Manuscript Details

Silovsky, J., Bard, D., Owora, A. H., Milojevich, H., Jorgensen, A., & Hecht, D. (2022). Risk and protective factors associated with adverse childhood experiences in vulnerable families: Results of a randomized clinical trial of SafeCare®. Child Maltreatment, 28(2), 384–395. https://doi.org/10.1177/10775595221100723

Peer Reviewed

Model(s): SafeCare®
High rating
This manuscript received a rating of high because it is a randomized-controlled trial with low-attrition.

Study reviewed under: Handbook of Procedures and Standards, Version 2.3
Family Economic Self-Sufficiency
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Family Resources Scale-Revised (FRS), Resource adequacy Immediate Post-Service High
0.05 Not statistically significant, p= 0.65 559 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Family Resources Scale-Revised (FRS), Resource adequacy 6-months Post-Service High
0.05 Not statistically significant, p= 0.60 559 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Maternal Health
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Beck Depression Inventory-2 (BDI-2): Parental depression Immediate Post-Service High
0.26 Statistically significant, p= 0.02 556 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Beck Depression Inventory-2 (BDI-2): Parental depression 6-months Post-Service High
0.25 Statistically significant, p= 0.01 556 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Diagnostic Interview Schedule (DIS): Alcohol use Immediate Post-Service High
0.20 Not statistically significant, p= 0.80 557 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Diagnostic Interview Schedule (DIS): Alcohol use 6-months Post-Service High
0.40 Not statistically significant, p= 0.55 557 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Social Provision Scale-Short Form (SPS), Social support Immediate Post-Service High
0.31 Statistically significant, p< 0.01 561 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Social Provision Scale-Short Form (SPS), Social support 6-months Post-Service High
0.15 Not statistically significant, p= 0.08 561 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant
Reductions in Juvenile Delinquency, Family Violence, and Crime
Outcome Measure Timing of Follow-Up Rating Direction of Effect Effect Size (Absolute Value) Stastical Significance Sample Size Sample Description
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Injury subscale Immediate Post-Service High
0.61 Not statistically significant, p= 0.63 409 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Negotiation subscale Immediate Post-Service High
0.28 Not statistically significant, p= 0.19 457 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Negotiation subscale 6-months Post-Service High
0.12 Not statistically significant, p= 0.62 457 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Physical assault subscale Immediate Post-Service High
1.11 Not statistically significant, p= 0.26 416 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Physical assault subscale 6-months Post-Service High
0.44 Not statistically significant, p= 0.54 416 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Psychological aggression subscale Immediate Post-Service High
0.08 Not statistically significant, p= 0.88 437 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Psychological aggression subscale 6-months Post-Service High
0.17 Not statistically significant, p= 0.67 437 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Conflict Tactics Scale 2 (CTS2): Intimate partner violence (IPV), Sexual coercion subscale 6-months Post-Service High
0.00 Not statistically significant, p= 0.94 414 families SafeCare vs. Services As Usual (SAU), Southwest United States, 2002-2010, full sample of participants with a partner
Effect rating key
Favorable finding / Statistically significant
Unfavorable finding / Statistically significant
Ambiguous finding / Statistically significant
No effect / Not statistically significant

Note: Tables do not include findings that HomVEE rated low or indeterminate, or found to be ineligible for review.

This study included participants with the following characteristics at enrollment:

Race/Ethnicity

The race and ethnicity categories may sum to more than 100 percent if Hispanic ethnicity was reported separately or respondents could select two or more race or ethnicity categories.

Black or African American
40%
White
40%
Some other race
20%
Unknown
<1%

Maternal Education

Less than a high school diploma
33%
High school diploma or GED
34%
Unknown
33%

Other Characteristics

Data not available

This study included participants from the following locations:

  • State not reported or international
Study Participants
  • Families with children age 5 years or younger were referred to the study by professionals and community agencies (such as doctors, schools, and faith groups). Families were eligible if they had a primary caregiver age 16 or older and had at least one of the following risk factors: problematic substance use by a parent or caregiver, mental health issues in a parent or caregiver, or experiences with intimate partner violence.
  • After enrollment, families were randomly assigned to receive the SafeCare Augmented program (285 families) or home-based community mental health services as usual (277 families). The main participant in each family was the child’s primary caregiver.
  • Data were first collected at baseline before services began. Outcomes were assessed immediately after services ended (about six months after study enrollment) and six months after services ended.
  • At enrollment, the average age of caregivers was about 25. Fifty-four percent of caregivers reported a monthly income lower than $600 and 26 percent reported a monthly income between $600 and $1,250. 
Setting

The study took place in a large, urban county in the southwestern United States.

Intervention condition
SafeCare®

Note: Navigate to the model page for more information about the home visiting model. See the source manuscript for more information about how the model was implemented in this study.

Comparison Conditions
  • Families assigned to the comparison group were not eligible to receive intervention services through SafeCare or SafeCare Augmented.
  • Comparison group members could receive other home-based mental health services available in the community. These included therapy and case management tailored to each family’s needs. Families could receive support for parenting, mental health, substance use, or other challenges. 
Author Affiliation
  • The authors were affiliated with the University of Oklahoma Health Sciences Center (Pediatrics), Indiana University (Public Health), and the Human Resources Research Organization.
  • Jane Silovsky, the lead author of this manuscript, was involved in developing the SafeCare Augmented enhancement to the SafeCare home visiting model.
Funding Sources

The study was funded by the Oklahoma Department of Human Services and the Centers for Disease Control and Prevention (CDC) under award number CE00044.

Study design characteristics contributing to rating
Design Random assignment compromised? Attrition Baseline equivalence Confounding factors? Valid, reliable measures?
Randomized controlled trial No Low

Not assessed for randomized controlled trials with low attrition

No

Yes
Notes from the review of this manuscript

Two findings from the Diagnostic Interview Schedule and two findings from the Conflict Tactics Scale 2 received a low rating because the corresponding reliability statistics for the outcomes did not meet the HomVEE reliability requirements.

Information used to assess outcome reliability, determine analytic sample sizes, and analyze the study’s imputation approach was based on correspondence with the author.