AMERICORPS IMPACT EVALUATION

SACRAMENTO COUNTY

BIRTH AND BEYOND HOME VISITATION PROGRAM

2013 – 2015

December 2015 
ACKNOWLEDGEMENTS 

This evaluation was made possible by an ongoing collaboration among a number of agencies and 

individuals who have a demonstrated commitment to understanding and improving the lives of families 

in Sacramento County. 

First 5 Sacramento 

Toni Moore | Executive Director (former) 

Julie Gallelo | Executive Director (current) 

Child Abuse Prevention Council of Sacramento, an agency of the Child Abuse Prevention 

Center 

Sheila Boxley | President and CEO 

Stephanie Biegler | Chief Program Officer 

Sara Fung | Program Manager AmeriCorps Initiatives 

Tali Palmrose | Birth & Beyond AmeriCorps Project Manager 

Sacramento County Department of Health and Human Services 

Dr. Sherri Heller | Director 

Holly Thurston | Chair Department of Health and Human Services Research Review Committee 

Sacramento County Health and Human Services Child Protective Services 

Michelle Callejas | Deputy Director of Child Protective Service 

Nancy Marshall | Child Protective Services, Program Planner, Birth & Beyond Program 

Tammie Ostroski | Child Protective Services, Program Specialist 

Birth & Beyond Family Resource Centers 

Roy Alexander | Chief Executive Officer Sacramento Children’s Home

Laurie Clothier | Chief Executive Officer, River Oak Center for Children 

Richard Dana | Executive Director, Mutual Assistance Network 

Jonathon Porteus | Executive Director, WellSpace Health 

Rachel Rios | Executive Director, La Familia Counseling Center, Inc. 

Robert Sanger | Executive Director, Folsom Cordova Community Partnership 
CONTENTS 

EXECUTIVE SUMMARY .................................................................................................................................. 1 

AMERICORPS IMPACT EVALUATION | BIRTH & BEYOND HOME VISITATION .............................................. 3 

Introduction .............................................................................................................................................. 3 

Summary of Evaluation Results ................................................................................................................ 8 

Key Findings & Recommendations .........................................................................................................14

APPENDIX I | B&B PROGRAM DATA ANALYSIS ...........................................................................................18

Participant Demographics & Sample ......................................................................................................18

Rates of Program Completion .................................................................................................................19

Pre-Post Comparison of AAPI Assessment..............................................................................................20

APPENDIX II | QUASI-EXPERIMENTAL COMPARISON OF CPS RECIDIVISM .................................................23

Methods ..................................................................................................................................................23

Results from Analyses .............................................................................................................................27

Conclusions .............................................................................................................................................32

APPENDIX III | AMERICORPS LOGIC MODEL ...............................................................................................39
LIST OF ACRONYMS 

AAPI-2 Adult-Adolescent Parenting Inventory 

ACSN AmeriCorps State and National 

B&B Birth & Beyond Program 

CAPC Child Abuse Prevention Council of Sacramento, an agency of the Child Abuse Prevention 

Center 

CPS Sacramento County Child Protective Services 

CWS/CMS Child Welfare Service/Case Management System 

FRC Birth & Beyond Family Resource Center 

HV Home Visitation 

NPP Nurturing ParentingTM Program 

WIC Women Infant and Children Program 
FIGURES AND TABLES 

Figure 1 | Map of Home Visitation Clients with CPS History Served by AmeriCorps Members (2013-2015) 

and B&B Family Resource Centers in Sacramento County ........................................................................... 6 

Figure 2 | Continuum of AmeriCorps B&B Home Visitation Evaluation Measures ...................................... 7 

Figure 3 | Percentage of Parents Receiving at Least 8 Hours of HV Program and Completing Program Plan 

by NPP Cohort Group .................................................................................................................................... 8 

Figure 4 | Pre/Post Comparisons of AAPI Assessment Scores: Prevention Group (n = 137) .....................10

Figure 5 | Pre/Post Comparisons of AAPI Assessment Scores: Intervention Group (n = 330) ...................10

Figure 6 | Pre/Post Comparisons of AAPI Assessment Scores: Treatment Group (n = 80) ........................11

Figure 7 | Demographics of all HV Program Participants Served by AmeriCorps Members Sept 2012 to 

July 2015 (n=1,312) .....................................................................................................................................18

Figure 8 | Characteristics of all HV Participants Served by AmeriCorps (n=1,312) ....................................19

Figure 9 | At Least One Hour of HV Programming & Substantiated CPS Referrals ....................................28

Figure 10 | At Least One Hour of HV Programming & Any CPS Referral ....................................................29

Figure 11 | Receiving 25-34 Hours of HV Programming & Substantiated CPS Referrals............................30

Figure 12 | Receiving 25-34 Hours of HV Programming & Any Type of CPS Referral ................................32

Table 1 | Summary of Cox Regression Analysis Results between HV Program Group & Comparison Group

....................................................................................................................................................................12

Table 2 | Case Status at Closure by NPP Service Level Group ....................................................................19

Table 3 | Average Participation in HV Program by NPP Service Level (Closed Cases n=1,075)..................20

Table 4 | Description of AAPI Parenting Constructs ...................................................................................21

Table 5 | Closed HV Participants Receiving at Least 8 Hours of Programming with Match Pre and Post 

AAPI Assessments .......................................................................................................................................22

Table 6 | Pre-Post Comparison of AAPI Assessment Scores for NPP Service Level Groups .......................22

Table 7 | List of Parent Characteristics Used in Propensity Score Matching ..............................................25

Table 8 | Means, Percentages, and Standard Deviations (SD) for All Study Variables ...............................33

Table 9 | Cox Regression for Hazard of Recidivism as a Function of Treatment (N=1,478) .......................35

Table 10 | Cox Regression for Hazard of Recidivism as a Function of Dosage (N=1,478) ..........................37

 
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EXECUTIVE SUMMARY 

The Birth & Beyond (B&B) Family Resource Center Initiative (FRC) an AmeriCorps State and National 

(ASCN) program, is dedicated to reducing the incidence of child abuse and neglect. This evaluation focuses

on the delivery of parent education during weekly home visits by 96 AmeriCorps members. Home 

visitation (HV) parenting education uses the evidence-based Nurturing Parenting ProgramTM (NPP) which 

includes an Adult-Adolescent Parenting Inventory-2 (AAPI) to determine a parent’s risk level for child 

abuse and neglect. AmeriCorps members and parents develop a Family Nurturing Plan that prescribes the 

content and number of NPP lessons, over the course of weekly home visits as determined by the AAPI risk 

level. Program outputs and outcomes were measured for the 2013/14 and 2014/15 AmeriCorps program 

years. Measures and key findings include:

Program Completion | Parents completing their assigned NPP program hours are in the 

minority. Program attendance data identified those parents receiving at least eight hours of home 

visitation as well as those completing the total hours prescribed in their NPP plan. Less than one-third 

(28%) of the parents with closed cases during the study period completed their assigned dosage of NPP 

lessons. This number shrinks more than half (13%) when looking at those parents who came into the 

program with the highest risk. On average, parents received 19.4 hours at the close of their case with 67 

percent receiving at least eight hours.

Improvement in Parenting Skills | Parents receiving at least eight hours of HV program services 

show statistically significant improvement (p < 0.001) in their parenting skills and attitudes. A

pre/post comparison of average AAPI scores was conducted for those parents who had received at least 

eight hours of service to measure reduced risk/increase in parenting skills and attitudes. Parents in all 

program groups increased an average of 1.1 points (on a 10-point scale) across all of the five parenting 

domains measured. This suggests that even though program participants may not be reaching their 

program goals in terms of hours, their levels of risk for child abuse and neglect are being reduced from 

those NPP lessons they do receive. Parents entering the program at the highest risk levels are showing 

the greatest gains in their AAPI scores (i.e., decrease in risk levels).

CPS Recidivism | As a result of any level of participation in the HV program, parents with 

previous CPS history reduce the likelihood of future substantiated referrals. A quasi-experimental 

study compared participating HV parents with previous CPS referrals and a comparison group of parents

who did not participate in home visiting, using CPS records and propensity score matching. A Cox 

regression analysis was used to show a statistically significant difference between parents receiving HV 

services and those who did not. Being in the HV program group rather than the comparison group 

decreased the probability of having a substantiated referral by 41 percent at a given time point (p <0.05) 

and the probability of having any CPS referral by 18 percent at a given time point (p <0.10) when all other 

variables were held constant. 

Optimal Program Hours for Preventing CPS Recidivism | Parents with previous CPS history,

receiving 25-34 hours of HV program services demonstrated the greatest reduction in postprogram referrals of any kind. In particular, parents who received 25-34 hours of HV program were 

173 percent less likely at a given time to have a substantiated referral and 57 percent less likely at a given 
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time to have any CPS referral, than those in the comparison group (both significant at the p < 0.05 level). 

However, when divided into dosage groups, there were no statistically significant differences between 

the comparison group and HV participants who received less than 25 hours of face-to-face service and

those who received more than 34 hours of service. This suggests that participants who receive between 

25-34 hours of service receive the maximum benefit from participating in the HV program in relation to 

CPS recidivism. Parents in the program group receiving less than 25 hours of HV programming had a rate 

of substantiated CPS referrals of 13 percent, compared to those parents receiving 25 hours or more who 

had a rate of nine percent.

Conclusion | Findings from thisstudy confirm that any participation in the HV program makes 

a statistically significant impact in preventing substantiated CPS referrals for those parents 

with CPS history, and eight hours of the HV program makes a significant improvement in 

parenting attitudes and practices for all parents, regardless of CPS history. Thus we can infer 

with the evidence from this study that participation in the Birth and Beyond HV program 

resulted in the reduction of parental risk and incidences of child maltreatment. 

Recommendation #1 | Consider aligning the dosage of the home visitation program towards the 

optimal 25-34 hour range. Looking at the current sample of parents who closed during the study period 

(including those without CPS history), 13 percent of the closed cases (143 parents) received 25-34 hours

of the HV program and 18 percent (197 parents) received 35 hour or more. It should be noted that parents 

participating more than 34 hours in HV programming may continue to accrue other types of important 

benefits such as strengthening their parenting knowledge, skills, and attitudes and/or connecting to other 

types of program services and supports.

