver report

Not reported by author

Primary
High

DIS drug and alcohol module

The Diagnostic Inventory Schedule (DIS) is an interview based on the Dignostic and Statistical Analysis of Mental Disorders. The authors used a modified self-report instrument, which has been used in past studies. The alcohol and drug modules were included in the study.

Parent/caregiver report

Not reported by author

Secondary
Outcome Domain: Reductions in Child Maltreatment Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
High

CAPI

The Child Abuse Potential Inventory (CAPI)is a 160-item questionnaire in agree/disagree format developed to estimate child abuse risk.

Parent/caregiver report 

Not reported by author

Primary
High

CTS-PC

The Conflict TacticsScale-ParentChild (CTS-PC) assesses neglectful, psychologically aggressive, and abusive parenting behaviors and acts. The authors used the subscales for nonviolent discipline, psychological aggression, and physical assault. Four items comprising the assault subscale were not used because of abuse reporting concerns.

Parent/caregiver report

Not reported by author

Secondary
Outcome Domain: Reductions in Juvenile Delinquency, Family Violence, and Crime Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
High

CTS2 victimization, negotiation

The Conflicts Tactic Scale 2 (CTS2) was developed to assess adult-to-adult conflict and includes five subscales measuring negotiation, psychological aggression, physical assault, injury, and sexual coercion.

Parent/caregiver report

Not reported by author

Secondary
High

CTS2 victimization, partnered

The ConflictTacticScale 2 (CTS2) was developed to assess adult-to-adult conflict and includes five subscales measuring negotiation, psychological aggression, physical assault, injury, and sexual coercion.

Parent/caregiver report

Not reported by author

Secondary
Outcome Domain: Family Economic Self-Sufficiency Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
High

FRS-R

The Family Resource Scale –Revised (FRS-R) is a 30-item instrument designed to measure the adequacy of resources in households with children. The instrument includes seven scales: income, childcare, communication/employment, intrafamily support, physical shelter, nutrition/protection, health/necessities, and growth/social support.

Parent/caregiver report

Not reported by author

Secondary
High

SPS

The Social Provisions Scale (SPS) examines social the capacity of relationships to provide dimensions of social support

Parent/caregiver report

Not reported by author

Secondary
Outcome Domain: Linkages and Referrals Outcome Measures
Rating Outcome Measure Description of measure Data collection method Properties of measure Outcome Type
High

Referrals/linkages to additional services

The percentage of program providers who referred and linked families to additional services.

Review of program records

Not applicable

Primary