National Evaluation of Safe Start Promising Approaches Results Appendix B: Broward County, Florida

The Broward County Safe Start Program implemented a family-centered intervention intended to improve outcomes for children (ages 0–8) exposed to violence. The program included four phases: assessment and joining; restructuring and value change, which both included individual and family counseling; and termination or generalization. A full description of the program can be found in National Evaluation of Safe Start Promising Approaches: Assessing Program Implementation (Schultz et al., 2010). The evaluation of this program consisted of a randomized controlled trial of the intervention, with randomization occurring at the family level, and a six-month wait-list control group. A total of 201 families were recruited, but only 94 (47 percent) were retained at six months, and only 35 of these were in the control group. Participants in the study were largely minorities and impoverished, with about 30 percent of children scoring in the clinical range at baseline for child posttraumatic stress disorder (PTSD) symptoms, and about one-third of caregivers reporting parenting stress in the clinical range. Among those families retained at six months, 97 percent received some services, with an average of 44 hours of therapy. Those who participated in the intervention arm received an array of services, with over 60 percent of those enrolled taking part in family therapy, and the vast majority (93 percent) of those retained in the six-month sample taking part in family therapy. Given the number of participants in this study, we had an 80-percent chance to detect a medium-to-large effect size of 0.6 at six months. We expected a large intervention effect, given the intensity of the intervention. In the domains of parenting stress and social-emotional competence, some significant improvements within the intervention group were observed over time, but they did not differ from changes observed in the control group. Intent-to-treat analyses showed no statistically significant differences between groups over time. Examination of families that received low, medium, and high doses of intervention services likewise did not reveal any statistically significant differences between families in the intervention and comparable families in the control group. Although it is possible that the services as implemented in this study were not effective in improving outcomes for children in the intervention group relative to controls, there are several other possible explanations for the results presented here. The lack of significant difference between intervention effect; intervention effects in the enhanced usual care, consisting of contact and case management for the control group; selection bias related to low retention overall, and particularly in the control group; increased recognition of symptoms as a function of the intervention; insufficient time to observe intervention effects; or a lack of a meaningful difference between the intervention and the control arms on the particular outcomes measured. In sum, the work demonstrates the need for further evaluation of this intensive approach at intervention with children exposed to violence.