Recommendation #2 | Explore strategies to address program attrition in order to ensure parents are 

receiving optimal level of HV program dosage. While this evaluation provides evidence of the 

effectiveness of the HV program, it equally underscores the need for participants to be engaged in the 

program for a considerable length of time. We recommend that B&B focus on their rates of participant 

attrition, in order to retain a higher proportion of those parents entering the program. High drop-out rates 

are a given when targeting highly vulnerable and at risk populations. B&B has already taken a significant 

step in addressing the surrounding vulnerabilities of the families it serves through their Crisis Intervention 

Services. 

Recommendation #3 | Consider additional research to explore remaining and emergent questions from 

this study about effectiveness and impact. The current study demonstrates that parents participating in 

the HV program are making significant gains in their parenting attitudes and practices, in addition to 

confirming the impact of the program in lowering probability of recidivism among HV participants. While 

these findings provide evidence of the HV program’s overall impact, the study also generated more 

nuanced questions that remain to be explored. 
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AMERICORPS IMPACT EVALUATION | BIRTH & BEYOND HOME VISITATION 

Introduction 

The Birth & Beyond Family Resource Center Initiative (B&B FRC) an AmeriCorps State and National (ACSN) 

program, is dedicated to reducing the incidence of child abuse and neglect through parenting education 

delivered during home visits and FRC workshops. B&B FRC is governed by the Family Support Collaborative

(FSC) which was created in 1998 by the Sacramento County Board of Supervisors and is supported 

extensively by First 5 Sacramento, Sacramento County Department of Health and Human Services, and 

the State Commission for National and Community Service. FSC is a broad-based public/private 

community collaborative focusing on child abuse and neglect prevention-to-intervention-to-treatment 

services for families with children 0-5 years. Its purposes are to engage the community in developing 

strategies to address child abuse and neglect as well as to coordinate the implementation of B&B services, 

including but not limited to: 1) home visitation; 2) parenting education; 3) crisis intervention; 4) 

connection to resources; 5) school readiness; and 6) parent leadership. 

The home visitation (HV) component is coordinated through Family Resource Centers (FRCs) located in 

nine Sacramento County neighborhoods which provide culturally and linguistically diverse services to 

families who disproportionately reflect social and economic risk factors for child abuse and neglect: longterm poverty, limited education, single parenting, and lack of health care access. The FRCs are operated 

by six non-profit partner organizations: Folsom Cordova Community Partnership; La Familia Counseling 

Center; Mutual Assistance Network; River Oak Center for Children; Sacramento Children’s Home; and 

WellSpace Health. These agencies are responsible for managing services, supervising staff, and collecting 

data. The Child Abuse Prevention Council of Sacramento (CAPC) houses the FSC and provides collaborative 

support, administers the ACSN grant that provides AmeriCorps members who serve families. CAPC also

conducts training, coordinates program evaluation, and monitors program compliance. 

For the 2013/14 and 2014/15 AmeriCorps program years, 9-10 full-time members served annually as 

Home Visitors and Family Resource Aides at each FRC for a total of 166 members. This evaluation focused 

on the 96 members who delivered education during weekly home visits. B&B parenting education uses 

the evidence-based Nurturing Parenting ProgramTM which includes an Adult-Adolescent Parenting 

Inventory (AAPI) to determine a parent’s risk level for child abuse and neglect. AmeriCorps members and 

parents develop a Family Nurturing Plan based on the AAPI assessed risk level, that prescribes the content 

and number of NPP lessons, over the course of weekly home visits.

The following study was generously supported by the ACSN program and represents the desire of B&B to 

increase the level of evidence with which they demonstrate the impact of the home visitation program in 

Sacramento County. LPC Consulting Associates, Inc. (LPC) has been working with the B&B program for 14

years, developing and managing the home visitation program database as well as conducting regular 

evaluation activities for the initiative. For this report LPC subcontracted with JBS International, Inc. for 

analytical support in conducting the quasi-experimental comparison for measuring the impact of the 

home visitation program on Child Protective Services (CPS) recidivism. 
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Description of Home Visitation Program Implementation 

The Birth & Beyond (B&B) Home Visitation Program supports at risk families with the ultimate goal of 

preventing child abuse and neglect in Sacramento County. The core component of the HV program is the 

evidence-based parenting curriculum, Nurturing Parenting ProgramTM. Families enrolled in the HV 

program are also provided referrals and support for a wide range of supports including, but not limited 

to, resources and referrals to health services, support groups, developmental child care, and assistance 

with basic needs such as food access. 

Participant Recruitment: Families served by the HV program have one or more risk factors for child 

maltreatment, ranging from inadequate financial resources, one-parent households, to prior history with 

CPS. Families can enter the HV program through a number of routes. CPS may refer families who came 

to the attention of CPS, but upon further investigation, did not result in the suspension of parental custody 

(i.e., evaluated out, unfounded, or inconclusive CPS referrals). Families may learn of the program through 

their local networks or community FRC and self-enroll. Families are also referred by medical providers and 

other public/private agencies such as the Women Infant and Children Program (WIC). Since parents who 

have an open CPS case are not eligible for HV, a small number of families are referred into the program 

after the conclusion of an open CPS case as a means of parental support throughout the reunification 

process with their children. Participation in the HV program is voluntary. 

Program Content: The Nurturing ParentingTM Program (NPP) is a competency-based curriculum 

designed to meet a family’s needs based on parenting strengths and weaknesses.1 The curriculum content 

focuses on parents’ attitudes and knowledge about topics such as child development, appropriate 

discipline, and empathy (positive bonding) in a one-to-one instructional model which is offered in the 

family home. Instructors are able to observe family dynamics within the home setting and provide 

coaching and immediate reinforcement with parents. The NPP curriculum is accompanied by an

assessment tool, the Adult-Adolescent Parenting Inventory – 2 (AAPI), which measures parenting beliefs 

and practices known to result in child maltreatment. Based upon the APPI risk level assessed at intake, 

parents are assigned into one of three program service level groups. All families in the HV program receive 

an initial six NPP lessons, with the total number of program lessons determined by their AAPI assessment 

level and discussion between the home visitor and the client: Prevention Group 16 lessons; Intervention 

Group 27 lessons; Treatment Group 55 Lessons. This minimum level of eight hours was developed based 

on the historical patterns of B&B program participation and an assumption of program effectiveness. The 

impact of HV program dosage on outcomes was measured for the first time by B&B in the following 

evaluation. 

 

1

 To learn more about the NPP curricula, visit http://www.nurturingparenting.com/ . 
AmeriCorps Impact Study | B&B Home Visitation Program

Program Delivery: Program services are delivered through the nine FRC sites, which are located in highneed communities with a concentrated risk for child maltreatment and CPS involvement: 

 Arcade Community Center  North Sacramento Family Resource Center 

 Firehouse Community Center  River Oak Family Resource Center at Dunlap House in 

 Folsom Cordova Community Partnership Oak Park 

 La Familia Counseling Center  Valley Hi Family Resource Center 

 Meadowview Family Resource Center  WellSpace Health’s North Highlands Multi-Service Center 

Each FRC has a service delivery team, including a Program Manager, Team Leader, Crisis Intervention 

Specialist, Family Resource Center Coordinator, and a multi-disciplinary team of professionals from 

Sacramento County substance abuse treatment, mental health, child protective services, and welfare to 

review cases. The Team Leader supervises the AmeriCorps Home Visitors at each FRC. Members receive 

extensive training at the onset of their term and shadow subsequent team members prior to being 

assigned families. Once a referral is received the Team Leader assesses the referral for appropriateness 

for B&B and matches a member with the family. Members carry an average caseload of 15 families. 

Members receive a minimum of one hour of supervision weekly. 
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Figure 1 | Map of Home Visitation Clients Served by AmeriCorps Members (2013-2015) 

and B&B Family Resource Centers in Sacramento County
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Evaluation Design 

This evaluation incorporates measures of short-term and medium-term outcomes for those families with 

children 0-5 years, who have been served by AmeriCorps members and have received HV program 

services between September 2013 to August 2015. A quasi-experimental design is used to measure 

recidivism into the Sacramento County Child Protective Services system and includes four primary 

research questions that address the continuum of desired program outcomes. 

1. What proportion of HV program participants completed their assigned lesson plans based 

upon their initial program groups? What proportion of the participants receive the 

performance targeted minimum amount of program services (i.e., 8 hours)? 

2. Do parents receiving at least eight hours of home visitation programming show significant 

improvement in their parenting attitudes and practices as measured by the AAPI? 

3. Do parents with previous CPS referrals receiving any home visitation services, have lower 

rates of subsequent CPS involvement compared to similar parents who did not participate? 

4. What is the optimal range of HV program hours, for parents with previous CPS referrals to 

have reductions in subsequent CPS involvement compared to similar parents who did not 

participate? 

The evaluation measures the degree to which these parents completed their program plans, experienced 

changes in their assessed parenting skills/risk for child maltreatment, and compares the rate of CPS 

referrals during and after program participation to non-B&B families. Figure 2 summarizes the AmeriCorps 

HV program logic model to demonstrate how these measures are related. For the full logic model, see 

Appendix III. 

Figure 2 | Continuum of AmeriCorps B&B Home Visitation Evaluation Measures 

Program 

Intervention

•NPP Home 

Visitation 

Program 

Outputs

•Complete 

Parenting 

Lessons 

Short-Term

Outcomes

•Increase 

Parenting 

Skills

Medium-Term 

Outcomes

•Decrease CPS 

Recidivism

B&B participant and case management records are used in this evaluation to report participant 

demographics and to measure program completion and average program dosage. Change in parenting 

skills are measured by a pre-post-comparison of participant AAPI scores. 

Due to the constraints in developing a control group that significantly represents B&B participants, the 

rate of CPS recidivism is examined only for those B&B participants with at least one prior CPS referral. 

Over two-thirds of the HV participants (69%) had at least one prior CPS referral which may or may not 

have been substantiated, and were included in the referral if their role was the: 1) perpetrator; 2) nonperpetrator adult but residing in the household (e.g., non-perpetrating mother); or 3) victim when a 

minor. 

A comparison group was constructed from CPS referral records of non-B&B participants who had similar 

referral histories and demographic profiles using propensity score matching. CPS referrals between the 
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B&B participant group and the comparison group were tracked over similar time periods to measure the

impact of program participation on CPS recidivism. 

