A young woman sees one of her parents beating her other parent frequently . . .

A toddler is abused and neglected . . .

Adolescents playing at a park witness a drive-by shooting . . .

Communities Working Together

To Help Children Exposed to Violence

Findings From Phase I of the Safe Start Initiative

Children around the world are exposed to violence in 

alarming numbers. The findings of the National Survey of 

Children’s Exposure to Violence indicate that 60 percent 

of the Nation’s youth were exposed to violence, crime, 

or abuse during the year of the study (Finkelhor, Turner, 

Ormrod, Hamby, & Kracke, 2009). Exposure ranged from 

brief encounters as witnesses to victims of serious violent 

episodes. Nearly 25 percent of children were victims 

of robbery, more than 1 in 4 (25.3 percent) witnessed 

a violent act, and nearly 1 in 10 (9.8 percent) saw one 

family member assault another (Finkelhor et al., 2009).

Frequent or intense exposure to violence can harm 

children’s and youth’s natural, healthy development—

unless they have supports to heal. Negative impacts of 

exposure to violence depend on factors that include (but 

are not limited to) the frequency and severity of exposure, 

the relationship of the child to the victim/perpetrator, the 

age of the child at the time of exposure, and the availability 

of other caring adults (Kracke & Hahn, 2008). With the 

supports to heal, however, children and youth can recover.

The Safe Start Initiative

The Safe Start Initiative is a collaboration funded by the 

Office of Juvenile Justice and Delinquency Prevention 

(OJJDP), involving national, State, and local public 

and private agencies working together to prevent and 

reduce the consequences of childhood exposure to 

violence.* Safe Start defines exposure to violence as 

direct or indirect exposure to violence in the home or in 

the community. The initiative is being implemented in 

four phases (Exhibit 1 on next page). Each phase builds 

and disseminates knowledge about policy and practice 

innovations for addressing the needs of children exposed 

to violence (Kracke & Cohen, 2008). 

Findings From Phase I of the Safe Start 

Initiative 

Phase I of the Safe Start Initiative was implemented 

in 11 communities over 5 years.† Local communities 

developed and tested strategies to reduce the impact 

of childhood exposure to violence. Practitioners in 

these demonstration communities formed crossdisciplinary partnerships to transform local service 

delivery systems. These partners responded to children 

exposed to violence at all points along the continuum 

of care (prevention, intervention, treatment, response) 

by screening for children exposed to violence, referring 

them to services, providing intervention and treatment 

services, and following up to ensure service linkages. 

Safe Start Demonstration Sites 

Baltimore (Maryland), Bridgeport (Connecticut), Chatham 

County (North Carolina), Chicago (Illinois), Pinellas County 

(Florida), Rochester (New York), San Francisco (California), 

Spokane (Washington), Washington County (Maine), Sitka 

Tribe (Alaska), and the Pueblo of Zuni (New Mexico)

A national evaluation of the Safe Start Demonstration 

Sites was conducted by the Association for the Study 

and Development of Community (currently Community 

Science) (Hyde, Lamb, Arteaga, & Chavis, 2008). This 

evaluation measured the extent to which the sites 

reduced the impact of childhood exposure to violence and 

determined the system changes required for effective 

community responses to children and their families 

(Kracke, Lamb, & Hyde, 2008) The national evaluation 

team partnered with local evaluators in each community 

to examine child and family outcomes and systems-level 

outcomes. Knowledge gained from the demonstration 

*OJJDP in coordination with other agencies in the U.S. Department of Justice and the U.S. Department of Health and Human 

Services developed the Safe Start Initiative to address the issue of childhood exposure to violence as a critical prevention strategy for 

juvenile delinquency.

July 2009 • Revised October 2011
2

July 2009 • Revised October 2011

Source: Kracke, Lamb, & Hyde, 2008, p. 94 .

For a full discussion of the table and related findings of the Safe Start Initiative, please see the special issue of Best 

Practices in Mental Health: An International Journal devoted to the topic (Sower & Rowe, 2008).

Knowledge Building

Knowledge Transfer

Phase IV: Seed Sites

Phase I: Safe Start Demonstration Sites

Phase II: Safe Start Promising Approaches

Phase III: Safe Start Replication

What We Will Accomplish:

Provide prescriptive instructions 

for replicating proven strategies 

for reducing children’s exposure to 

violence. Assess the success of the 

replications to operationalize plans 

for seeding new sites in Phase IV.

What We Will Accomplish:

Understanding how communities 

can successfully develop and implement innovative policy and practice 

interventions to reduce children’s 

exposure to violence.

What We Will Accomplish:

OJJDP will leverage seed funds into widespread 

implementation of evidence-based practices to 

reduce children’s exposure to violence.

What We Will Accomplish:

Understanding the impact of 

specific intervention strategies 

on outcomes for children and 

families. Phase II will be the 

first phase to achieve child-level 

outcome data.

Exhibit 1. Four Phases of the Safe Start Initiative

project focused on two areas: changes in children and 

families following the intervention and changes in local 

service delivery systems (Kracke, Lamb, & Hyde, 2008). 

