To evaluate Safe Start interventions' effectiveness in reducing violence's harmful effects, RAND Corporation researchers partnered with community-based sites to develop rigorous controlled evaluation designs and analyze data on child and family outcomes. This report presents findings and perspectives from this evaluation.

Improving Outcomes for Children Exposed to Violence

Safe Start Promising Approaches

Dana Schultz, Lisa H. Jaycox, Lynsay Ayer, Claude Messan Setodji, Ammarah Mahmud, Aaron Kofner, Dionne Barnes-Proby

ResearchPublished Mar 14, 2017

Cover: Improving Outcomes for Children Exposed to Violence
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Children's exposure to violence is common and can lead to mental health problems and delinquent behaviors. Because many interventions have focused on specific violence types or symptoms and been difficult to implement in real-world settings, the evidence base is still emerging. The Office of Juvenile Justice and Delinquency Prevention's Safe Start Promising Approaches (SSPA) initiative focused on preventing and reducing the impact of children's exposure to violence through interventions in ten diverse communities. The evaluation examined the effectiveness of the SSPA interventions to address issues for children and families exposed to violence. The ten sites were diverse in their intervention approaches, types of violence exposure targeted, and implementation settings. To evaluate each approach's effectiveness in reducing violence's harmful effects, RAND researchers partnered with the community-based sites to develop a rigorous controlled evaluation design for each intervention, with either a randomized control group or a comparison group selected on similar characteristics. The longitudinal analyses found that families in both the intervention and comparison groups had positive gains on many outcomes, but there was no evidence that the intervention groups improved more. Among those who received Safe Start services, one site produced large, significant improvements in posttraumatic stress disorder symptoms, and another site produced medium, significant effects on several outcomes (child self-control, posttraumatic stress disorder, and behavior; caregiver depression; and family conflict). Although the initiative added to knowledge about how to address the problem, there was no clear case for using a particular intervention to help these children and their families.

Key Findings

Almost All of the Sites Succeeded in Launching Interventions Relevant to Children Exposed to Violence

  • Almost 1,500 families received Safe Start services (and about 1,250 received comparison group services) across the ten sites.
  • However, families did not take up the services fully, receiving fewer services than planned. Nonetheless, satisfaction with services was high.
  • Program staff were trained in specific intervention models and brought those skills to families who might not otherwise have had access to these types of family-focused programs.

Families Who Participated in Safe Start Improved over Time

  • Analyses found positive change in many of the outcomes, with families in six of the studies showing statistically significant improvement in their primary outcomes over time (in the intervention or comparison group).
  • Among the powered studies, there was no strong evidence that the intervention groups improved more than the comparison groups on the outcomes examined.

There Was a Range of Effect Size Changes Across the Outcomes Examined

  • For those who received Safe Start services, only one site had large significant effect size changes on outcomes (child posttraumatic stress disorder), and one site had medium significant effect size changes on multiple outcomes (child self-control, posttraumatic stress disorder, and behavior; caregiver depression; and family conflict). Otherwise, the changes in outcomes within the intervention group were generally small.

Recommendations

  • From a public health perspective, efforts to improve outcomes for children exposed to violence should include targeted, selective, and universal prevention and intervention approaches.
  • Although there are proven and promising approaches that provide intensive services for those experiencing prolonged adjustment issues, more work is needed to see how these treatments can be delivered effectively in real-world settings.
  • For families who have been identified as exposed to violence but who are experiencing only mild or moderate symptoms or on a path to recovery on their own, it will be necessary to explore a range of services, identify the intensity level of services and supports that might be most fruitful, and offer a flexible menu of services and supports to meet families' needs.
  • Prevention efforts that might prepare families and communities for recovery from violence are needed.
  • Collecting longitudinal data on children following violence exposure to learn about how they fare and recover without specialized intervention is important.
  • Future research efforts should include evaluations of interventions at multiple levels, including community and agency prevention efforts focused on improving resilience in the face of violence; supportive and mental health early interventions geared toward helping families and children with mild to moderate symptoms; and bringing evidence-based, intensive services into the community in ways that retain their effectiveness.

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RAND Style Manual
Schultz, Dana, Lisa H. Jaycox, Lynsay Ayer, Claude Messan Setodji, Ammarah Mahmud, Aaron Kofner, and Dionne Barnes-Proby, Improving Outcomes for Children Exposed to Violence: Safe Start Promising Approaches, RAND Corporation, RR-1728-DOJ, 2017. As of October 8, 2024: https://www.rand.org/pubs/research_reports/RR1728.html
Chicago Manual of Style
Schultz, Dana, Lisa H. Jaycox, Lynsay Ayer, Claude Messan Setodji, Ammarah Mahmud, Aaron Kofner, and Dionne Barnes-Proby, Improving Outcomes for Children Exposed to Violence: Safe Start Promising Approaches. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/research_reports/RR1728.html.
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This research was conducted by the Justice Policy Program within RAND Justice, Infrastructure, and Environment and the Population Health Program within RAND Health.

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