Summary of Evaluation Results 

Parenting Lesson Program Completion 

The immediate desired output for HV program participants is that they will have completed their assigned 

NPP lesson plans at the time of their case closure. NPP lesson plans are based on the risk assessed through 

the AAPI score and discussion with the home visitor and family. Participants with relatively lower risk 

were assigned 16 lessons (Prevention), those with medium risk were assigned 27 lessons (Intervention), 

and those with the highest risk were assigned 55 lessons (Treatment). Figure 3 below shows the 

proportion of HV program participants assigned into the three program service levels. Over half (57%) of 

the parents were assigned to the medium dosage (Intervention) service level group. About a quarter (24%) 

of the parents were in the higher (Treatment) service level group and 19 percent were assigned to the 

lower (Prevention) service level group. 

Parents ‘complete’ their program, when they have received the full ‘dosage’ of lessons in their assigned 

group. At the closure of the HV case, AmeriCorps members record if the parent has completed his or her 

program goals as planned. A total of the percentage of parents who achieved the identified minimum 

level of eight hours of program participation are also reported in Figure 3 below. 

Figure 3 | Percentage of Parents Receiving at Least 8 Hours of HV Program and 

Completing Program Plan by NPP Cohort Group

 
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Overall, 28 percent of HV program participants completed the full series of lessons in their assigned group; 

however this proportion varied significantly between groups with 13 percent of the Treatment Group 

completing the assigned 55 lessons. The proportion of HV program participants receiving a minimum of 

eight hours programming was more consistent across groups ranging from 70 percent for the Intervention

Group and 59 percent for the Treatment Group, with a 67 percent minimum completion rate across all 

groups.

Change in Parenting Skills | Pre-Post AAPI Comparison 

The AAPI assessment measures parent beliefs and practices along five constructs known to contribute to 

child maltreatment: 

A. Expectations of Children; 

B. Parental Empathy towards Children’s Needs;

C. Use of Corporal Punishment 

D. Parent-Child Role; and 

E. Children’s Power. 

Scores for each of the dimensions are standardized on an index from 1 to 10. Scores ranging from 1-3 are 

considered “high risk”, those ranging 4-7 are “medium risk” and scores 8-10 are considered “low risk". In 

order to validate the identified minimum program dosage of eight hours, pre and post program AAPI 

scores were compared for those participants with a closed case and receiving at least eight hours of HV 

services. With the exception of one2, all parenting dimensions across all three groups showed statistically 

significant improvement at the p<0.001 level. 

Comparison of the average change across the three service level groups demonstrates the average levels 

of risk in which participants entered the program and their relative improvement at their case closure. 

Figure 4 shows that participants in the Prevention Group began the program with the highest average 

AAPI pre-test scores and that each construct score increased by at least 0.5 points, except the Children’s

Power construct which only increased by 0.1 points. 

 

2

See Figure 5 – The Power construct, related to placing high value on children’s independence, for the low risk 

group was the only measure that did not show a statistically significant improvement.
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Figure 4 | Pre/Post Comparisons of AAPI Assessment Scores: Prevention Group (n = 137)

Parents in the Intervention Group saw an average increase of at least 0.5 points from pre- to post-test. 

On average, the Empathy construct scored the lowest among the constructs and accordingly, saw the 

greatest increase at 1.3 points (see Figure 5). 

Figure 5 | Pre/Post Comparisons of AAPI Assessment Scores: Intervention Group (n = 330) 

Finally, the parents in the Treatment Group had all scores increase the greatest amount, by at least 1.0 

point, with the Empathy construct showing the largest average increase (2.3 points). Overall, the average 

risk levels from each of the five constructs improved to the extent that the high risk parents left the 

program with AAPI risk scores within the medium risk range (see Figure 6).
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Figure 6 | Pre/Post Comparisons of AAPI Assessment Scores: Treatment Group (n = 80)

In summary, all parents who participated in the HV program lessons for at least eight hours showed 

statistically significant gains in their parenting attitudes and practice. Improvement was seen across all 

risk groups, with the highest risk parents showing the greatest improvement and an overall reduction in 

their risk level. 

CPS Recidivism | Quasi-Experimental Comparison

In order to estimate the effects of HV program participation on recidivism into the CPS system, a quasiexperimental comparison was conducted between program participants who had at least one CPS referral 

and other individuals with prior CPS referrals. The study used HV program data and CPS referral records 

to match on key demographic and CPS referral history variables between the HV program participants and 

a hypothetically eligible pool of parents. This process - propensity score matching - identifies individuals 

to be included in a comparison group who have a statistically balanced likelihood to have participated in 

the HV program without using a random assignment. The initial sample included 496 HV program

participants and 9,210 comparison parents. The propensity score matching process yielded matches for 

493 program participants and 985 comparison individuals from the CPS records (i.e., two ‘matched’ 

comparison individuals were identified for each program participant).

In the process of constructing the comparison group, several interesting findings were identified when 

examining the unmatched differences between HV program participants and the comparison group. In 

contrast to a similar population of individuals (e.g., women with at least one child 0-5) with referrals in 

the same time period, HV program participants were more likely to be from a minority group (non-white), 

were an average of three years younger than comparison individuals, and were on average younger at the 

time of their first referral (i.e., 17 years old vs. 24 years old). In terms of past CPS referral history, HV 

program participants were more likely to have been a victim, with more severe victimization, and had 

overall more referral history than the comparison group. These comparisons indicate that B&B is 

successfully engaging a high-need population with their HV program.
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After the matching process, most of these significant differences between the program group and the 

comparison group were eliminated, and any remaining significant factors were controlled for in the final 

analysis. Subsequently, a comparison was made between the groups in terms of two outcome variables: 

1) occurrence of only those referrals that were substantiated; and 2) occurrence of any type of subsequent 

CPS referral (i.e., substantiated, inconclusive, unfounded, or pending). A survival analysis was used to 

determine the differences in CPS recidivism between the HV participants and the comparison group over 

time. This kind of analysis is particularly well suited to studying recidivism and can predict not only 

whether or not an event will occur, but the probability that the event will occur at a particular point in 

time. 

As part of the survival analysis, Cox Regression was then used to predict the probability of referral based 

on the number of days since the participant entered the program (for the B&B HV program group) or 

became hypothetically eligible for the program (for the comparison group). Survival analysis is a useful 

analytical tool when each individual in a study is entering the HV program (or becoming eligible for the 

HV program) at a different point in time, and the probability of recidivism changes as time goes on. For 

example, an individual who entered the program in 2011, would have had significantly more time to have 

a referral to CPS than an individual who entered the program in 2015. To account for this, the model 

predicts the probability of having a referral as a function of time, program participation, and baseline 

characteristics (demographic and prior referral history variables). A detailed technical discussion of the 

propensity score matching process and analyses is included in Appendix II. 

Analyses were conducted looking at the effect of any program participation on CPS referrals and also to 

identify the optimal dosage range of program participation to predict significant impact. Each of these 

analyses are discussed below. All results are for parents with children 0-5 years old during the program 

period, who had a prior history of CPS referrals, and who were directly served by an AmeriCorps member. 

Table 1 | Summary of Cox Regression Analysis Results 

between HV Program Group & Comparison Group 

Subsequent CPS Referrals

Home Visiting 

Program Dosage

Independent Variables

Outcome/Dependent Variables

Outcome #1: 

Substantiated Referrals 

Only

Outcome #2:

All Referrals

(pending, unfounded,

inconclusive, substantiated)

HV Program Group HV Program Group

Any participation 41% less likely3 18% less likely

(1+ hours) to have a to have

substantiated referral* any referral

HV Program Group HV Program Group

Optimal participation 173% less likely 57% less likely

(identified at 25-34 hours) to have a to have

substantiated referral* any referral*

 

*Finding is statistically significant to p<.05 level

 

3

 All percentage differences in this table refer to hazards ratios, which give the probability difference of recidivism 

at t time X, provided that the individual has not already recidivated. 
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Table 1 summarizes the results from the Cox Regression analysis and outlines the relationships between 

the two different dosages of any HV participation (1 or more hours, and 25-34 hours) and subsequent CPS 

referrals (substantiated referrals only, and all referrals). HV parents who participated in the B&B program 

for at least one hour were 41 percent less likely to have a substantiated referral (statistically significant at 

the p <.05 level) and 18 percent less likely to have any referral at a given point in time (significant at the 

p <.10 level). The evaluation was initially to look at the stated minimum dosage for ACSN performance 

measurement purposes (i.e., 8 or more hours); however, a program participation range of 8-100 hours 

was not useful to determine an optimal range and further analysis was conducted to narrow the dosage. 

Thus, HV participation at 25-34 hours was identified as producing the most statistically significant impact 

on CPS recidivism and thus the optimal dosage for impacting the subsequent CPS referrals. B&B HV 

participants were 173 percent less likely to have a substantiated referral and 57 percent less likely to have 

any type of referral at a given point in time; both findings are significant at the p <.05 level.

Please see Appendix II for a more detailed description of each model and the full results of the Cox 

regression.

Effects of Any Program Participation (1+ Hours) on CPS Recidivism

Substantiated Referrals Only | Parents who participated in at least one hour of the B&B home visitation 

program were significantly less likely to have a substantiated CPS referral after they began the B&B HV 

program than those who did not receive any program services. Specifically, being in the HV program group 

rather than the comparison group decreased the probability of having a substantiated referral by 41 

percent at a given time point when all other variables were held constant. Across both groups, the 

probability of having a substantiated referral is relatively low—only 15.4 percent of individuals in the 

sample have a subsequent substantiated referral and on average the first substantiated referral occurs 

about 529 days after the start of the program period. However, the probability of recidivism increases the 

more time passes, with the comparison group’s risk for recidivism increasing to a larger extent over time 

than the HV program group.

All Referrals | A similar pattern emerges when predicting the number of days before any type of referral 

occurred (i.e., substantiated, inconclusive, unfounded, and pending/unknown dispositions) and where the 

client was the perpetrator or other adult; however, this difference was only marginally significant (p < 

0.10). Parents who received any home visitation were less likely to have a CPS referral after they began 

the program than those who did not receive any HV program services. Specifically, being in the HV 

program group rather than the comparison group decreased the probability of having a CPS referral by 18 

percent at a given time point when all other variables were held constant. Overall 48.5 percent of the 

entire sample had a CPS referral during the post-period, with the average person having their first CPS 

referral approximately 335 days after the start the program. CPS referrals with any disposition occur more 

frequently than only substantiated referrals, and occur earlier on average in the post-period. However, a 

similar pattern emerged over time with the probability of having a referral increasing as more days pass 

and increasing more over time for the comparison group than the program group. Given that these results 

were only marginally significant they should be interpreted with caution, but they do provide preliminary 

evidence of the program’s impact on all CPS referrals that could be explored in future studies. 

