Violence Exposure: The importance of evidence-based interventions

From Elena Cohen, project director of the Safe Start Center. For decades she has worked on the issue of children’s exposure to violence.

Most of us want to be smart shoppers. For example, before purchasing a car, we read consumer guides to learn what cars are most reliable, which get the best gas mileage and which are the best buy for our money.  When given the choice between selecting a medical treatment that has been recommended – but not back by scientific evidence – or one that has been proven by clinical research to be effective, most of us will choose the one backed by scientific evidence.

Importantly, the federal government, associations such as the American Psychological Association, American Pediatric Association and the National Association of Social Workers, as well as private funding groups are increasing their demands to base social policy and other decisions and programs on sound evidence as to their effectiveness. Using an evidence-based approach to social policy has a number of advantages because it has the potential to decrease the tendency to run programs which are socially acceptable (e.g. drug education in schools) but which often prove to be ineffective when evaluated.

When it comes to children and youth who are exposed to violence, most are never formally identified, assessed, and/or treated. Yet the emotional, social, and psychological impact of their exposure is observed by families and practitioners in many settings. Research has demonstrated that exposure to violence is associated with increased use of health and mental health services and increased risk of involvement with the child welfare and juvenile justice systems.

For many children who have been exposed to violence, a change in the environment may not be enough.   Some may require specialized interventions that are delivered in their homes and communities.  Such interventions, when they are effective, can improve outcomes for children well into their adult years and can generate benefits to society that far exceed program costs.

How do we know if an intervention is effective?

An effective intervention is one that has been shown by available research to produce the desired outcomes for persons with the same characteristics, situation and preferences.  Evidence-based practices are treatments that have been shown through clinical research to produce positive outcomes for children and their families. In short, the practices have been shown through research to be effective.

To determine effectiveness in the typical research study, participants are assigned to one of two groups. One group receives the treatment that is being studied to better understand its effectiveness, while the second group does not receive that treatment, and may instead be given usual treatment, placed on a waitlist, or given an alternative treatment. The two groups are compared to see whether the outcomes for the group receiving the treatment being studied are better than the outcomes for the group that did not receive that treatment.

The publication Choosing the Right Treatment: What Families Need to Know About Evidence-Based Practices provides an easy to understand explanation of the research needed to categorize an intervention as evidence-based.

In the past, many interventions for children exposed to violence have been based on loose bodies of knowledge that are mostly drawn from the experiences of generations of practitioners. Much of it has no valid scientific evidence on which to be justified.

What do we know about evidence-based interventions for children exposed to violence?

For all children, participation in high-quality early care and education programs can enhance physical, cognitive, and social development and promote readiness and capacity to succeed in school and cope with every day stressors.

For at-risk or vulnerable families, research shows that early identification of and intervention with home visiting and early intervention programs and schools, pediatric care and mental health interventions, as well as screening and assessment in child welfare systems and court and law enforcement agencies can prevent threats to healthy development by detecting and addressing emerging problems.

For children who have been exposed to violence, there is evidence that specialized trauma-focused systems of care and interventions may reduce behavioral problems, stop the negative chain reaction following exposure to violence and other traumatic stressors, and improve health and well-being outcomes for children and their families.

The Department of Justice and Human Services put together a prelimary list of evidence-based practices for children explore to violence from Federal databases.  This document can be found at:

http://www.safestartcenter.org/pdf/Evidence-Based-Practices-Matrix_2011.pdf

For a list of evidence based practices for vulnerable children and families, go to www.crimesolutions.gov

Practices based on research findings are more likely to result in the desired outcomes across various settings and geographic locations. Evidence-based practice provides opportunities for services to be more individualized, more effective, streamlined, and dynamic, and to maximize effects of clinical judgment.

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