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Children's exposure to violence (CEV)--including direct child maltreatment, witnessing domestic violence, and witnessing community and school violence--can have serious consequences, including a variety of psychiatric disorders and behavioral problems, such as posttraumatic stress disorder, depression, and anxiety. Fortunately, research has shown that interventions for CEV can substantially improve children's chances of future social and psychological well-being. Safe Start Promising Approaches (SSPA) was the second phase of a planned four-phase initiative focusing on preventing and reducing the impact of CEV and sponsored by the U.S. Department of Justice's Office of Juvenile Justice and Delinquency Prevention (OJJDP). The RAND Corporation conducted the national evaluation of the SSPA phase of the initiative, in collaboration with the national evaluation team: OJJDP, the Safe Start Center, the Association for the Study and Development of Communities, and the 15 program sites. The evaluation design involved three components: a process evaluation, including a cost analysis; an evaluation of training; and an outcomes evaluation. This document provides the results for the process and training evaluations. It documents the activities of the 15 SSPA programs for the first two years of implementation. The main body of this report synthesizes information across all 15 sites to describe the program and community settings, interventions, and implementations. The appendixes provide a detailed description of each SSPA program and the results of the training evaluation. These results will be of interest to clinicians, practitioners, policymakers, community leaders, and others interested in implementing programs for children exposed to violence. The report contains seven chapters following an introduction. Chapter One presents the introduction; and Chapter Two provides background information on the 15 sites across the United States that implemented SSPA programs. Chapter Three discusses the various program contexts and how factors associated with these contexts affected the interventions; Chapter Four examines the interventions themselves; and Chapter Five examines how the programs were implemented. Chapter Six discusses additional components of the programs that influenced the implementation of the programs. Chapter Seven presents our conclusions and draws implications for communities and other organizations that are considering developing and implementing similar interventions. Appendix A describes the process and training evaluation methodologies. Appendix B provides a detailed program description for each of the SSPA sites. Appendix C presents the results of the training evaluation. (Contains 39 tables, 29 figures, and 31 footnotes.)[This research was conducted under the auspices of the Safety and Justice Program within RAND Infrastructure, Safety, and Environment and under RAND Health's Health Promotion and Disease Prevention Program.]

Introduction: The vestibular rehabilitation is an exercise-based method, aiming to maximize central nervous system (CNS) compensation at vestibular nuclear and other CNS levels for vestibular pathology. Vestibular rehabilitation includes exercises to habituate symptoms, exercises to promote vestibular adaptation and substitution, exercises to improve balance and dynamic postural control, and exercises to improve general conditioning. Recent advances in balance and gait training, gaze stability training, habituation training, are discussed in this chapter in the context of unilateral and bilateral vestibular disorders. Method: Narrative review. Results: Exercises are prescribed that address VOR adaptation, habituation, sensory substitution, gait and posture, strengthening, flexibility, and endurance to maximize functioning. Customized exercise programs have been shown to be more effective than providing a patient with a generic exercise program. It is thought that compliance is enhanced with customization and with follow-up visits with a physical therapist. Discussion/ conclusions: VR therapy is effective in improving functional deficits and subjective symptoms resulting from unilateral and bilateral peripheral vestibular hypo function, as well as from central balance disorders. The goals of vestibular rehabilitation are to reduce subjective symptoms, to improve gaze and postural stability (particularly during head movements), and to return the individual to normal activities, including regular physical activity, driving, and work. Clinicians should offer vestibular rehabilitation to persons with impairments and functional limitations related to the vestibular deficit. Vestibular rehabilitation is now considered the standard of care for persons with peripheral vestibular dysfunction., Introducción: La rehabilitación vestibular (RV) basada en la terapia física, tiene el objetivo, en el caso de patología vestibular, de inducir la compensación del sistema nervioso central (SNC) a nivel de núcleos vestibulares y de otros niveles del SNC. Incluye ejercicios de habituación, adaptación y sustitución vestibular, ejercicios para mejorar el equilibrio y el control postural dinámico y ejercicios para el acondicionamiento general. En este capítulo discutimos los recientes avances sobre el adiestramiento del equilibrio y de la marcha, la estabilidad de la mirada y la habituación, en el contexto de los trastornos vestibulares uni y bilaterales. Método: Revisión narrativa. Resultados: Los ejercicios se prescriben para mejorar la función; fortaleciendo, y favoreciendo la flexibilidad y la resistencia, a través de la adaptación del RVO, la habituación, la sustitución sensorial, la marcha y el equilibrio postural. Son más eficaces los programas personalizados que los genéricos. El cumplimiento mejora con la personalización y las visitas de seguimiento a un fisioterapeuta. Discusión/Conclusiones: La RV permite mejorar el déficit funcional y los síntomas subjetivos derivados de la hipofunción vestibular periférica uni y bilateral, así como las alteraciones del equilibrio de origen central. Los objetivos de la RV consisten en reducir los síntomas para mejorar la estabilidad postural y de la mirada (particularmente durante los movimientos de la cabeza) y devolver al individuo a sus actividades normales, incluyendo la actividad física, la conducción y el trabajo habitual. Los médicos deben ofrecer la RV a quienes muestren limitaciones funcionales relacionadas con un déficit vestibular, pues actualmente se considera el tratamiento estándar en la disfunción vestibular periférica.