Effect of Optimal Program Participation on CPS Recidivism

Substantiated Referrals Only | Parents who received between 25-34 hours of HV programming were 

significantly less likely to have a substantiated referral after they began the program than those who did 
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not receive services. In particular, parents who received 25-34 hours of home visiting were 2.73 times less 

likely at a given time point (representing a 173 percent decrease) to have a substantiated referral than 

those in the comparison group. However, when the HV participants are divided into dosage groups, there 

were no statistically significant differences between the comparison group and program group for those 

parents who received less than 25 hours of face-to-face service or for those who received more than 34

hours of service. This suggests that participants who receive between 25-34 hours of service receive the 

maximum benefit from the HV program in terms of preventing substantiated referrals. Overall, the rates 

of substantiated CPS referrals in a given time period are relatively low; however, the difference is notable 

when comparing the dosage of participation in the HV program. Parents in the program group receiving 

less than 25 hours of HV programming had a rate of substantiated CPS referrals of 13 percent, compared 

to those parents receiving 25 hours or more who had a rate of 9 percent.

All Referrals | When predicting the number of days before all types of CPS referrals, a similar pattern 

emerged. Once again, parents who received between 25-34 hours of HV programming were significantly 

less likely to have any type of CPS referral after they began the program than those who did not receive 

HV services. In particular, parents who received 25-34 hours of home visitation were 57 percent less likely 

at a given time point to have any CPS referral than those in the comparison group. However, there were 

no statistically significant differences between the comparison group and HV participants who received 

less than 25 hours of face-to-face service and those who received more than 34 hours of service. This 

suggests that participants who receive between 25-34 hours of service receive the maximum benefit from 

the home visitation program in terms of preventing any type of CPS referral. 

Key Findings & Recommendations 

Since 2002, the annual evaluations of the Birth and Beyond Home Visitation Program and parents served 

by AmeriCorps members have suggested the positive impacts of program participation on desired 

individual outcomes. This evaluation was the first time these impacts were confirmed through the use of 

a quasi-experimental study. Key findings from study research questions provide evidence about the 

benefits received by program participants as well as help identify potential areas for future HV program 

modification. 

Parents completing their assigned NPP program hours are in the minority. Less than one-third (28%) of 

the parents with closed cases completed their assigned dosage of NPP lessons. This number shrinks more 

than half (13%) when looking at those parents who came into the program at the highest risk levels. The 

NPP program is competency-based, which means that parents do not ‘complete’ a lesson until they 

demonstrate the skills, knowledge, and attitudes a lesson was intended to improve. It could be the trend 

that the majority of the parents have far too many intervening factors that frustrate their participation in 

the program and/or their ability to demonstrate improvement in their competency levels needed to 

advance along in their program schedule. The very low completion rate could also indicate that engaging 

high-risk parents, for example, in 55 hours of home visitation is an unrealistic programmatic goal. The 

level of programming may inadvertently discourage program participants as too overwhelming of an 

objective to achieve, with the unintended result of producing a high attrition rate for the program (i.e., 

55% either dropping out or no longer responsive to contact). 
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Parents receiving at least eight hours of HV program services show statistically significant improvement 

in their parenting attitudes and behaviors. Despite the high attrition rate, program participants are 

showing statistically significant improvement (at the p<0.001 level) in their parenting skills and attitudes 

as demonstrated by the average improvement in the AAPI constructs. This suggests that even though 

program participants may not be reaching their program goals in terms of hours, their levels of risk for 

child abuse and neglect is being reduced from those NPP lessons they do receive. Parents entering the 

program at the highest risk levels are showing the greatest gains in their AAPI scores (i.e., decrease in risk 

levels). 

As a result of any level of participation in the home visitation program, parents with previous CPS 

history reduce the likelihood of future substantiated referrals. This study shows a statistically significant 

difference between parents receiving HV services and those who did not. Being in the HV program group 

rather than the comparison group decreased the probability of having a substantiated referral by 41 

percent at a given time point (p <0.05) and the probability of having any CPS referral by 18 percent at a 

given time point (p <0.10) when all other variables were held constant. 

As a result of receiving 25-34 hours of HV program services, parents with previous CPS history 

demonstrated the greatest reduction in post-program referrals of any kind. In particular, parents who 

received 25-34 hours of HV program were 173 percent less likely at a given time to have a substantiated 

referral and 57 percent less likely at a given time to have any CPS referral, than those in the comparison 

group (both at the p < 0.05 level). However, when divided into dosage groups, there were no statistically 

significant differences between the comparison group and HV participants who received less than 25 

hours of face-to-face service and those who received more than 34 hours of service. This suggests that 

participants who receive between 25-34 hours of service receive the maximum benefit from participation 

in the program. 

Note that the CPS recidivism study did not address HV program effect on subsequent CPS referrals for those 

parents without a prior CPS referral history. However, these findings do confirm that any participation in 

the HV program makes a significant impact in preventing substantiated CPS referrals for those parents 

with CPS history, and a low-level dosage of the program makes a significant improvement in parenting 

attitudes and practices across all parents with at least eight hours of participation. Thus we can infer with 

the evidence from this study that participation in the Birth and Beyond HV program resulted in the 

reduction of parental risk and incidences of child maltreatment. 

Several recommendations are suggested based upon the above findings. 

Recommendation #1 | Consider aligning the dosage of the home visitation program towards the 

optimal 25-34 hour range. Parents with previous CPS history show significant impacts in their CPS 

recidivism after receiving this identified dosage of HV program service. While identifying the optimal range 

of program dosage across all participants, this finding does not address the current NPP program model 

in which parents are assigned a scaled number of lessons according to their assessed risk levels. Given the 

finding that relatively few parents in the High Risk group (and a minority of the other risk groups) actually 

complete their NPP lessons as prescribed, it is recommended that B&B recalibrate the assigned program 

to a more achievable and impactful level. That is, it may be the most effective for all participants to receive 

a core program dosage with the 25-34 hour target regardless of assessed risk level, noting that there was 

no significant effect on CPS recidivism for those participating in the HV program outside of this range. 

Looking at the current sample of parents who closed during the study period (including those without CPS 
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history), 13 percent of the closed cases (143 parents) received 25-34 hours of the HV program and 18 

percent (197 parents) received 35 hour or more. It should be noted that parents participating more than 

34 hours in HV programming may continue to accrue other types of important benefits such as 

strengthening their parenting knowledge, skills, and attitudes and/or connecting to other types of 

program services and supports.

Recommendation #2 | Explore strategies to address program attrition in order to ensure parents are 

receiving optimal level of HV program dosage. While this evaluation provides evidence of the 

effectiveness of the HV program, it equally underscores the need for participants to be engaged in the 

program for a considerable length of time. We recommend that B&B focus on their rates of participant 

attrition, in order to retain a higher proportion of those parents entering the program. High drop-out rates 

are a given when targeting highly vulnerable and at risk populations. B&B has already taken a significant 

step in addressing the surrounding vulnerabilities of the families it serves through their Crisis Intervention 

Services. We recommend that B&B conduct research with their FRC sites and the HV participants to 

understand and address why approximately half of the participants drop out of the program after 

receiving some HV services. 

Recommendation #3 | Consider additional research to explore remaining and emergent questions from 

this study about effectiveness and impact. The current study demonstrates that parents participating in 

the HV program are making significant gains in their parenting attitudes and practices, in addition to 

confirming the impact of the program in lowering probability of recidivism among HV participants. While 

these findings provide evidence of the HV program’s overall impact, the study also generated more 

nuanced questions that remain to be explored. 

Unpacking Dosage Effects. The current report examined dosage effects exclusively as a function of the 

number of hours of face-to-face home visitation services. While the current report notes that 25-34 hours 

seems to be the most effective dosage amount, it may be useful for future studies to narrow this dosage 

window and determine which activities (if any) are most essential to effective home visitation services. 

While home visitation is a primary intervention in the B&B program, it is not the only service in which 

parents participate. Future research is needed to determine how recidivism varies as a function of 

participation in other key program components such as group parenting classes, crises intervention 

services, personal development classes, and community supports. 

Limiting Recidivism to Closed Cases. The CPS recidivism was looked at from the point at which women 

enter the HV program after a triggering referral (i.e., before they complete their lessons or their case is 

closed). This may not be the ideal model for measuring recidivism because it does not take into account 

that the conditions around child endangerment often require a significant amount of time regardless of 

program participation (e.g., a mother leaving an abusing partner or relocating into a new 

environment/home). It may be more appropriate to model recidivism only after the HV program has been 

completed. The current timeframe was used because we were unable to identify a satisfactorily 

comparable date for the comparison group. The current model assumes that even if the program works 

as intended it may take time for benefits to emerge; however, once the program has been completed 

recidivism should be especially unlikely. One way to examine this effect in future research would be to 

measure referrals only after the HV case has closed (as well as after a closure of eligibility date for the 

comparison group) and look at how these subsequent referrals differ as a function of dosage in the HV 

program group. 
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AAPI Risk Levels and Stratified Results. In addition to examining recidivism it would be helpful for future 

studies to examine the impact of program participation and program dosage on parenting attitudes and 

practices as measured by the AAPI. It would be useful to determine if there is a significant relationship 

between the initial assessed risk from the AAPI and subsequent CPS referrals, and the extent to which 

growth in the AAPI score can predict CPS recidivism. To the extent that this information can be mapped 

onto program dosage information, it would be useful to determine if the positive findings for the 25-34

hour dosage group replicate equally across AAPI risk cohorts (High, Medium, and Low Risk Groups).

Accounting for Case Information. One limitation of the current study is that some individuals with open 

CPS cases may have been included in the comparison group even though the HV program is not available 

to families who have an open case. For this evaluation, it was not feasible to map the multiple dates in 

the CPS case data set which is organized by child records, onto the comparison CPS referral dataset, which 

is organized by adult record, and isolate only those referrals which were open, and which were closed. It 

was possible to identify which adults had an open case at the point of eligibility or after, but this 

information could not be linked to specific referrals. In future studies this information could be used to 

model the exact periods during which individuals would or would not be eligible for the program as a 

result of their family case status.

