Enhanced Home Visitation Program

The Safe Start Promising Approaches Project will develop and support practice enhancements and innovations to prevent and reduce the impact of children's exposure to violence in their homes and communities. The project will help communities implement collaborative and evidence-based practices across the services continuum for children and their families. Exposure to violence includes being a victim of violence or a witness to violence, and encompasses abuse, neglect or child maltreatment, domestic violence, and community violence.
This program is authorized by Sections 261 and 262 of the Juvenile Justice and Delinquency Prevention Act of 1974, as amended (42 USC 5665-5666).The 10 pilot sites will test various evidence-based enhancements and practice innovations such as AF-CBT, TF-CBT, Strengthening Families Program, Coping Resources and other interventions in community-based settings such as DV shelters, libraries, Head Start, community mental health clinics and afterschool clubs. NCA/NCF

OJJDP has a specific mission to develop and disseminate knowledge about what works to prevent juvenile delinquency and violence and improve the effectiveness of the juvenile justice system. The Juvenile Justice and Delinquency Prevention Act of 1974, 42 U.S.C. § 5601 et seq authorizes the Administrator of OJJDP to conduct research or evaluations and undertake statistical analyses on a wide range of juvenile justice matters. OJJDP also provides funding to states and localities to carry out research, evaluation, and statistical analyses.

The Enhanced Home Visitation Program (EHVP) consists of an integration of trauma screening (for exposure and symptoms), and intervention with an existing home-based Early Head Start (EHS) program. The intervention, S.E.L.F., is a manualized, theory-based, trauma-informed, psycho-educational group curriculum.

S.E.L.F. provides a nonlinear, cognitive behavioral therapeutic approach to facilitate client movement through four critical stages of trauma recovery: Safety (attaining safety in self, relationships, environment, and beliefs); Emotional Management (identifying levels of affect and modulating affect in response to memories, persons, events); Loss (feeling grief, dealing with personal losses, and confronting resistance to change), and Future (trying out new roles, ways of relating and behaving as a survivor to ensure personal safety and help others).

SELF is a component of the Sanctuary model of interventions developed by Sandra Bloom, MD. S.E.L.F. has been implemented in a variety of settings including residential treatment for women, residential treatment for children, homeless shelters, domestic violence shelters, and outpatient trauma recovery programs.

The target population includes all families eligible to receive services from the EHS program. The program targets vulnerable young children, ages 28 months or younger (i.e., children with at least 8 months left in the EHS program), who live in families affected by HIV/AIDS, substance abuse, homelessness, family history of child abuse/neglect, incarceration of a parent or family member, family and community violence, and/or mental illness. Targeted children reside in one of four Philadelphia zip codes with some of the highest rates of poverty, crime, violence, poor maternal and child health, homelessness, and mental health problems.

The intervention is designed for caregivers and their families. The SELF curriculum is being adapted slightly to be used in the home and individually as opposed to in clinical group settings.

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This program furthers the Department's mission by providing grants and cooperative agreements for research and evaluation activities to organizations that OJJDP designates.

The Safe Start Promising Approaches project supports the development and study of the practice enhancements and innovations to prevent and reduce the impact of children's exposure to violence in their homes and communities. The eight continuation projects serve as the practice pilots for a multi-site national evaluation using experimental and quasi-experimental research design to test the effectiveness of new approaches to improve outcomes for children exposed to violence in real world community-based settings. The national evaluation is being conducted by RAND and supported through OJJDP research funding. The project helps communities implement collaborative and evidence-based practices across the service continuum.

The Health Federation of Philadelphia is testing the integration of a trauma specific treatment model, S.E.L.F in an existing home based Early Head Start Program in Philadelphia. S.E.L.F, an acronym for Safety, Emotions, Loss and Future, is a 24 module psycho-educational curriculum that is a component of the Sanctuary model developed by Sandra Bloom, MD. Originally designed to be delivered in group formats, the Enhanced Home Visitation Project is adapting the S.E.L.F.model to be used as an individual, home-based intervention.

The goals of the Enhanced Home Visiting Program are to: 1) reduce the incidence and impact of children's exposure to violence; and 2) increase the protective factors afforded to children by strengthening primary caregivers' ability to provide safe, stable, nurturing relationships.
The grant comes out of DOJ's Safe Start Promising Approaches initiative. The Safe Start Projects further DOJ's mission by developing and supporting practice enhancements and innovations to prevent and reduce the impact of children's exposure to violence in their homes and communities.
Specifically, Enhanced Home Visiting Program aims to break the cycle of intergenerational transmission of trauma and violence by embedding maternal trauma screening and intervention in a home based Early Head Start program. Over the course of four years, the Project aims to provide the S.E.L.F intervention to 192 families and they will be compared to a control group. Additionally, the Enhanced Home Visiting Program will build capacity to provide a continuum of trauma informed services to the families it serves by offering skills based training and consultation to its program staff and community partners regarding trauma informed policies and practices.
As part of the Project, the Health Federation of Philadelphia is participating in a cross-site rigorous evaluation using quantitative and qualitative measures that has designed and is being conducted by the RAND Corporation. The evaluations will seek to determine if Project results in reductions in caregiver trauma symptoms and increases parenting capacities.

NCA/NCF