WITHDRAWN:Impact of Safe@Home on Placement and Permanency Outcomes: Results of a Quasi-Experimental Study

Background and Purpose: The purpose of this study was to rigorously test the effectiveness of Safe@Home, an in-home parent skill-based intervention implemented in Clark County, Nevada. Safe@Home is designed to prevent out-of-home placement for children at imminent risk of placement (Placement Prevention population) and minimize time in out-of-home care for children already in foster care (Reunification population).

Methods: This study used a retrospective, longitudinal, quasi-experimental design that relied on child welfare administrative data. Using Coarsened Exact Matching (CEM), all children who received Safe@Home and met inclusion criteria were matched on age, race/ethnicity, previous in-home or out-of-home child welfare case, and safety threats to a comparison group of children served before Safe@Home was available in their community. All children in the study (N = 2,144) were determined by Clark County Department of Family Services to be unsafe and in need of immediate intervention. They represented two non-overlapping samples:

• Placement Prevention (PP): n = 403 children who received Safe@Home services as part of in-home safety plans intended to prevent out-of-home placement and n = 421 matched comparison children
• Reunification (R): n = 641 children who received Safe@Home services in order to reunify with parents/caregivers following out-of-home placement and n = 679 matched comparison children

Logistic regressions, Poisson regressions and Cox proportional hazard regressions were used to model the impact of Safe@Home on the following outcomes:

1a. Out-of-home (OOH) placement prevention
1b. Sustained OOH placement prevention 12 months after end of services
2. Length of time (days) in OOH care within the first year of case start
3. Case closure within a year of case start
4. Permanency with a parent
5a. Maltreatment within 6 months after case closure
5b. Maltreatment within 12 months after case closure
6a. Re-entry in OOH within 6 months after case closure
6b. Re-entry in OOH within 12 months after case closure

Statistical models controlled for child race/ethnicity, child age, number of siblings, and type of safety threats.

Results: Matched study samples demonstrated strong baseline equivalence. Children who received Safe@Home experienced a significantly lower rate of out-of-home placements (PP OR: 0.05 [95% CI: 0.03 - 0.07]), substantially higher rate of permanency with a parent (PP HR: 3.00 [2.52 - 3.56]; R HR: 2.58 [2.24 - 2.97]), fewer days in out-of-home care (PP IRR = 0.26 [0.26 - 0.27]; R IRR = 0.69 [0.69 - 0.70]), and shorter time to case closure (PP OR: 2.86 [2.11 - 3.87]; R OR 3.04 [2.41 - 3.82]). There was no effect of Safe@Home on post-permanency outcomes of maltreatment after case closure and re-entry. Large favorable placement prevention effects were sustained for 12 months after the end of Safe@Home (PP OR: 0.17 [0.12 - 0.24]).

Conclusions and Implications: This rigorous quasi-experimental study offers strong initial support for average population-level treatment effects of Safe@Home in key outcome areas that are important to child welfare systems’ goals of keeping children safe and families together.