Additional Demographic and History Variables. Given the limited number of shared demographic variables 

available across the program and comparison groups, the current evaluation was limited to modeling and 

controlling for demographic differences according to race (white vs. non-white), age, and primary 

language. It would be useful to control for and analyze other important demographic covariates such as 

educational background and socio-economic status in the future. This report uses CPS referral history as 

a proxy for each individual’s history of abuse; however, CPS data rarely includes all the incidents of abuse 

in an individual’s past. To get a better sense of the actual abuse history of each individual it would be

useful for future studies to include any additional abuse history information that might be available--such 

as the results of any Structured Decision Making (SDM) child abuse and neglect risk assessments which 

may have been performed. 
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APPENDIX I | B&B PROGRAM DATA ANALYSIS 

Participant Demographics & Sample 

Detailed participant information is collected during the intake of all families. These data as well as program 

participation information are recorded into a central Birth and Beyond database which is regularly 

updated and cleaned by LPC. 

Between September 1, 2013 and July 31, 

Figure 7 | Demographics of all HV Program Participants Served 

by AmeriCorps Members Sept 2013 to July 2015 (n=1,312) 

2015, AmeriCorps members served 1,614 

families with at least one home visit through 

the B&B program. This represents a total of 

1,758 individual cases. A number of these 

cases were removed from the sample 

population for the purposes of this report to 

allow for comparability across measures and 

results: cases assigned to the Father’s Group 

(n=45 men); the Prenatal Group (n=50

women); had yet to be assigned (n=102); or

unknown (n=5). Families with multiple 

entries into the program were also filtered 

(n=383). The resulting base sample includes 

1,312 parents who were assigned to one of 

three program service level groups (i.e., 

Prevention, Intervention, and Treatment) in 

the HV program. Individual demographic 

data reported are related specifically to the 

primary parent. The sample primarily 

included people who identified as African 

American or Hispanic/Latino, with the 

majority of participants identifying English 

as their primary language. Additional 

demographic information is presented in 

Figure 7. 

Two-thirds of the families (64%) have two or more children at home, and 40 percent reported never being 

married or living with a partner suggesting that many B&B participants parent alone. 

While most participants had at least a high school education, the majority of participants were 

unemployed at the time they participated in the program, and utilized governmental assistance programs, 

such as WIC or food stamps. Figure 8 presents employment status and the usage of governmental 

assistance programs of HV program participants served by AmeriCorps members. 
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Figure 8 | Characteristics of all HV Participants Served by AmeriCorps (n=1,312)

Rates of Program Completion 

During the course of the study period, 82 percent of the cases served by AmeriCorps members closed 

(n=1075). The status of the program lessons and reasons for closure from the case records are noted 

below in Table 2; the status at case closure of 33 participants were missing in the case records. 

Table 2 | Case Status at Closure by NPP Service Level Group 

Prevention Intervention Treatment All Groups

Status at Case Closure # % # % # % # %

Completed program as planned 115 44% 180 30% 23 13% 318 31%

No contact per contact policy 61 23% 212 35% 79 44% 352 34%

Declined further service 52 20% 128 21% 40 22% 220 21%

Moved out of service area, no longer 

eligible 31 12% 66 11% 28 16% 125 12%

CPS case, child safety 4 2% 13 2% 10 6% 27 3%

Total 263 100% 599 100% 180 100% 1042 100%

Parents enrolled in the Prevention Group had the highest rate of completion at 44 percent, which is 

somewhat expected given their lesson dosage is the lowest (16 lessons). In contrast, only 13 percent of 

the Treatment Group completed their program as planned. Looking at those who did not complete their 

program lesson, the majority of all participants across all groups (55%) were closed due to no longer being 

able to contact participants or because they declined further service. 
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Overall, participants served by AmeriCorps members received an average of 19.4 hours of home visitation 

programming. As expected, participants in the Prevention group received the least amount of service at 

16.0 hours on average, while the Intervention and Treatment groups received the most (20.5 hours). 

Table 3 | Average Participation in HV Program by NPP Service Level (Closed Cases n=1,075) 

Prevention

16 Lessons

Intervention

27 Lessons

Treatment

55 Lessons All Groups

Average Visits 12.7 16.9 16.7 15.8

Average Hours 16.0 20.5 20.5 19.4

Received 8+ Hours 180 (67%) 432 (70%) 113 (59%) 725 (67%)

Two-thirds (67%) of all cases closed after receiving at least eight hours of lessons, with the Treatment

group having the lowest proportion of participants receiving the minimum dosage. 

While two-thirds of all participants closing a case during the study period received a minimum of eight 

hours HV programming, only about a third of all participants stayed with the program long enough to 

complete their program goals. The Treatment group, with both the highest risk and the greatest number 

of prescribed lessons, had the lowest rates of program completion and proportion of participants 

receiving at least eight hours of HV programming. 

Pre-Post Comparison of AAPI Assessment 

The Adult-Adolescent Parenting Inventory - 2 (AAPI) is a 40 item, norm-referenced, Likert scale designed 

to assess the parenting beliefs and practices of adult and adolescent parent and non-parent populations. 

The AAPI is designed to assess the beliefs for parenting children from infancy to 12 years of age. Responses 

to the AAPI provide an index of risk for child maltreatment in five parenting practices known to result in 

child maltreatment. The AAPI measures attitudes and behaviors along five constructs of parenting to 

assess change in the parents’ risk for practicing behaviors known to be attributable to child abuse and 

neglect. These five constructs are described in Table 4 below. 

The AAPI provides a level of risk for child maltreatment on three levels: High, Moderate and Low. It is 

administered by an AmeriCorps Home Visitor during one of the first home visits. Parents are assigned a 

program service level group (i.e., Prevention, Intervention, or Treatment) based upon their initial AAPI 

risk level and discussion between the participant and the home visitor. The AAPI is re-administered to 

parents during their participation in the HV program, with the last assessment completed serving as their 

“post” score. Because of client attrition, home visitors periodically administer the assessment to ensure 

the likelihood that there will be a comparison assessment for the high proportion of families who do not 

finish their parenting lessons. A comparison of a pre- and post-AAPI scores provided an understanding of 

how participants’ knowledge and practices changed throughout the HV program. 

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Table 4 | Description of AAPI Parenting Constructs 

CONSTRUCT High Risk Low Risk

Low AAPI Score Description High AAPI Score Description

 Expectations exceed developmental  Understands growth and development.

A. 

capabilities of children.

Lacks understanding of normal child 

 Children are allowed to exhibit normal 

developmental behaviors.

Expectations of 

Children 

growth and development.

Self-concept as a parent is weak and 

easily threatened.





Self-concept as a caregiver and provider 

is positive.

Tends to be supportive of children

 Tends to be demanding and controlling.

 Fears spoiling children.  Understands and values children's 

B.  Children's normal development needs 

not understood or valued. 

needs. 

Children are allowed to display normal 

Parental Empathy 

towards Children’s 







Children must act right and be good. 

Lacks nurturing skills. 

May be unable to handle parenting 



developmental behaviors. 

Nurtures children and encourage 

positive growth. 

Needs stresses.  Communicates with children. 

 Recognizes feelings for children.

 Hitting, spanking, slapping children is  Understands alternatives to physical 

appropriate and required. force. 

C.  Lacks knowledge of alternatives to 

corporal punishment. 

 Utilizes alternatives to corporal 

punishment. 

Use of Corporal  Lacks ability to use alternatives to 

corporal punishment. 





Tends to be democratic in rule making. 

Rules for family, not just for children. 

Punishment  Strong disciplinarian, rigid.  Tends to have respect for children and 

 Tends to be controlling, authoritarian. their needs.

 Values mutual parent-child relationship. 

 Tends to use children to meet self-  Tends to have needs met appropriately. 

needs.  Finds comfort, support, companionship 

 Children perceived as objects for adult from peers. 

D. gratification.  Children are allowed to express 

 Tends to treat children as confidant and developmental needs.

Parent-Child peer.  Takes ownership of behavior. 

Family Roles  Expects children to make life better by 

providing love, assurance, and comfort.

 Tends to feel worthwhile as a person, 

good awareness of self. 

 Tends to exhibit low self-esteem, poor 

self-awareness, and poor social life. 

 Tends to view children with power as  Places high-value on children's ability to 

E. 

threatening. 

Expects strict obedience to demands. 

problem solve. 

Encourages children to express views 

Children’s Power  Devalues negotiation and compromise but expects cooperation. 

and Independence 

as a means of solving problems. 

Tends to view independent thinking as 

 Empowers children to make good 

choices.

disrespectful. 

Scores from the earliest and latest administrations of the AAPI were matched for those HV participants 

who had closed after receiving at least 8 hours of programming. A total of 547 pairs were available for 

analysis (see Table 5 below). 

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Table 5 | Closed HV Participants Receiving at Least 8 Hours of Programming

with Match Pre and Post AAPI Assessments

Prevention

# (% group)

Intervention

# (% group)

Treatment

# (% group)

Total

# (% group)

Matched Pre-Post AAPI Score 137 (80%) 330 (82%) 80 (73%) 547 (80%)

A paired-samples t-test was conducted to compare pre-program and post-program AAPI scores, within 

the five parenting constructs and among each of the three program groups (see Table 6). Overall, 

participants’ average scores increased between the pre- and post-tests, across all the five constructs and 

these increases were found to be statistically significant at the p<0.001 level; one exception was the 

increase in the Power Domain within the low risk group which was not statistically significant. 

Table 6 | Pre-Post Comparison of AAPI Assessment Scores for NPP Service Level Groups 

AAPI DOMAINS

Pre Test Post Test

Paired t

Mean *p <.001

Standard

Deviation Mean

Standard

Deviation

Prevention Group n = 137

A. Expectation 5.98 2.15 6.61 2.05 -3.55*

B. Empathy 6.14 2.46 7.17 2.52 -4.63*

C. Punishment 6.44 2.02 7.31 2.16 -4.78*

D. Roles 6.97 2.66 7.48 2.23 -2.68*

E. Power 6.74 2.21 6.80 2.39 -0.22

Intervention Group n = 330

A. Expectation 5.06 1.84 5.73 1.96 -5.54*

B. Empathy 4.55 2.15 5.93 2.40 -9.48*

C. Punishment 5.56 1.78 6.57 2.01 -8.61*

D. Roles 5.45 2.20 6.47 2.29 -8.25*

E. Power 5.17 2.42 6.43 2.46 -7.86*

Treatment Group n = 80

A. Expectation 3.71 1.82 5.01 2.17 -4.67*

B. Empathy 2.54 1.86 4.81 2.40 -8.19*

C. Punishment 4.46 1.83 5.70 2.39 -4.70*

D. Roles 3.59 2.31 5.13 2.61 -5.79*

E. Power 4.63 2.34 6.08 2.75 -4.01*

The results suggest that parenting skills and attitudes improved over the course of their participation in 

the HV program as measured by the AAPI. Similar gains were seen across the five parenting constructs of 

the assessment with the average increase of 1.1 points for all Groups and Domains. 