This fact sheet presents findings from Phase I.

Stronger Children, Families, and Communities

Individual sites demonstrated that, with intervention and 

treatment, the impact of exposure to violence on children 

can be reduced (Exhibit 2). Each site implemented 

different program activities and conducted different 

local evaluations to test measures relevant to its local 

initiative; therefore, the measures tested and the related 

findings and outcomes vary from site to site. 

Stronger Systems of Care: Sites Expanded 

Existing and Created New Systems of 

Care for Children Exposed to Violence

The Safe Start Demonstration Sites changed systems of 

services and supports to better respond to the needs of 

children exposed to violence and their families. Systems 

change was achieved by improving identification, 

screening, and referral of children in need; coordinating 

and integrating services; increasing community 

awareness through public education; building the 

capacity of agencies, staffs, and families; and increasing 

cultural competence (Exhibit 3).

Policy and Practice Implications

■ Expand the definition of violence and its impact on 

children and families. Violence can be experienced 

directly (child abuse, intimate partner violence) and 

indirectly (witnessing violence). Thinking about exposure to violence in “silos” (type of violence/victim/perpetrator, location of violence) limits effective responses 

at the point of service, at the system level, and at the 

policy level. By expanding the definition of exposure to 

violence, providers can offer multiple points of entry 

into a continuum of care for children and their families. 

■ Move beyond a medical/mental health model of 

service needs and delivery. Families experiencing 

violence have a full range of needs—from basic (shelter), to informational (typical child development), to 

intensive (safety planning, supervised visitation, crisis 

intervention)—that fall along a continuum of prevention, early intervention, treatment, and response.

■ Develop protocols and adopt practices to screen 

and refer children who have been exposed to violence. Children exposed to violence are observed in 

schools, pediatric offices, child welfare systems, and 

other agencies serving children and families. It is important to establish protocols for screening in these 

and other agencies interacting with children to better 

identify children exposed to violence and provide 

them with referral/linkages to services. 

† Nine of the eleven sites were granted no-cost extensions through 2006.
3

Exhibit 2. Child and Family Outcomes by Safe Start Demonstration Sites

Outcome Measure Site Findings

Reduced Exposure to ViolenceTraumatic Events Screening Inventory (Bridgeport)There was a statistically significant decrease in the number of traumatic events experienced by children (N=49) over time.

Therapist ratings on 

the Child Completion of 

Services form (Chicago)

Therapists noted that 66 percent of children had no significant additional exposure to 

violence after treatment began. Twenty-four percent did have additional significant exposure and the additional exposure of the remaining 10 percent of children is unknown.

Reduced 

Trauma-Related 

Symptoms

Trauma Symptom Checklist for Young Children 

(Bridgeport)

There was a statistically significant decrease in children’s (N=20) trauma-related 

symptoms over time (i.e., on the post-traumatic stress intrusion subscale, the posttraumatic stress total subscale, and the dissociation subscale).

Trauma Symptom Checklist for Young Children 

(Chicago)

Caregivers reported observing fewer symptoms of trauma among their children after 

the intervention than they did before the intervention. The decrease in symptoms 

was statistically significant for older children but not significant for younger children.

Reduced Parental StressParenting Stress Index 

(Bridgeport)

There was a statistically significant decrease in parental stress (N=45) over time.

Parenting Stress Index 

(Pinellas)

Safe Start intervention groups reported decreases in overall parental stress after 

receiving services, but these changes were not statistically significant.

Improved Child 

Functioning

Therapist ratings on 

the Child Completion of 

Services form (Chicago)

The greatest improvement was seen in the ability to identify feelings, a decrease in 

overall symptoms, improved pro-social skills, and improved management of anger 

and aggression.

Improved Parent 

Functioning

Therapist ratings on the 

Caregiver Completion of 

Services form (Chicago)

According to therapists, parenting skills increased such that caregivers were more 

aware of the effects of violence on children and were better able to manage the 

effects of exposure to violence for both their children and themselves.

Source: Hyde et al., 2008, p. 115.

For a full discussion of the table and related findings of the Safe Start Initiative, please see the special issue of Best 

Practices in Mental Health: An International Journal devoted to the topic (Sower & Rowe, 2008).

Exhibit 3. System-Level Outcomes and Strategies

Change Outcomes Strategies and Sites Implementing

Creation of Opportunities 

To Identify, Screen, and 

Refer

• Enhancing 911 for identification of children present at incident (Bridgeport, Chicago, Rochester, San 

Francisco, Spokane)

• Educating families and service providers for identification (Chatham County)

• Purchasing police dispatch software and digital cameras for first responders (Washington County)

Services Integration 

Across Sectors

• Coordinating case review (Chatham County, San Francisco, Washington County)

• Developing cross-disciplinary partnerships (cross-disciplinary review, joint service planning, protocols 

for sharing information, co-location of services, joint training) (all sites)

• Sequencing case management (Pinellas County)

• Developing relationships with faith-based communities and incarcerated mothers (Chatham and 

Pinellas Counties)

