Home-based intervention for high-risk rural families: A randomized clinical trial
Silovsky, J., Bard, D., Chaffin, M., Hecht, D., Burris, L., Owora, A. et al. (2011). Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Services Review, 33(8), 1435-1444.
There has been little research in the area of child maltreatment prevention within high-risk rural populations. Rural caregivers struggling with substance use, intimate partner violence (IPV), and depression may be at high risk for perpetrating child maltreatment, yet few home-based prevention programs are customized for this population. SafeCare (SC) is a skills-based model designed to alter parenting behaviours related to child maltreatment and delivered by trained home based service providers. For the purposes of this study, the SC method was adapted for high-risk rural communities (SC+) enhanced with Motivational Interviewing and compared to a standard home-based mental health service (SAU). It was hypothesized that families who received SC+ (n=48), as compared to SAU (n=57), would have: 1) enhanced engagement in services; 2) lower rates of out-of-home placements; and 3) greater improvement of risk factors (i.e., depression, substance misuse, IPV) and parenting skills (e.g., dealing with child health and home hazards).
Families randomized to SC+ were significantly more likely than SAU participants to complete the initial intake meeting where home visitors obtain demographic information and a needs assessment of the family. Providers of SC+ were more likely to refer and connect families to additional services, compared to SAU service providers. Further, SC+ participants were much more likely to be satisfied with the service they received. Caregiver self-reports indicated participants randomized to SC+ were better able to address child health and home hazards, as well as prevent child behaviour problems. Ten participants (21%) of SC+ and 18 participants (32%) of SAU had a future referral to child welfare services. Amongst families with additional child welfare referrals the median length until a first report was 103 days for SAU participants and 200.5 days for those receiving SC+. Differences in re-referral rates and time were not statistically significant. Although preliminary results suggest engagement and satisfaction with SC+ service, further examination with a larger sample size is required for more rigorous results.
One hundred and five parents of children 5 years or less who had identifiable risk of depression, IPV, or substance abuse were randomized to SC+ or SAU. There were no significant differences between the two groups with respect to demographic characteristics (i.e., age, gender, ethnicity, marital status, education, pregnancy and employment status). The average age of caregivers was 27 years (SD=9), and families had an average of two children. Both African American and First Nation populations were overrepresented compared to their rates in the general population in the United States.
This study was limited by drop out over time, although all analyses are based on results for the full randomized samples. The sample size was also quite small, which may explain the lack of significance on some outcome measures.