National Evaluation of Safe Start Promising Approaches Results Appendix F: Erie, Pennsylvania

The Erie County Safe Start program developed an integrated treatment team approach with three main components: therapy, case management, and parent education groups. The objective of this program was to improve outcomes for children (ages 0–12) exposed to violence. 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 the program consisted of a randomized controlled trial of the intervention, with randomization occurring at the family level. Erie program staff enrolled 166 families in the study, with 63 percent of them retained for the six-month assessment. At baseline, caregivers reported that children had been exposed to an average of 4.9 types of violence in their lives. More than one-half of enrolled families reported baseline child posttraumatic stress disorder (PTSD) symptoms that fell in the “significant” range and levels of parental stress that fell in the “clinical” range. Erie’s tailored approach to services meant that families in the intervention group received an array of services, depending on their specific circumstances. Overall, 85 percent of Erie’s families in the six-month analysis sample received some form of therapy, with an average of 16.3 therapy sessions. Erie’s case manager averaged 4.9 case management contacts per family, and the integrated treatment team met an average of 5.4 times per family. Results from the evaluation of the study showed that the mean scores for the outcomes assessed moved in the expected direction. In the PTSD, social-emotional competence, and caregiver-child relationship domains, statistically significant changes were noted within the intervention group for the caregiver’s report of child’s PTSD symptoms, affective strengths, and cooperation and on the difficult child and total parental stress scales, but these changes did not differ significantly from those observed in the control group, with one exception. There was a significant difference between the intervention and control group, such that the intervention resulted in a larger decrease in caregiver reports of child assault between baseline and six months relative to control in unadjusted models. However, after controlling for demographic characteristics and baseline violence exposure in adjusted models, this difference was no longer significant. Similarly, examination of changes among families receiving different amounts of services as compared with comparable control families revealed only one statistically significant difference. Children in the high-dosage intervention group showed significant improvement on the passage comprehension test compared with children in the control group. Although it is possible that the services as implemented in this study were not effective in improving outcomes for the population under study or may not have been provided in an adequate dose to produce better outcomes than the comparison condition, the lack of statistical findings could also reflect a lack of statistical power to detect medium intervention effects because of the sample size limitations in the study, a mismatch between the program’s impact and the particular outcomes measured in this study, increased recognition of symptoms as a function of the intervention, insufficient time to observe intervention effects, or the robust nature of the services available to the control group. Overall, the Erie Safe Start model is an innovative model for providing tailored services to children exposed to violence, but firm conclusions about its effectiveness require further testing. test