• Engaging law enforcement agencies (Washington County)

Increased Public 

Awareness

• Developing social marketing campaigns (Bridgeport, Pinellas County, Rochester, San Francisco)

• Raising community awareness (Baltimore, Chicago, Spokane, Washington County)

• Engaging parents in community awareness (Bridgeport, Chicago, San Francisco)

Enhanced Service Provider Capacity• Training non-mental health professionals (Bridgeport [child protective services staff], Spokane [dependency court judges], Washington County [police]) 

• Specialized training in home-based therapeutic techniques for mental health professionals (Bridgeport, Chatham County, Pinellas County, San Francisco)

Improved Agency and 

Provider Cultural 

Competence

• Initiating totem pole carving discussions and other tribal healing traditions (Sitka Tribe, Pueblo of Zuni)

• Translating/adapting materials for Spanish speakers (Baltimore, Chatham County, Chicago, San 

Francisco)

Source: Association for the Study and Development of Community, 2006
4

■ Establish working relationships with community 

service providers to increase access to children 

who have been exposed to violence and widen the 

community support system. Coordinating care across 

organizations helps support children and families.

■ Develop and implement training protocols in each 

agency to build workforce capacity to screen children exposed to violence and identify and respond 

to their needs and those of their families. Cross-organizational trainings increase understanding of each 

agency’s roles, responsibilities, and available services. 

Building on the Work of the Demonstration Sites and Next Steps

Phase I of the Safe Start Initiative has advanced 

understanding of effective system and practice 

responses to children exposed to violence. Perhaps the most encouraging result of the Safe Start 

Demonstration Sites is that, with intervention, the 

negative consequences of childhood exposure to 

violence can be reduced. Phases II and III of the 

Safe Start Initiative will advance knowledge by 

evaluating the efficacy of evidence-based interventions with children exposed to violence in a variety 

of community settings. This phased approach to applied research and practice ensures that knowledge 

of the effects of and interventions for childhood 

exposure to violence grows. Action on this issue is 

critical for protecting children.

References

Association for the Study and Development of Community. 

(2006). Promising practices of Safe Start Demonstration 

Project Sites 2005, Cross-site analysis, Draft. Gaithesburg, 

MD: Author. Retrieved September 4, 2011, from http://

www.capacitybuilding.net/Promising%20Practices/Safe%20

Start%20Promising%20Practices%20Report%202006.pdf

Finkelhor, D., Turner, H., Ormrod, R., Hamby, S., & Kracke, K. 

(2009). Children’s exposure to violence: A comprehensive 

national survey. Washington, DC: Office of Justice Programs. 

Retrieved September 20, 2011, from https://www.ncjrs.gov/

pdffiles1/ojjdp/227744.pdf

Hyde, M.M., Lamb, Y., Arteaga, S.S., & Chavis, D. (2008). 

National evaluation of the Safe Start Demonstration Project: 

Implications for mental health practice. Best Practices in 

Mental Health: An International Journal, 4(1), 108–122.

Kracke, K., & Cohen, E.P. (2008). The Safe Start Initiative: Building 

and disseminating knowledge to support children exposed to 

violence. Journal of Emotional Abuse, 1(2), 155–174.

Kracke, K., & Hahn, H. (2008). The nature and extent of 

childhood exposure to violence: What we know, why we don’t 

know more, and why it matters. Journal of Emotional Abuse, 

1(2), 29–49. 

Kracke, K., Lamb, Y., & Hyde, M. (2008, Winter). The Safe Start 

Demonstration Project: Knowledge building to knowledge 

transfer for children exposed to violence. Best Practices in 

Mental Health: An International Journal, 4(1), 92–98.

Sower, K., & Rowe, W. (Eds.). (2008, Winter). Best Practices in 

Mental Health: An International Journal, 4(1).

Working Together To Help Children Exposed to Violence

Safe Start Center

5515 Security Lane, Suite 800 • North Bethesda, MD 20852 •1-800-865-0965 • www.safestartcenter.org

The Safe Start Center is funded by the Office of 

Juvenile Justice and Delinquency Prevention to support 

the Safe Start initiative. The goals of the Center are to:

• Broaden the scope of knowledge and resources 

for responding to the needs of children exposed to 

violence and their families

• Develop and disseminate information about the Safe 

Start initiative and emerging practices and research 

concerning children exposed to violence

• Raise national awareness about the impact of 

exposure to violence on children 

For copies of this and other Safe Start Center 

publications, contact the Safe Start Center at 1-800-865-

0965 or info@safestartcenter.org or visit the Safe Start 

Center Web site at www.safestartcenter.org.

An electronic version of this publication can be found on 

the Web at www.safestartcenter.org.

The opinions, findings, and conclusions or 

recommendations expressed in this publication are 

those of the author(s) and do not necessarily represent 

the official position or policies of OJJDP or the U.S. 

Department of Justice.

The original document was produced under Contract 

No. GS-10F-0285K, Order No. 2006F_35. It was revised 

under Order No. 2010F_10090.

July 2009; Revised October 2011