Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes

Few studies have specifically examined prevention of child maltreatment among higher-risk populations in rural communities. The overarching goal of this study was to conduct a randomized clinical trial of SafeCare augmented for rural high-risk population (SC+) compared to standard home-based mental health services (SAU) to examine reductions in future child maltreatment reports, as well as risk factors and factors proximal to child maltreatment. Parents (N = 105) of young children (5 years or less) who had identifiable risk of depression, intimate partner violence, or substance abuse were randomized to SC+ or SAU. Participants randomized to SC+ were more likely to enroll (83% vs. 35% for SAU) and remain in services (35 h vs. 8 h for SAU). SC+ (for participants who successfully completed services) may have had limited impact on child welfare reports during service provision. Further, SC+ had fewer child welfare reports related to DV than SAU. Parent self-reports of parenting behaviors, risk factors, and protective factors did not demonstrate significant sustained program impact. Limitations include power constraints related to sample size. Promising next steps entail future trials with larger sample sizes examining service compliance and further augmentation of SafeCare to bolster service impact and address risk and protective factors.

► Participants randomized to SC+ were more likely to enroll in and remain in services than in the SAU program. ► SC+ participants reported greater improvements in the parenting behaviors targeted by SC+ than SAU participants. ► Within-group improvements for SC+ were found in family resources, social support, child abuse potential, depression, and nonviolent parenting strategies. ► Short-term improvement in use of nonviolent parenting strategies were found in SC+ when compared to SAU participants. ► Group difference were not found in risk and protective factors or reports to child welfare, except DV reports.