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
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| 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 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
| 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 |
| 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 |
| 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 | 17 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 | 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 | 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 | 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 |
| 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 | 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, 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, 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 |
| 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 | 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 | 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 | 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 | Negative effect is favorable to the intervention. |