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SafeCare® [Home Visiting for Child Well-Being]

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. SafeCare® [Home Visiting for Child Well-Being] has been rated by the CEBC in the area of: Home Visiting Programs for Child Well-Being.

Target Population: Parents at-risk for child neglect and/or abuse and parents with a history of child neglect and/or abuse

For children/adolescents ages:

For parents/caregivers of children ages:

Brief Description

SafeCare® [Home Visiting for Child Well-Being] is an in-home parenting program in which parents are taught (1) how to interact in a positive manner with their children, to plan activities, and respond appropriately to challenging child behaviors, (2) to recognize hazards in the home in order to improve the home environment, and (3) to recognize and respond to symptoms of illness and injury, in addition to keeping good health records.

SafeCare® has also been by the CEBC in the areas of Home Visiting for Prevention of Child Abuse and Neglect, Interventions for Neglect, Parent Training, and Prevention of Child Abuse and Neglect (Secondary). Please click here to see the SafeCare® entry and rating in these topic areas.

Program Goals:

The goals of SafeCare® are:

  • Reduce future incidents of child maltreatment
  • Increase positive parent-child interaction
  • Improve how parents care for their children's health
  • Enhance home safety and parent supervision
  • Essential Components

    Planned Activities assessment and training:

    • Teach parent time management
    • Explain rules to child
    • Reinforcement/rewards
    • Incidental teaching
    • Activity preparation
    • Outcome discussions with child
    • Explain expectations to child

    Home Safety assessment and training:

    • Assess accessible home hazards with the Home Accident Prevention Inventory-Revised to assess accessible home hazards
    • Provide parents with door and cabinet latches
    • Use graduated plan to have parents remove identified hazards and to child proof doors and cabinets
    • Perform healthy home assessment and training

    Infant and child health care assessment and training:

    • Use HEALTH checklists to assess parent skills
    • Teach any skill deficits (i.e., how to take a temperature)
    • Teach use of health checklists and how to determine when to self-treat illness and when to seek medical care
    • Include problem solving training as needed

    Parent and staff training:

    • Modeling
    • Role rehearsal
    • Performance criteria in simulation and actual interactions.
    • Monitoring of staff for model fidelity.
    • Booster training if performance falls below criteria

    Child/Adolescent Services

    SafeCare® [Home Visiting for Child Well-Being] directly provides services to children/adolescents and addresses the following:

    • Difficult behavior and inability to do developmentally appropriate daily living tasks.

    Parent/Caregiver Services

    SafeCare® [Home Visiting for Child Well-Being] directly provides services to parents/caregivers and addresses the following:

    • Difficulty managing behavior, unable to prevent challenging behavior, and child health and safety concerns.

    Delivery Settings

    This program is typically conducted in a(n):

    • Adoptive Home
    • Birth Family Home
    • Foster/Kinship Care

    Homework

    SafeCare® [Home Visiting for Child Well-Being] includes a homework component:

    Planned activities, safety, and health care checklists.

    Languages

    SafeCare® [Home Visiting for Child Well-Being] has materials available in languages other than English:

    French, Spanish

    For information on which materials are available in these languages, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

    Resources Needed to Run Program

    The typical resources for implementing the program are:

    • A Home Visitor
    • A Coach
    • Space for offices

    Material resources needed to implement the program include:

    • Audio recorders (one for each home visitor so that they can audiotape each sessions for the purpose of coaching)
    • Basic safety latches (cabinet latches, drawer latches, and door knob latches), which are fairly inexpensive (e.g., 10 for $2)
    • A screwdriver for each home visitor for the installation of safety latches
    • Dolls (used dolls are fine) to use during role-plays with the parents
    • Plastic bins to carry materials
    • Other optional supplies include such things as digital thermometers, stickers for reinforcing children's positive behaviors
    • Band-aids
    • An electric screwdriver for the installation of safety latches, etc.

    Minimum Provider Qualifications

    Experience suggests at least a college education, but it has not been fully explored. The most important issue is that staff be trained to performance criteria.

    Education and Training Resources

    There is a manual that describes how to implement this program, and there is training available for this program.

    Training Contact:
    Training is obtained:

    Provided onsite by certified trainers.

    Number of days/hours:

    1.5 training hours per week.

    Implementation Information

    Since SafeCare® [Home Visiting for Child Well-Being] is highly rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

    Show implementation information...

