The Evidence Base

The Safe Babies approach improves the lives of young children and their families

Since 2005, the Safe Babies approach has worked to translate the science of early childhood development into child welfare so that infants and toddlers can reach their full potential. While the approach is anchored in courts, it is an entry point for cross-systems collaboration and building – at the child and family, community, and state levels – to serve young children and their families across the promotion, prevention, and treatment continuum.

Over nearly two decades, a growing body of national evaluation studies has consistently shown positive outcomes for children and families supported by the Safe Babies approach. 

Key Outcomes

for infants and toddlers supported by the Safe Babies approach

The young child’s development is on a healthy track

At least 83% of children received needed developmental screenings, Early Intervention services, and evidence-based intervention to repair and strengthen the child-parent relationship within 60 or fewer days—with no differences by race or ethnicity.

Attachment relationships are nurtured and protected

Reunification is the most common type of permanency outcome, with a median time of 9-10 months, 6-8 months sooner than children in a comparison group.

Prevention of repeat child welfare involvement

During the height of the COVID-19 Pandemic the repeat maltreatment rate for Safe Babies children was 3.6% within 12 months compared with the Children’s Bureau national performance indicator of 9.7%.

For additional key outcomes read this Evidence and Impact Summary of Key Evaluation Findings

National Evaluation Studies

Over the years, ZERO TO THREE has served as a national training and technical assistance center under the auspices of the Administration for Children and Families Children’s Bureau and the Health Resources and Services Administration Maternal and Child Health Bureau. These funding initiatives, which included support for national evaluations, refer to ‘infant-toddler court teams’ or ‘infant-toddler courts” to describe the field of court innovations based on the ZERO TO THREE Safe Babies approach. Studies conducted for these national initiatives, as well as other studies carried out by external evaluators, are described below.

As the National Resource Center for the infant-toddler court program, ZERO TO THREE is currently partnering with James Bell Associates (JBA) to conduct the external evaluation of the ITCP. The mixed-methods evaluation will be conducted with 12 awardee states. The evaluation will assess the impact of Infant-Toddler Courts (including those working to align with the Safe Babies approach and related approaches) on child and family health and well-being and child welfare outcomes. The evaluation also aims to understand the impact of state and site-level efforts to build a stronger early childhood system that includes child welfare.

  • A national evaluation of the Infant-Toddler Court Program was conducted by RTI International. The mixed-methods evaluation examined child and family outcomes for 11 sites and implementation outcomes for 16 new sites across six states. Data was collected between 2019-2022, which included the period of the COVID-19 Pandemic. See the ITCP Final Evaluation Report.
  • A retrospective study was conducted by researchers at RTI International examining permanency outcomes for 183 children at nine Safe Babies sites, using data collected between 2010 and 2018. The researchers employed a quasi-experimental study design, using data from the National Survey of Child and Adolescent Well-Being to create a matched comparison group. Findings are reported in the journal Children and Youth Services Review.
  • A study was conducted by researchers at RTI International exploring the impact of the first year of the COVID-19 pandemic (between April 2019 and February 2020) on parents’ access and receipt of services at Safe Babies sites, compared with the previous year (between April 2020 and February 2021). Findings are published in the Maternal and Child Health Journal.    
  • A qualitative study was conducted by researchers at RTI International examining the impact of the COVID-19 pandemic on the accessibility and timeliness of services of services for children supported by ITCTs. Findings are published in the journal Children and Youth Services Review. 

A national evaluation of the QIC-ITCT was conducted by RTI International. The mixed-methods evaluation examined outcomes for 251 infants and toddlers across ten Safe Babies sites, using data collected between April 2015 and May 2017. Findings are reported in the QIC-ITCT Final Evaluation Report and published in the journal Child Welfare. The RTI research team conducted a second analysis of maltreatment recurrence using data collected through May 2018 and reported the finding in an infographic, Making a Difference in the Lives of Families. Additionally, RTI produced a series of research briefs for the QIC-ITCT (see Briefs section below).

  • A retrospective study was conducted by researchers at American Institutes for Research examining maltreatment recurrence and time to permanency for children at three Safe Babies Court Team sites, using data collected during different time periods for each site (overall, between 2009-2019). The researchers used a natural experiment design in which control cases were assigned by the court system to traditional dependency court judges. Findings are reported in an Evaluation Report and Infographic.
  • A study was conducted by researchers at the University of North Carolina-Chapel Hill examining permanency outcomes for 298 children at the four original ‘Court Teams’ sites, using data collected between 2005 and 2010. The researchers employed a quasi-experimental design, using data from the National Survey of Child and Adolescent Well-Being to create a matched comparison group. Findings are published in the journal Children and Youth Services Review.
  • In 2012, a cost study was conducted by researchers at the University of North Carolina-Chapel Hill estimating the full costs of the ‘Court Teams initiative’ and subsequent taxpayer reduced costs (savings) in the first year of implementation. Findings are reported in this Cost Analysis.
  • A mixed-methods evaluation examined outcomes for 186 infants and toddlers at the four original ‘Court Teams’ sites, using data collected between 2007 and 2008. Findings are reported in a final Evaluation Report. 

Briefs

Adverse Childhood Experiences, Family Risk Factors, and Child Permanency Outcomes
Download Here
The Adverse Childhood Experiences of Very Young Children and Their Parents Involved in Infant-Toddler Court Teams
Download Here
Helping Children Affected by Adult Opioid Use
Download Here
Services Support for Young Children and Families in the Child Welfare System
Download Here
When Less is Better: Reducing Out-of-Home Care Placements for Young Maltreated Children
Download Here
Working with Families in the Child Welfare System Affected by Incarceration
Download Here
Using Data to Drive Decision Making and Promote Continuous Quality Improvement
Download Here

State-Led Evaluation Studies

The Safe Babies approach has inspired early childhood advocates across a spectrum of disciplines and sectors, particularly infant and early childhood mental health, to work with ZERO TO THREE to implement the approach in their communities or to develop a related initiative based on the Safe Babies approach. Explore the publications and reports listed below for information about their evaluation findings. 

  • Krysik, J., Sayrs, L., Gearing, R., & Mabingani, D. (2016). Cradle to Crayons: Maricopa County Safe Baby Court Teams Initiative, 2012-2016. Center for Child Well-Being, Arizona State University. Cradle-to-Crayons-Study (pcaaz.org)  
  • Stacks, A.M., Barron, C.C., & Wong, K. (2019). Infant mental health home visiting in the context of an infant-toddler court team: Changes in parental responsiveness and reflective functioning. Infant Mental Health Journal, 1-16. https://doi.org/10.1002/imhj.21785  
  • Stacks, A.M., Wong, K., Barron, C., & Ryznar, T. (2020). Permanency and well-being outcomes for maltreated infants: Pilot results from an infant-toddler court team. Child Abuse & Neglect, 101. https://doi.org/10.1016/j.chiabu.2019.104332  

The Research and Evaluation team is available for support in understanding and interpreting the evidence base for the Safe Babies™ approach. If you or your State and Site partners have questions or evaluation-related needs, email safebabies@zerotothree.org.

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