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APPENDIX II | QUASI-EXPERIMENTAL COMPARISON OF CPS RECIDIVISM 

Prepared by JBS International, Inc.

Methods 

The current report describes findings based on Child Protective Services (CPS) child abuse allegation data 

and internal data on participation in the Birth and Beyond (B&B) AmeriCorps Home Visitation (HV) 

Program. To be included in the analysis, female participants had to meet the following three criteria: 

1. Be born between January 1, 1970 and December 31, 1999 (approximately 16-45 years old); 

2. Have at least one child born between 9/1/2008 and 7/30/2015; and 

3. Have at least one CPS referral (or have entered the B&B program) after January 1, 2011. 

Data Aggregation and Variables 

To estimate the effects of HV program participation on CPS referrals, JBS International, Inc. (JBS) created 

an aggregated dataset predicting CPS outcomes at the individual level for HV participants and a 

comparison group. This dataset consisted of prior referral history data (pre-data) and outcome data (postdata) for each participant. For the HV group, all CPS allegations up to and including the start date of the 

HV program were considered pre-data, while all referrals after that were considered post-data. For the 

comparison group, all referrals up to and including their first referral post-2011 were considered pre-data, 

and all subsequent referrals were considered post-data. This pre/post cut-off was selected for the 

comparison group since the first post-2011 referral represents the date at which each individual would 

have become eligible for the B&B program.

Demographic and Program Participation Variables. Basic demographic variables included: date of 

birth, gender, ethnicity, and primary language (see Table 8). HV program participation variables included: 

the intake date, the date they ended the program, whether or not they received services from AmeriCorps 

members, and the number of hours of face-to-face home visitation services they received. 

CPS Allegation History Variables. JBS used a data construction procedure that resulted in a series of 

scores to describe each individual’s CPS allegation history. Each allegation was classified based on five 

categories of abuse (sexual, physical, severe neglect, general neglect, and emotional) and three categories 

describing the individual’s role in the allegation (victim, perpetrator, or other). This information was then 

aggregated to give each individual a score on a total of 15 types of abuse (e.g. Sexual Victimization, Sexual 

Perpetration, etc.). These scores indicated the extent to which each individual had perpetrated, 

witnessed, and/or been victimized in a particular category during their pre- and post-program/eligibility 

period. Scores ranged from 0-3 and were based on whether the individual had no allegations within that 

category of abuse (0), only missing or unfounded allegations (1), only inconclusive allegations (2), or at 

least one substantiated allegation (3). In addition to calculating summary scores for each type of abuse, 

JBS also recorded the date of the first and last allegation, the number of unique referrals, and the age of 

the individual at the date of their first referral. This information was presented separately for each period 

(pre- and post-program/eligibility), and was also broken down by role category (victimization, 

perpetration, and other) and for all referrals and substantiated referrals only. For a more detailed 

description of these data cleaning procedures, please see Table 8.

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Primary Outcome Variables. The primary outcomes analysis was constructed from CPS-allegations 

during the post-program/eligibility period for HV program and comparison individuals. As described in 

greater detail below, a survival analysis was used to measure recidivism4. To model these effects, JBS 

created variables measuring the number of: 

 Days to the first CPS referral during the post-period, regardless of disposition (substantiated, 

inconclusive, unfounded, or pending), where the individual is identified as the perpetrator or 

other adult5 (Any CPS Referral); and 

 Days to the first referral during the post-period where the disposition was substantiated 

(Substantiated Referral). 

Propensity Score Matching 

To assess the impact of participation in the HV program, this evaluation used propensity score matching. 

This process allows the JBS team to compare the outcomes of two groups – one of which received services 

and the other which did not – in a statistically robust manner that provides more plausible evidence that 

program participation is the likely reason for any observed changes on key outcome measures (rather 

than other possible causes). Given the retrospective nature of this study, random assignment was not 

possible and as such propensity score matching was selected as a way of simulating an experimental 

design6. 

In a propensity score matched design, the group that participates in the program and the comparison 

group are not randomly assigned or selected. Because of this, the two groups may differ in both observed 

and unobserved ways prior to matching that could be the explanation for any changes observed in the 

outcomes. Propensity score matching minimizes these differences between the two groups statistically. 

The statistical procedure used in propensity score matching matches program participants with nonparticipants based on an array of characteristics (see Table 7 below for the characteristics used in this 

evaluation), without necessitating a one-to-one match on all factors. For this study, each program 

participant is matched with two non-participants based on a constructed score using the characteristics 

outlined in Table 7. 

 

4

 Operationalized as CPS-referrals in the post-period. 

5

 This category includes referrals where the role of the individual was listed as “Other” and was 17 or older at the 

date of the referral. This composite variable was selected as an outcome because it represents the key actions that 

the HV program is designed to prevent—the perpetration and adult witnessing of abuse (based on the assumption 

that when the individual is an adult witness of abuse they have a responsibility to intervene or remove the child 

from the abusive situation). 

6

See Guo and Fraser (2009) for an introduction on PSM and its applications. 

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Table 7 | List of Parent Characteristics Used in Propensity Score Matching

Demographic 

Characteristics

 Race (White vs. Non-White)

 Primary Language (English vs. Not)

 Age in 2015

Number of Referrals7 and

Age at First Referral

 Number of Unique Perpetrator or Adult Other Referrals8

 Number of Unique Victimization Referrals

 Age at First Referral

Referral Severity

(Ranging from 0-9)9

 Most Serious Victimization Referral 

 Most Serious Perpetration Referral 

 Most Serious Other Referral 

Referral History 

Scored from 0-3 

0 = no referrals,

1 = only pending/missing 

referrals

2 = only inconclusive referrals

3 = at least one substantiated

referral

 Sexual Victimization History

 Physical Victimization History

 Severe Neglect Victimization History

 General Neglect Victimization History

 Emotional Neglect Victimization History

 Sexual Perpetration History

 Physical Perpetration History

 Severe Neglect Perpetration History

 General Neglect Perpetration History

 Emotional Neglect Perpetration History

 Sexual Other History

 Physical Other History

 Severe Neglect Other History

 General Neglect Other History

 Emotional Neglect Other History

Matching Procedures. The propensity scores were generated in SPSS using a logistic regression model, 

and an R plug-in for SPSS (MatchIt10) was used to perform a nearest neighbor 1:2 matching technique with 

calipers of one quarter of a standard deviation. The initial sample included 496 HV participants and 9,210 

comparison participants. The propensity score matching process yielded matches for 493 HV participants 

and 985 comparison participants. 

Baseline Equivalency Prior to the Match. Prior to matching, HV participants appeared to be more atrisk for perpetrating abuse and had more severe abuse histories than comparison individuals. In terms of 

demographics, HV participants were more likely to be minorities, were an average of three years younger 

than comparison individuals, and were on average younger at the time of their first referral (17 years old 

 

7

 All referral history information used in the propensity score matching was based on the referrals that occurred before each 

individual began the HV program or became eligible for the HV program (for comparison individuals). 

8

 This category includes referrals where the individual was listed as the “Perpetrator” at any age or “Other” and was 17 or older 

at the date of the referral. Perpetration referrals and referrals where the individual was an adult listed as “Other” were combined. 

9

 Each type of abuse was ranked based on the demonstrated severity of the abuse shown in prior literature. Scores ranged from 

0-9 where: 0 = No abuse at all, 1 = At Risk, Sibling Abused, 2 = Caretaker Absence/Incapacity, 3 = Substantial Risk, 4 = Emotional 

Abuse, 5 = General Neglect, 6= Severe Neglect, 7 = Physical Abuse, 8 = Exploitation, and 9 = Sexual Abuse.

10 See Ho, Imai, King, & Stuart (2007) for more details on MatchIt.

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vs. 24 years old). In terms of referral history, HV participants had a larger number of victimization referrals, 

a larger number of perpetration or adult other referrals, and more severe victimization and other 

referrals. Furthermore, HV participants were more likely to have had a substantiated victimization referral 

(across all abuse types), were more likely to have had a substantiated physical and general neglect 

perpetration referral, and were more likely to have had a substantiated other referral (across all abuse 

types). Please see Table 8 for a full listing of baseline equivalency results.

Baseline Equivalency After the Match. After the matching, almost all of these significant differences 

between the HV and comparison group were eliminated. The only remaining difference after the match 

was that HV participants were still slightly more likely to have had a substantiated general neglect 

perpetration referral. To address this, JBS included the full set of propensity score variables (listed in Table 

1 above) in the final analysis models as covariates. This strategy allows the analysis to limit the influence 

of any covariates that were not fully equalized through the propensity score matching process. 

Survival Analysis

A survival analysis was used to determine the unique effects of HV participation on referrals into CPS 

(either referrals with a substantiated disposition regardless of the individual role,11 or referrals regardless 

of disposition where the individual’s role was as the perpetrator or other adult) over time. Survival analysis 

models are well-suited to predicting recidivism (in this case, referrals to CPS) because they allow 

researchers to investigate the effect of several variables (e.g., program participation and referral history) 

on the time that recidivism takes to occur (as measured by the number of days before a referral). This 

kind of analysis can predict not only whether or not an event will occur, but the probability that the event 

will occur at a particular point in time. 

In this case, a Cox Regression (or Proportional Hazards Regression) was used to predict the probability of 

referral based on the number of days since the participant entered HV (for the HV group) or became 

hypothetically eligible for HV (for the comparison group). This type of survival analysis accounts for the 

fact that each individual is entering HV (or becoming eligible for HV) at a different point in time and the 

probability of recidivism increases as time goes on. For example, an individual who entered the program 

in 2011, would have had significantly more time to have a referral than an individual who entered the 

program in 2015. To account for this, the model predicts the probability of having a referral as a function 

of time, program participation, and baseline characteristics (demographic and prior referral history 

variables). 

 

11 Substantiated referrals include referrals of any role—victim, perpetrator, and other.

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Results from Analyses 

Do parents with previous CPS referrals receiving any home visitation services, reductions in 

subsequent CPS involvement compared to similar parents who did not participate? 

