Outcomes from a Randomized Controlled Trial of the Relief Nursery Program

  • J. Mark EddyEmail author
  • Joann Wu Shortt
  • Charles R. MartinezJr
  • Alice Holmes
  • Alice Wheeler
  • Jeff Gau
  • John Seeley
  • Jean Grossman


An independent, randomized controlled trial of the community-developed, multiple-component Relief Nursery prevention program was conducted with families with young children considered “at risk” for child abuse and neglect. This established program, currently operating at multiple sites in the state of Oregon, comprises an integrated package of prevention services to children and families, including early childhood education, home visiting, and parent education and support, as well as other interventions tailored to the needs of each particular family. Families who contacted the Relief Nursery for the first time were randomly assigned to one of two conditions, the Full Program condition, whose members had access to all services available from the Relief Nursery, or the Respite Care condition, whose members had access only to respite care and referrals to services provided by other community agencies. A primary caregiver in each family was interviewed prior to intervention and then every 6 months across a period of 2 years. Standardized measures were collected on a variety of risk and protective factors related to child abuse and neglect. Analyses were conducted at the end of the study period. Differences were found between the conditions in terms of perceived helpfulness and satisfaction with services and in terms of social support, in each case favoring the Full Program condition. Implications of the findings for future studies of multicomponent child abuse prevention programs with similar characteristics to the Relief Nursery are discussed.


Crisis nursery Early childhood education Child abuse and neglect Parenting Home visiting Randomized controlled trial 



We are grateful to each of the families who participated in this study, to the staff members of the Relief Nursery of Eugene–Springfield who delivered services to study families and children, and to each of the organizational members of the Oregon Association of Relief Nurseries, whose staff members provided extensive input into the design of the study. Special thanks to Kelly Sutherland, Lory Britain, Irene Alltucker, Sharri da Silva, Jean Phelps, Amy Ripley, Becky Lamoureux, Walt Letkiewicz, Kevin Alltucker, Leslie Finlay, Julia Richards, Diana Strand, Sally Schwader, Melanie Hyers, Julie Stubbs, Beth Green, and Ben de Haan for their contributions to this work.


This study was funded by the Office of Child Abuse and Neglect, Children’s Bureau, Administration for Children and Families, Administration on Children, Youth, and Families, Grant No. 90CA1781. The services to families were funded through a variety of public and private sources, including the state of Oregon and the Meyer Memorial Trust.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Ethical Approval

This research was conducted with the approval of the Oregon Social Learning Center Institutional Review Board. All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent or assent was obtained from all individual study participants.

