Paper
Community-based child abuse prevention: Outcomes associated with a differential response program in California
- issue: Issue 1 / 2009
- authors: Amy Conley, Jill Duerr Berrick
- keywords: children, abuse, prevention, Usa
- views: 4068
- downloaded: 0
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abstract
Background. Traditionally, the American child welfare system intervenes only in cases of evident and severe child maltreatment. Families who are in need of help, but who have not yet reached a crisis level, are excluded from most government-provided family support services. Practitioners, policy-makers, and researchers have recently begun promoting the incremental development of a complementary system that addresses child well-being. Under this new approach, differential response (DR), families assessed as low-to-moderate risk at the child abuse hotline are referred to community-based agencies that offer voluntary, home-based services and social services referrals. As of 2003, more than twenty states (U.S. Department of Health and Human Services, 2003) and a number of countries, including Australia, New Zealand, Ireland and Canada (Connolly, 2005), were in the process of implementing reforms similar to DR. Differential response holds great promise for supporting vulnerable children and families. By addressing needs early rather than waiting until a crisis point, the psychological, cognitive, and biological sequelae of abuse can potentially be averted and the family can be kept intact. This study contributes to the growing evidentiary base on DR.
Purpose. Alameda County is the pilot site of California's first DR program, Another Road to Safety (ARS). The ARS program offers services to families who meet the following criteria: screened out of traditional investigation; child age 0-5 or a pregnant mother in the home; and residence in certain designated neighbourhoods with high rates of reported child maltreatment. ARS clients receive up to nine months of intensive home visiting and case management. The ultimate goal of ARS is to promote family safety and to prevent future occurrence of child maltreatment.
Research questions. This study examined the evidentiary base for DR services. The following research questions were addressed:
- What are the experiences of ARS staff with service delivery and the experiences of clients with the services they receive?
- How does the availability of social services in the target neighbourhoods affect the intervention?
- Is ARS successful in preventing future child maltreatment, comparing outcomes for clients against a comparison group?
Method. A mixed-methods design was used. For question 1, staff experience of implementing and delivering services was assessed through in-person interviews with administrators (n=15) and focus groups with direct line staff (n=12). Telephone interviews were conducted with current clients (n=30) to explore their experiences and satisfaction with services. Transcripts were analyzed for emergent themes. In response to Question 2, research on the ARS neighbourhoods had a descriptive and an analytic component. During telephone interviews, clients were asked about their need for social services and whether they were available in their community. Geographic data on services for children and families were collected and analyzed using Geographic Information Systems (GIS) software to identify patterns related to service availability. For Question 3, a quasi-experimental static group design (Hoyle et al., 2002) was used to examine client outcomes. All clients who have completed services formed the treatment group (n=250); a comparison group was constructed with all families who were reported for child maltreatment in the same timeframe and were eligible for DR services, but were not referred because of program capacity (n=600). Survival analysis was used to compare the rates of re-report to the child abuse hotline and rates of substantiated reports for the treatment and comparison group.
Key findings and implications. The main themes identified in the study included the importance of tailoring services to the community context and establishing partnerships among staff, clients, and community collaborators in order to ensure positive outcomes for children and families. Staff shared common views about the importance of developing and nurturing strong collaborative relationships with other service providers in the neighbourhoods. Clients expressed their views on the importance of a non-judgmental person who would listen to their concerns, help them locate concrete resources such as employment assistance and health services, and relieve stress related to parenting. Neighbourhoods were a source of challenges and strengths for clients; while many clients expressed concerns about violence and lack of safe places for their children to play, they also mentioned essential resources that were available close-by, such as after school programs.
GIS analysis of the neighbourhood service arrays revealed differences among the ARS neighbourhoods that had significant implications for the abilities of staff to address client needs.
Quantitative findings (currently under analysis) will be presented on the outcomes of families who completed services, as compared to similar families. Survival analysis was conducted to examine the relationship between treatment and subsequent rates of re-referral for child maltreatment. A Kaplan-Meier test was conducted to determine whether the overall rates of re-referral differed between the treatment and comparison groups. Cox regression was used to estimate the effects of treatment on subsequent rates of child maltreatment reports, adjusting for covariates such as child ethnicity, age, gender, number of prior reports, and most serious abuse allegation. Preliminary analysis suggests that families who complete treatment are less likely to be re-reported for child maltreatment.
Unlike other published studies of differential response, this study combines an examination of outcomes with a unique focus on community context and client and staff experiences. As the differential response model involves connecting families to local resources, the ability of agencies to form connections with other service providers and neighbourhood institutions is a key element of program success. This study has important implications for how to consider the neighbourhood context in planning and conducting research on differential response and other child abuse prevention programs.
Key references
Connolly, M. (2005). Differential responses in child care and protection: Innovative approaches in family-centered practice [Special Edition: Differential response in child welfare]. Protecting Children, 20(2&3), 8-20.
Hoyle, R. H., Harris, M. J., Judd, C. M. (2002). Research Methods in Social Relations. (7th ed.). Fort Worth, TX: Wadsworth.
U.S. Department of Health and Human Services, Administration for Children and Families/Children's Bureau and Office of the Assistant Secretary for Planning and Evaluation. (2003). National study of child protective services systems and reform efforts: Review of state CPS policy. (Washington, DC: U.S. Government Printing Office).
Contacts: Amy Conley, MSW, Ph.D candidate, Center for Child & Youth Policy, UC Berkeley, 2339 Haste St. Berkeley, CA 94720 U.S.A., Phone 510-541-0301, E-mail: a_conley@berkeley.edu.