Effects for Substantiated Referrals. Parents of children 0-5 who received any home visitation from 

AmeriCorps members were significantly less likely to have a substantiated CPS referral after they began 

the program than those who did not receive any HV services. Specifically, being in the HV group rather 

than the comparison group decreased the probability of having a substantiated referral by 41 percent at 

a given time point when all other variables were held constant. Please see Table 9 for a more detailed 

description of the model and the full results of the Cox regression. 

Figure 9 below shows the predicted probability of having a substantiated referral (shown on the y-axis) as 

a function of program participation (as indicated by green and blue lines) and the number of days from 

when an individual began HV or became eligible for HV (shown on the x-axis). This figure shows that 

overall the probability of having a substantiated referral is relatively low—only 15.4 percent of individuals 

in the sample have a substantiated referral in the post-period, and on average, the first substantiated 

referral occurs about 529 days after the start of the HV program. However, the probability of having a 

referral increases as more days pass and increases even more over time for the comparison group than 

the HV group. For example, at zero days there is almost no probability of having a substantiated referral, 

but by 1000 days there is roughly a 9 percent predicted probability of having a substantiated referral in 

the HV group and a 12 percent predicted probability in the comparison group. This gap widens over time, 

suggesting that over time HV participants have a lower probability of having substantiated referrals than 

those who did not receive these services. 

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Figure 9 | At Least One Hour of HV Programming & Substantiated CPS Referrals 

Chart demonstrating that parents who receive any home visitation services (treatment group) have a lower 

probability than the comparison group of having a substantiated referral over time.

Effects for Any CPS Referrals. A similar pattern emerges when predicting the number of days before 

any referrals where the client was the perpetrator or other adult12, however this difference was only 

marginally significant13. Parents of children 0-5 who received any home visitation were less likely to have 

a CPS referral after they began the program than those who did not receive any HV program services. 

Specifically, being in the HV group rather than the comparison group decreased the probability of having 

a CPS referral by 18% at a given time point when all other variables were held constant. Given that these 

results were only marginally significant, they should be interpreted with caution, but they do provide 

preliminary evidence that could be expanded upon in future studies. Please see Table 1 for a more 

detailed description of the model and the full results of the Cox regression.

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Figure 10 below models the predicted probability of having any CPS referral (shown on the y-axis) as a 

function of program participation (as indicated by green and blue lines) and the number of days from 

when individual began HV or became eligible for HV (shown on the x-axis). Overall, 48.5 percent of the 

sample had a CPS referral during the post-period, with the average person having their first CPS referral 

approximately 335 days after the start of the HV program. This suggests that CPS referrals are more 

common than substantiated referrals, and occur earlier on average in the post-period. However, a similar 

pattern emerged over time, with the probability of having a referral increasing as more days pass and 

increasing more over time for the comparison group than the HV group. For example, at zero days there 

 

12 Note. This measure includes both substantiated, inconclusive, unfounded, and pending/unknown dispositions.

13 Marginal significance indicates p-values less than 0.10.

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is almost no probability of having a CPS referral, but by 1000 days there is roughly a 50 percent predicted 

probability of having a CPS referral in the HV program group (compared to a 60% predicted probability in 

the comparison group). This gap widens over time suggesting that HV participants have a lower probability 

of having perpetration or adult other referrals than those who did not receive these services the longer 

they are out of the program. 

Figure 10 | At Least One Hour of HV Programming & Any CPS Referral 

Chart demonstrating that parents who receive any home visitation services (treatment group) have a lower 

probability than the comparison group of having any type of CPS referral over time.

What is the optimal range of HV program hours, for parents with previous CPS referrals to 

have reductions in subsequent CPS involvement compared to similar parents who did not 

participate? 

Dosage Effects on Substantiated Referrals. Parents who received between 25-34 hours of home 

visitation were significantly less likely to have a substantiated referral after they began the program than 

those who did not receive HV services. In particular, parents who received 25-34 hours of home visitation 

were 2.73 times (a 173% reduction) less likely at a given time point to have a substantiated referral than 

those in the comparison group. However, there were no statistically significant differences between the 

comparison group and HV program participants who received less than 25 hours of face-to-face service 

and those who received more than 34 hours of service. This suggests that participants who receive 

between 25-34 hours of service receive the maximum benefit from participation. Please see Table 10 for 

a more detailed description of the model and the full results of the Cox regression.

Figure 11 below models the predicted probability of having a substantiated referral (shown on the y-axis) 

as a function of program dosage (as indicated by the lines labeled on the right) and the number of days 

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from when an individual began HV or became eligible for the HV program (shown on the x-axis). This figure 

shows that the probability of having a referral increases as more days pass. However, this increase is 

generally largest in the comparison group (illustrated with the black line below) and in the HV group who 

received more than 55 hours of home visitation services (illustrated with the red line below)14. Although 

there are no statistically significant differences between the comparison group and HV participants 

receiving 0-25 hours and 34-55 hours of home visitation, there does seem to be a trend suggesting that 

these groups may have a slightly lower probability of recidivism than the comparison group. That said, the 

only HV dosage group which was significantly different from the comparison group (shown in the black 

line below) was the 25-34 hour group (indicated by the purple line below). By the end of the HV period, 

there is roughly a four percent predicted probability of having a substantiated referral in the HV group 

and a 15 percent predicted probability in the comparison group. This gap shows that HV participants who 

receive 25-34 hours of home visitation services have a significantly lower probability of having 

substantiated referrals than those who did not receive these services. 

Figure 11 | Receiving 25-34 Hours of HV Programming & Substantiated CPS Referrals 

Chart demonstrating that parents receiving 25-34 hours of home visitation services (treatment group) have a lower 

probability than the comparison group of having a substantiated CPS referral over time. 

 

14 Note. Here the findings for the comparison group (in black) and the 55+ hours of HV group (in red) appear to be 

very similar and are not significantly different from one another. However, findings for the HV group who received 

more than 55 hours of face-to-face home visitation services should be interpreted with caution given the low 

sample sizes (N=15) and the wide range of hours encompassed (55-78 hours).

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Dosage Effects on Any CPS Referrals. A similar pattern emerges when predicting the number of days 

before any CPS referral15. Once again, parents who received between 25-34 hours of home visitation were

significantly less likely16 to have a CPS referral after they began the program than those who did not 

receive HV services. In particular, parents who received 25-34 hours of home visitation were 57 percent

less likely at a given time point to have a CPS referral than those in the comparison group. However, there 

were no statistically significant differences between the comparison group and HV program participants 

who received less than 25 hours of face-to-face service and those who received more than 34 hours of 

service. This suggests that participants who receive between 25-34 hours of service receive the maximum 

benefit from participation. Please see Table 10 for a more detailed description of the model and the full 

results of the Cox regression.

Figure 12 below models the predicted probability of having any CPS referral (shown on the y-axis) as a 

function of program dosage (as indicated by the lines labeled on the right) and the number of days from 

when individual began the HV program or became eligible for the HV program (shown on the x-axis). This 

figure shows that the probability of having a referral increases as more days pass. However, this increase 

is generally largest in the comparison group (shown in the black line below) and in the HV group who 

received more than 55 hours of home visitation services (shown in the red line below)17. Although there 

were no statistically significant differences between the comparison group and HV participants receiving 

0-25 hours and 34-55 hours of home visitation, there did seem to be a trend suggesting that these groups 

may have a slightly lower probability of having a CPS referral than the comparison group. That being said, 

the only HV group which was significantly different from the comparison group (shown in the black line 

below) was the 25-34 hour group (indicated by the purple line below). By the end of the HV period there 

was roughly a 40 percent predicted probability of having a CPS referral in the 25-34 hour HV group (shown 

in the purple line below) and a 65 percent predicted probability in the comparison group (shown in the 

black line below). This gap shows that HV AmeriCorps participants who receive 25-34 hours of home 

visitation services have a significantly lower probability of having CPS referrals than those who did not 

receive these services.

 

15 Note. This measure includes both substantiated and unsubstantiated referrals. 

16 These results are marginally significant, p=0.055. 

17 Note. Findings for the HV program group who received more than 55 hours of face-to-face home visitation services 

should be interpreted with caution given the low sample sizes (N=15) and the wide range of hours encompassed 

(55-78 hours). Also, please note that there are no statistically significant differences between participants in the 55+ 

hours HV group and the comparison group. The results presented are Hazards Ratios, which can be above 1. 

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Figure 12 | Receiving 25-34 Hours of HV Programming & Any Type of CPS Referral

Chart demonstrating that parents receiving 25-34 hours of home visitation services (treatment group) have a lower 

probability than the comparison group of having any type of CPS referral over time.

Conclusions

This study suggests that being in the B&B home visitation group rather than the comparison group 

decreased the probability of having a substantiated referral by 41 percent and the probability of having 

any CPS referral by 18 percent at a given time point when all other variables were held constant. In 

particular, parents who received 25-34 hours of home visitation from HV AmeriCorps members were 173 

percent less likely at a given time point to have a substantiated referral and 57 percent less likely at a 

given time point to have any CPS referral than those in the comparison group. However, there were no 

statistically significant differences between the comparison group and HV participants who received less 

than 25 hours of face-to-face service and those who received more than 34 hours of service. This suggests 

that participants who receive between 25-34 hours of service receive the maximum benefit from 

participation in the program and the program may want to target this level of service in the future.