Supplementary material

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  1. Abidin, R. R. (1995). Parenting Stress Index, Third Edition: Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.Google Scholar
  2. Achenbach, T. M. (1992). Revised child behavior checklist. Burlington, VT: University of Vermont.Google Scholar
  3. Allison, P. (2009). Missing data. In R. E. Millsap & A. Maydeu-Olivares (Eds.), The Sage handbook of quantitative methods in psychology (pp. 72–89). London: Sage.CrossRefGoogle Scholar
  4. Belsky, J. (1980). Child maltreatment: An ecological integration. American Psychologist, 35, 320–335.CrossRefGoogle Scholar
  5. Bronfenbrenner, U. (1979). The ecology of human development. Cambridge, MA: Harvard University Press.Google Scholar
  6. Burrus, S. W. M., Green, B. L., & Lambarth, C. H. (2009). Evaluation of Oregon’s Relief Nursery Program: July 1, 2007–June 30, 2008. Portland, OR: NPC Research.Google Scholar
  7. Casillas, K. L., Fauchier, A., Derkash, B. T., & Garrido, E. F. (2016). Implementation of evidence-based home visiting programs aimed at reducing child maltreatment: A meta-analytic review. Child Abuse & Neglect, 53, 64–80.CrossRefGoogle Scholar
  8. Chamberlain, P., & Reid, J. (1998). Comparison of two community alternatives to incarceration for chronic juvenile offenders. Journal of Consulting and Clinical Psychology, 6, 624–633.CrossRefGoogle Scholar
  9. Cicchetti, D., & Toth, S. L. (2015). Child maltreatment. In M. E. Lamb & R. M. Lerner (Eds.), Handbook of child psychology and developmental science: Socioemotional processes (pp. 513–563). Hoboken, NJ, US: John Wiley & Sons Inc.Google Scholar
  10. Collins, L. M., Murphy, S. A., & Bierman, K. L. (2004). A conceptual framework for adaptive preventive interventions. Prevention Science, 5, 185–196.CrossRefGoogle Scholar
  11. Dunst, C. J., Trivette, C. M., & Deal, A. G. (1988). Enabling and empowering families: Principles and guidelines for practice. Cambridge, MA: Brookline Books.Google Scholar
  12. Eddy, J. M., Reid, J. B., & Fetrow, R. A. (2000). An elementary-school based prevention program targeting modifiable antecedents of youth delinquency and violence: Linking the Interests of Families and Teachers (LIFT). Journal of Emotional and Behavioral Disorders, 8(3), 165–176.CrossRefGoogle Scholar
  13. Eddy, J. M., Finlay, L., Alltucker, K., & Shortt, J. W. (2018). The relief nursery program: A multimodal, tailored prevention intervention targeted child abuse and neglect. Manuscript submitted for publication.Google Scholar
  14. Ehrensaft, M. K., Knous-Westfall, H. M., Cohen, P., & Chen, H. (2015). How does child abuse history influence parenting of the next generation? Psychology of Violence, 5, 16–25.CrossRefGoogle Scholar
  15. Garbarino, J. (1976). A preliminary study of some ecological correlates of child abuse: The impact of socioeconomic stress on mothers. Child Development, 47, 178–185.CrossRefGoogle Scholar
  16. Gelles, R. J., & Perlman, S. (2012). Estimated annual cost of child abuse and neglect. Chicago IL: Prevent Child Abuse America Available from Accessed 15 April 2018.Google Scholar
  17. Gibaud-Wallston, J., & Wandersman, L. P. (1978, August). Development and utility of the parenting sense of competence scale. Toronto: Paper presented at the meeting of the American Psychological Association.Google Scholar
  18. Green, B. L., & Mitchell, L. (2012). Evaluation of the Oregon Relief Nurseries. Center for Improvement of Child and Family Services. Portland, OR: Portland State University.Google Scholar
  19. Gustafsson, H. C., Barnett, M. A., Towe-Goodman, N. R., Mills-Koonce, W. R., Cox, M. J., & the Family Life Project Key Investigators. (2014). Family violence and children’s behavior problems: Independent contributions of intimate partner and child-directed physical aggression. Journal of Family Violence, 29, 773–781.CrossRefGoogle Scholar
  20. Klevens, J., & Whitaker, D. J. (2007). Primary prevention of child physical abuse and neglect: Gaps and promising directions. Child Maltreatment, 12, 364–377.CrossRefGoogle Scholar
  21. Luthar, S. S. (2015). Mothering mothers. Research in Human Development, 12, 295–303.CrossRefGoogle Scholar
  22. Luthar, S. S., & Eisenberg, N. (2017). Resilient adaptation among at-risk children: Harnessing science toward maximizing salutary environments. Child Development, 88(2), 337–349.CrossRefGoogle Scholar
