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.
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Established on race, SES, and baseline outcomes | None | None |
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.
In a general review of the HomVEE 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 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. |
| 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. |
| 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 | 10 months | 105 families | Mean = 136.00 | Mean = 138.60 | Mean difference = -2.60 | HomeVEE calculated = -0.11 | Not statistically significant, p ≥ 0.05 | |
| High | FRS-R | FavorableUnfavorable or ambiguousNo 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 |
| 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 | = 0.50 | = 0.00 | Difference = 0.50 | Not available | Statistically significant, p < 0.05 |
| 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 | 17 months | 105 families | Mean = 15.50 | Mean = 11.20 | Mean difference = 4.30 | HomeVEE calculated = 0.31 | Not statistically significant, p ≥ 0.05 | |
| High | BDI-2 | FavorableUnfavorable or ambiguousNo 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 | |
| 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 | HomeVEE 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 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 |
| 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 | HomeVEE 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 | HomeVEE calculated = 0.38 | 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 | HomeVEE calculated = 0.16 | 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 | HomeVEE calculated = 0.01 | Not 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 | Post-enrollment 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 |
| 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 | HomeVEE 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 | HomeVEE calculated = -0.08 | Not statistically significant, p ≥ 0.05 | |
| High | CTS2 victimization, partnered | FavorableUnfavorable or ambiguousNo Effect |
Rural Southwest | 10 months | 105 families | % = 48.00 | % = 76.00 | Difference = -28.00 | HomeVEE calculated = -0.75 | Not statistically significant, p ≥ 0.05 | |
| High | CTS2 victimization, partnered | FavorableUnfavorable or ambiguousNo Effect |
Rural Southwest | 17 months | 105 families | % = 62.00 | % = 72.00 | Difference = -10.00 | HomeVEE calculated = -0.28 | Not statistically significant, p ≥ 0.05 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
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 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Referrals/linkages to additional services |
The percentage of program providers who referred and linked families to additional services. |
Review of program records |
Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
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 |
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 |
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 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
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 |
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 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
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 |
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 |
