Community-Based Child Abuse Prevention: Outcomes Associated with a Differential Response Program in California

Background and Purpose. Traditionally, the American child welfare system intervenes in cases of evident and severe child maltreatment. Families in need of help, but who have not reached a crisis level, are excluded from most government-provided family support services. Practitioners have recently promoted the incremental development of a complementary system that addresses child maltreatment. Under Differential Response (DR), families assessed as low-to-moderate risk are referred to community-based agencies that offer voluntary, home-based services and social service referrals.

Alameda County is the site for California's first DR program, Another Road to Safety (ARS). The ARS program offers voluntary services to families who live in certain zip codes with high rates of reported child maltreatment. Clients receive up to nine months of intensive home visiting and case management. The goals of ARS are to promote family safety and prevent future child maltreatment.

This study examined the evidentiary base for DR services in Alameda County. The following research questions were addressed:

1. What are the primary interventions that families are offered?

2. Is ARS successful in preventing future child maltreatment for program families against a comparison group?

Methods. A mixed-methods design was used. For question 1, interviews were conducted with all administrators (n=15), focus groups with all direct line staff (n=12), and telephone interviews with a convenience sample of clients (n=50). Transcripts were analyzed for emergent themes. In response to Question 2, a quasi-experimental static group design was used to examine client outcomes. All clients who completed services formed the treatment group (n=161); a comparison group was constructed with all families reported for child maltreatment in the same timeframe who were eligible for services, but were not referred because of program capacity (n=447). Survival analysis was used to compare rates of re-report and substantiated re-report for the treatment and comparison groups.

Results. Cox regression was used to estimate the effects of ARS. The unadjusted hazard ratio and its p-value (HR 1.03, p-value 0.87) suggest that treatment had no effect on subsequent child maltreatment reports. However, these outcomes were confounded by the presence of prior reports; families with prior reports were more likely to be assigned to receive ARS services. The lack of randomization in assignment to treatment is a major limitation of this study. Since only a small percentage of children referred to treatment did not have prior reports (16 out of 161), they were dropped from the analysis. Restricting analyses to children with prior reports only, treatment appears to trend toward a positive effect, though this is not statistically significant (HR 0.69, p-value 0.064). Other analyses show few effects.

Conclusions and Implications. Based on interviews with staff, the program appears robust and maintains fidelity to the model; social science theory also supports the model. Nevertheless, these findings are in line with meta-analyses of child maltreatment prevention studies, and other studies of DR. The intervention may achieve beneficial outcomes with regards to proximal goals including, for example, families' connections to resources, however, the study design did not allow for examination of these effects.