Re: Interesting US paper with long term follow up?

June 7, 2012

Many thanks for this Woody, it is an interesting paper, although I found it difficult to contextualise because US services and child protection regulations are so different from ours (must remember this when reviewers remind me of the 'international audience' in submitted papers!!)SafeCare is described as a structured behavioural skills training program that focuses on concrete caregiving, household management and parenting skills - I haven't come across it before and feel I should check it out, as it has apparently been in use in university settings (does that mean in research or for students, I wonder?) since 1979 and resulted in over 60 publications. I note that, for this trial, it was being used with families whose children were aged up to 12 years old, in conjunction with home visiting, although I didn't find any information about the intensity of that home visiting. I found it distracting that they used the acronym HV to refer to 'paraprofessional home visitors,' who were characterised in a table as 'HV licensed' (between 15 and 20%, depending on arm of trial) and graduate (between 23% and 42%). I would like to know more about these people, who are clearly not health visitors as we know them, but seem to be doing a very good job, since trials that show a reduction in 'recidivism' for child maltreatment are very few and far between, particularly with a focus on neglect and follow-up as long as six yearsThank you for drawing this to our attention.best wishes On 7 Jun 2012, at 09:47, Caan, Woody wrote: Chaffin M, Hecht D, Bard D, et al. A statewide trial of the SafeCare home-based services model with parents in Child Protective Services. Pediatrics. 2012 Mar;129(3):509-15. Epub 2012 Feb 20. (Original) PMID: 22351883 Abstract OBJECTIVES: In this trial, we compared Child Protective Services (CPS) recidivism outcomes between the home-based SafeCare (SC) model for child neglect and comparable home-based services, but without SC modules, for parents in the CPS system across 2 quality control strategies: coached © and uncoached implementation. SC is a home-based behavioral skills training model designed for neglecting or maltreating parents. The study was conducted in a scaled-up, statewide implementation setting. METHODS: Two thousand one hundred seventy-five maltreating parents, treated by 219 home visitors, were enrolled and treated in a 2 x 2 (SC versus services as usual x C versus uncoached implementation strategy) randomized cluster experiment. Cases were followed for an average of 6 years for CPS recidivism events. Subpopulation analyses were conducted for parents meeting customary SC inclusion criteria. RESULTS: Consistently significant main effects in favor of SC were found across simple and more complex modeling approaches (hazard ratios = 0.74-0.83). Larger effects were found among the subpopulation meeting customary SC inclusion criteria. C implementation yielded smaller and occasionally significant effects in analyses that included more diverse cases falling outside customary SC inclusion criteria. CONCLUSIONS: Findings support the adoption and use of SC within CPS home-based services systems. C implementation may be especially valuable for cases where the client-model fit is less strong. From: [ ] on behalf of Cheryll [cheryllma@...] Sent: Wednesday, June 06, 2012 3:44 PM Subject: FW: Fantastic opportunity to build a new Parent Infant Psychotherapy service in Northamptonshire! Great opportunity for the right person, please pass onto anyone who may be interested. 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June 7, 2012

That's funny. I couldn't find much on the SafCare thing either. It's new to me. The thing that leaves me gasping is the sheer size of the US studies and the detailed data they can access. It makes our Millenium Cohort work look really small, but however do they manage if their DPA legislation is akin to the UK Act?

Must chase it up, but my PC is currently having a rebuild so I'm working on an elderly laptop & have to keep loading more coal into it...

PS Apropos US stuff on safeguarding/child protection, there's a couple of interesting keynote speakers at that Ulster conference on risk assessment that I'm attending. Aron Shlonsky and Will are both speaking (pause for frisson of nerdy excitement!). There's also a kind of pre-

conference mini symposium on systematic reviews. http://www.socsci.ulster.ac.uk/irss/dare2012/programme.pdf

June 7, 2012

Just a quick note, .

The US does not often use small scale studies and their tendency is to fund very large quantitative studies.

The UK weakness, of course, is that we have little research that is generalizable because the input funding is so small and qualitative research is actually more expensive than quantitative studies yet receives less money. The consequence is, generally speaking, too many descriptive and small #s/small scale research projects in the UK.

We're not comparing "like with like" between the UK and the USA whether we're talking about practice in the field or about approaches to research.