  23. Martinez, C. R., Jr., McClure, H. L., & Eddy, J. M. (2008). Latino immigrant children and families: Demographics, challenges, and promise. In R. Bussel (Ed.), Understanding the immigrant experience in Oregon: Research, analysis, and recommendations from University of Oregon Scholars (pp. 57–67). Eugene, OR: Creative Publishing.Google Scholar
  24. McCall, R. B., Ryan, C. S., & Plemons, B. W. (2003). Some lessons on evaluating community-based, two-generation service programs: The case of the comprehensive child development program. Journal of Applied Developmental Psychology, 24, 125–141.CrossRefGoogle Scholar
  25. Milner, J. (1986). The Child Abuse Potential Inventory Manual. DeKalb, IL: Psytec Inc.Google Scholar
  26. Milner, J. S., Gold, R. G., Ayoub, C., & Jacewitz, M. M. (1984). Predictive validity of the child abuse potential inventory. Journal of Consulting and Clinical Psychology, 52, 879–884.CrossRefGoogle Scholar
  27. Morawska, A., & Sanders, M. R. (2006). A review of parental engagement in parenting interventions and strategies to promote it. Journal of Children’s Services, 1, 29–40.CrossRefGoogle Scholar
  28. Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9, e1001349.CrossRefGoogle Scholar
  29. Olds, D. L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3, 153–172.CrossRefGoogle Scholar
  30. Olds, D. L., Sadler, L., & Kitzman, H. (2007). Programs for parents of infants and toddlers: Recent evidence from randomized trials. Journal of Child Psychology and Psychiatry, 48, 355–391.CrossRefGoogle Scholar
  31. Paul, G. L. (1967). Strategy of outcome research in psychotherapy. Journal of Consulting Psychology, 31, 109–118.CrossRefGoogle Scholar
  32. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  33. Sandler, I., Schoenfelder, E., Wolchik, S., & MacKinnon, D. (2011). Long-term impact of prevention programs to promote effective parenting: Lasting effects but uncertain processes. Annual Review of Psychology, 62, 299–329.CrossRefGoogle Scholar
  34. Shelton, K. K., Frick, P. J., & Wootton, J. (1996). Assessment of parenting practices in families of elementary school-age children. Journal of Clinical Child Psychology, 25, 317–329.CrossRefGoogle Scholar
  35. Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32(6), 705–714.CrossRefGoogle Scholar
  36. Skowron, E., & Reinemann, D. H. S. (2005). Effectiveness of psychological interventions for child maltreatment: A meta-analysis. Psychotherapy: Theory, Research, Practice, and Training, 42, 52–71.CrossRefGoogle Scholar
  37. Thomas, D., Leicht, C., Hughes, C., Madigan, A., & Dowell, K. (2006). Emerging practices in the prevention of child abuse and neglect. Washington, DC: Children’s Bureau Office on Child Abuse and Neglect.Google Scholar
  38. Toth, S. L., Gravener-Davis, J. A., Guild, D. J., & Cicchetti, D. (2013). Relational interventions for child maltreatment: Past, present, and future perspectives. Development and Psychopathology, 25, 1601–1617.CrossRefGoogle Scholar
  39. U.S. Department of Health & Human Services, Administration for Children and Families, Children’s Bureau. (2018). Child Maltreatment 2016. Available from maltreatment. Accessed 15 April 2018.
  40. van der Put, C. E., Assink, M., Gubbels, J., & Boekhout van Solinger, N. F. (2018). Identifying effective components of child maltreatment interventions: A meta-analysis. Clinical Child and Family Psychology Review, 21, 171–202.CrossRefGoogle Scholar
  41. Van Ryzin, M. J., Roseth, C. J., Fosco, G. M., Lee, Y. K., & Chen, I. C. (2016). A component-centered meta-analysis of family-based prevention programs for adolescent substance use. Clinical Psychology Review, 45, 72–80.CrossRefGoogle Scholar
  42. Vanderbilt-Adriance, E., & Shaw, D. S. (2008). Protective factors and the development of resilience in the context of neighborhood disadvantage. Journal of Abnormal Child Psychology, 36, 887–901.CrossRefGoogle Scholar
  43. Widom, C. S. (2017). Long-term impact of childhood abuse and neglect on crime and violence. Clinical Psychology: Science and Practice, 24, 186–202.Google Scholar

Copyright information

© Society for Prevention Research 2019

Authors and Affiliations

  1. 1.Family Translational Research Group, Department of Cariology and Comprehensive Care, College of DentistryNew York UniversityNew YorkUSA
  2. 2.Oregon Social Learning CenterEugeneUSA
  3. 3.Center for Equity PromotionUniversity of OregonEugeneUSA
  4. 4.Oregon Research InstituteEugeneUSA
  5. 5.Office of Population ResearchPrinceton UniversityPrincetonUSA

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