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Table 8 | Means, Percentages, and Standard Deviations (SD) for All Study Variables 

Unmatched Matched 2:1

Treatment Control Treatment Control

(N=496) (N=9,210) (N=493) (N=985)

Mean/ Mean/ SD Mean/ SD SD Mean/ SD

Variables Percent Percent Percent Percent

Demographics

Person was White (versus nonwhite) 29.20 - 36.70 *** - 29.40 - 30.60 -

Person's primary language was English (versus any 83.70 - 82.90 - 83.60 - 87.00 - other)

Age in 2015 27.46 6.28 30.39 *** 6.11 27.48 6.28 27.54 5.41

Unique Referrals at/Before Point of Eligibility for the Program

Number of Unique Perpetrator or Other (restricted to 2.94 4.43 1.92 *** 2.52 2.87 3.80 2.61 3.71 those when person was 17 or older) Referrals 

Number of Unique Victim Referrals 2.41 3.74 0.70 *** 2.04 2.35 3.61 2.35 3.53

Age of Person's First Referral 16.56 10.14 23.67 *** 9.61 16.63 10.12 16.62 9.76

Most Serious Type of Referral at/Before Point of Eligibility for the Program

Most Serious Victimization Referral (Range 0 to 91) 3.71 3.79 1.41 *** 2.88 3.69 3.78 3.89 3.82

Most Serious Perpetration Referral (Range 0 to 9) 3.54 2.83 3.59 2.70 3.54 2.84 3.49 2.77

Most Serious Other Referral (Range 0 to 9) 6.97 1.64 6.56 *** 1.44 6.96 1.64 6.98 1.53

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Presence of Specific Referral Dispositions at/before Point of Eligibility for the Program

Victim

Sexual2 Victimization (Range 0-3

3

)

0.34 0.80 0.11 *** 0.47 0.34 0.80 0.37 0.82

Physical Victimization (Range 0-3) 0.62 0.99 0.21 *** 0.63 0.60 0.98 0.53 0.99

Severe Neglect Victimization (Range 0-3) 0.25 0.77 0.07 *** 0.43 0.25 0.77 0.25 0.76

General Neglect Victimization (Range 0-3) 0.84 1.11 0.29 *** 0.77 0.84 1.11 0.83 1.13

Emotional Neglect Victimization (Range 0-3) 0.21 0.68 0.09 *** 0.43 0.21 0.67 0.27 0.73

Perpetrator

Sexual Perpetration (Range 0-3) 0.02 0.17 0.01 0.12 0.02 0.17 0.01 0.13

Physical Perpetration (Range 0-3) 0.28 0.68 0.21 * 0.59 0.28 0.69 0.21 0.58

Severe Neglect Perpetration (Range 0-3) 0.17 0.64 0.14 0.58 0.17 0.64 0.16 0.62

General Neglect Perpetration (Range 0-3) 1.14 1.17 0.95 ** 1.03 1.13 1.16 0.95 ** 1.04

Emotional Neglect Perpetration (Range 0-3) 0.08 0.39 0.05 0.30 0.08 0.39 0.50 0.90

Other

Sexual Other (Range 0-3) 0.49 0.88 0.26 *** 0.67 0.48 0.88 0.50 0.90

Physical Other (Range 0-3) 1.40 1.11 0.99 *** 1.04 1.39 1.10 1.28 1.09

Severe Neglect Other (Range 0-3) 0.64 1.14 0.37 *** 0.91 0.64 1.14 0.66 1.15

General Neglect Other (Range 0-3) 1.88 1.04 1.48 *** 1.04 1.87 1.04 1.80 1.05

Emotional Neglect Other (Range 0-3) 0.51 0.94 0.31 *** 0.75 0.50 0.93 0.57 0.97

*p<.05; **p<.01; ***p<.001 (treatment compared to comparison group).

1

See item 1c in Appendix B for details of the 0-9 scoring

2

 See item 2a in Appendix B for details of the allegation type groupings

3

See item 2b in Appendix B for details of the 0-3 scoring

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Table 9 | Cox Regression for Hazard of Recidivism as a Function of Treatment (N=1,478)

Substantiated Referral Any Type of Referral

Independent Variable O.R. se B O.R. Se B

Treatment 0.71 0.15 0.34 * 0.85 0.08 0.16 +

Demographics

Person was White (versus nonwhite) 1.37 0.14 0.31 * 1.25 0.08 0.22 **

Person's primary language was English (versus any other) 1.09 0.25 0.08 1.62 1.41 0.48 **

Age in 2015 1.02 0.02 0.02 1.03 0.01 0.03 *

Unique Referrals at/Before Point of Eligibility for the Program

Number of Unique Perpetrator or Other (restricted to those when person was 17 or 

older) Referrals 1.06 0.02 0.06 ** 1.06 0.01 0.06 ***

Number of Unique Victim Referrals 1.01 0.03 0.01 1.02 0.02 0.02

Age at Person's First Referral 0.98 0.02 -0.02 0.98 0.01 -0.02 *

Most Serious Type of Referral at/Before Point of Eligibility for the Program

Most Serious Victimization Referral (Range 0 to 9) 1.00 0.04 0.00 0.98 0.02 -0.02

Most Serious Perpetration Referral (Range 0 to 9) 0.89 0.04 -0.11 ** 0.95 0.02 -0.05 *

Most Serious Other Referral (Range 0 to 9) 0.94 0.08 -0.06 0.91 0.04 -0.10 *

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Presence of Specific Referral Dispositions At/Before Point of Eligibility for the Program

Victim

Sexual Victimization (Range 0-3) 1.05 0.10 0.05 0.98 0.06 -0.02 *

Physical Victimization (Range 0-3) 1.10 0.09 0.10 1.01 0.06 0.01

Severe Neglect Victimization (Range 0-3) 0.94 0.10 -0.06 1.01 0.06 0.01

General Neglect Victimization (Range 0-3) 0.99 0.09 -0.01 0.98 0.06 -0.02

Emotional Neglect Victimization (Range 0-3) 0.92 0.11 -0.09 1.00 0.06 -0.01

Perpetrator

Sexual Perpetration (Range 0-3) 1.50 0.33 0.41 1.50 0.19 0.40

Physical Perpetration (Range 0-3) 0.97 0.14 -0.03 1.11 0.08 0.11

Severe Neglect Perpetration (Range 0-3) 0.94 0.12 -0.07 0.92 0.07 -0.09

General Neglect Perpetration (Range 0-3) 1.12 0.11 0.11 1.01 0.06 -0.01

Emotional Neglect Perpetration (Range 0-3) 1.27 0.16 0.24 1.03 0.11 0.03

Other

Sexual Other (Range 0-3) 1.10 0.11 0.09 1.27 0.06 0.24 ***

Physical Other (Range 0-3) 1.20 0.09 0.18 * 1.01 0.05 0.01

Severe Neglect Other (Range 0-3) 0.96 0.07 -0.04 1.06 0.04 0.06

General Neglect Other (Range 0-3) 1.09 0.10 0.09 1.01 0.06 0.01

Emotional Neglect Other (Range 0-3) 1.07 0.08 0.07 1.03 0.05 0.03

Overall Percent Recidivism 15.40 - - 48.50 - -

Average Time to Recidivism (Days) 529.96 335.77

+p<.10; *p<.05; **p<.01; ***p<.001

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Table 10 | Cox Regression for Hazard of Recidivism as a Function of Dosage (N=1,478)

Substantiated Referral Any Type of Referral

Independent Variable O.R. se B O.R. se B

Dosage1

0-8 Hours of Face to Face Visits 0.747 0.22 -0.29 .844 .118 -.170

8-25 Hours of Face to Face Visits 0.78 0.23 -0.24 .912 .131 -.092

25-34 Hours of Face to Face Visits 0.37 0.51 -1.01 * .655 .221 -.423 +

34-55 Hours of Face to Face Visits 0.67 0.42 -0.40 .731 .225 -.313

55+ Hours of Face to Face Visits 0.99 0.59 -0.01 1.751 .297 .560

Demographics

Person was White (versus nonwhite) 1.37 .143 .313 * 1.249 .082 .222 **

Person's primary language was English (versus any other) 1.07 .251 .064 1.621 .142 .483 **

Age in 2015 1.03 .024 .024 1.026 .013 .026 *

Unique Referrals At/Before Point of Eligibility for the Program

Number of Unique Perpetrator or Other (restricted to those when person 

was 17 or older) Referrals 1.059 0.02 .057 ** 1.060 .012 .059 ***

Number of Unique Victim Referrals 1.003 0.03 .003 1.015 .019 .015

Age at Person's First Referral .976 0.02 -.025 .977 .010 -.023 *

Most Serious Type of Referral At/Before Point of Eligibility for the Program

Most Serious Victimization Referral (Range 0 to 9) .998 .039 0.00 .979 .022 -.021

Most Serious Perpetration Referral (Range 0 to 9) .893 .043 -0.11 ** .952 .023 -.049 *

Most Serious Other Referral (Range 0 to 9) .940 .077 -0.06 .904 .041 -.101 *

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Presence of Specific Referral Dispositions At/Before Point of Eligibility for the Program

Victim

Sexual Victimization (Range 0-3) 1.042 .104 .041 .981 .063 -.019

Physical Victimization (Range 0-3) 1.114 .093 .108 1.012 .056 .012

Severe Neglect Victimization (Range 0-3) .946 .096 -.056 1.006 .055 .006

General Neglect Victimization (Range 0-3) .999 .094 -.001 .982 .057 -.018

Emotional Neglect Victimization (Range 0-3) .914 .106 -.090 .999 .063 -.001

Perpetrator

Sexual Perpetration (Range 0-3) 1.504 .332 .408 1.493 .190 .401 *

Physical Perpetration (Range 0-3) .972 .137 -.029 1.123 .077 .116

Severe Neglect Perpetration (Range 0-3) .935 .120 -.067 .920 .068 -.084

General Neglect Perpetration (Range 0-3) 1.116 .106 .110 1.019 .058 .019

Emotional Neglect Perpetration (Range 0-3) 1.267 .156 .237 1.019 .110 .019

Other

Sexual Other (Range 0-3) 1.104 .107 .099 1.266 .063 .236 ***

Physical Other (Range 0-3) 1.194 .088 .177 * 1.012 .050 .012

Severe Neglect Other (Range 0-3) .961 .074 -.040 1.071 .042 .068

General Neglect Other (Range 0-3) 1.093 .098 .089 1.006 .055 .006

Emotional Neglect Other (Range 0-3) 1.074 .079 .071 1.034 .049 .033

Overall Percent Recidivism 15.40 - - 48.50 - -

Average Time to Recidivism (Days) 529.96 335.77

1 All dosage levels are compared to comparison group

+p<.10; *p<.05; **p<.01; ***p<.001

Child Abuse Prevention Council, Inc. 

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 LPC Consulting Associates, Inc. | 39

APPENDIX III | AMERICORPS LOGIC MODEL 

Child Abuse Prevention Council, Inc. 

16AC181622
 LPC Consulting Associates, Inc. | 40

Child Abuse Prevention Council, Inc. 

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 LPC Consulting Associates, Inc. | 41

Child Abuse Prevention Council, Inc. 

16AC181622
 

LPC Consulting Associates, Inc.

www.lpc-associates.com

Shannon Williams, PhD

Charles de Watteville, MA

For additional information about this report, please 

contact shannon@lpc-associates.com

We would like to acknowledge the analytical contributions of the 

following JBS International, Inc. staff:

Peter Lovegrove, PhD

Rebecca Frazier, PhD

Stacey Houston, MA

Child Abuse Prevention Council, Inc. 

16AC181622