    Pre-Implementation Materials

    There are pre-implementation materials to measure organizational or provider readiness for SafeCare® [Home Visiting for Child Well-Being] as listed below:

    The National SafeCare® Training and Research Center (NSTRC) Readiness Checklist and the SafeCare Application are documents that collect information about the agency and describe steps agencies should take prior to SafeCare® training. Agencies are sent the documents, asked to review, and then the documents are reviewed in a phone call with NSTRC prior to initiating a training contract. The documents focus on four main areas:

    • Population/systems - ensuring that the population targeted is appropriate for SafeCare®, and that the system in which SafeCare® will be implemented can support it (i.e., does it allow for an appropriate number of sessions, can coaching be paid for?)
    • Agency issues - ensuring that agency leadership and staff are all in support of SafeCare® implementation, and have communicated about why SafeCare® is being adopted, the importance of model fidelity, concerns that have arisen, caseloads, etc.
    • Staff to be trained - ensuring that the staff to be trained have been vetted and are in support of the model and comfortable with its approach, and have been briefed on training processes and expectations regarding implementation
    • Resources - discusses the resources needed for SafeCare® implementation.

    Additionally, NSTRC faculty conduct an onsite orientation for every agency trained. NSTRC expects agency leadership and trainees to be present, and it is recommended to invite referral agents as well. The orientation will provide an overview of SafeCare®, and typically includes breakout sessions with agency management/funders and providers to discuss and problem solve typical implementation challenges. For more information, email safecare@gsu.edu or visit http://safecare.publichealth.gsu.edu/training/training-readiness/.

    Formal Support for Implementation

    There is formal support available for implementation of SafeCare® [Home Visiting for Child Well-Being] as listed below:

    Certified SafeCare Coaches/Trainers provide support for Home Visitors. Home sessions are observed or listened to by the Coach to determine fidelity score and guide feedback to the Home Visitor in a Coaching call or meeting.

    The SafeCare Portal is a web-based portal that assists in trainee certification and fidelity monitoring, as well as allowing support for Home Visitors from their Trainer and/or Coach. The Portal also collects data on Home Visitor demographics, experience, and certification progress. Additionally, the Online Learning component allows for an alternate training option, partially online and partially in person.

    Fidelity Measures

    There are fidelity measures for SafeCare® [Home Visiting for Child Well-Being] as listed below:

    There are three measures that are used across each SafeCare® module. Each assesses approximately 25 behaviors that should be performed during the SafeCare® session (e.g., opens session, observes parent behavior during practice, provides positive and corrective feedback). Each item is rated as “implemented correctly,” “not implemented correctly,” or “not applicable” to that session. The measures can be requested at safecare@gsu.edu

    Implementation Guides or Manuals

    There are implementation guides or manuals for SafeCare® [Home Visiting for Child Well-Being] as listed below:

    Manuals and implementation tools are provided with each training. Manuals include tools for SafeCare® delivery including a session outline for each of the SafeCare® sessions, all handouts that are to be provided to parents (e.g., health manual, home safety handouts), and all clinical tools to be used by the provider (e.g., assessment tools for parenting, health, and safety). Manuals for coaches include fidelity monitoring tools and discussion of fidelity monitoring processes. Samples of the materials are available either by visiting http://safecare.publichealth.gsu.edu/training/curriculum/ or by emailing safecare@gsu.edu.

    Research on How to Implement the Program

    Research has been conducted on how to implement SafeCare® [Home Visiting for Child Well-Being] as listed below:

    • Aarons, G., Fettes, D., Flores, L., & Sornmerfeld, D. (2009). Evidence-based practice implementation and staff emotional exhaustion in children's services. Behaviour Research and Therapy, 47(11), 954-960.
    • Aarons, G., & Palinkas, L. (2007). Implementation of evidence-based practice in child welfare: Service provider perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 34(4), 411-419.
    • Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J. (2009). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect. Journal of Consulting & Clinical Psychology, 77(2), 270-280.
    • Palinkas, L., Aarons, G., Chorpita, B., Hoagwood, K., Landsverk, J., & Weisz, J. (2009). Cultural exchange and the implementation of evidence-based practices. Research on Social Work Practice, 19(5), 602-612.
    • Self-Brown, S., Frederick, K., Binder, S., Whitaker, D., Lutzker, J., Edwards, A., & Blankenship, J. (2011). Examining the need for cultural adaptations to an evidence-based parent training program targeting the prevention of child maltreatment. Children & Youth Services Review, 33(7), 1166-1172. doi:10.1016/j.childyouth.2011.02.010
    • Whitaker, D. J., Ryan, K. A., Wild, R. C., Self-Brown, S., Lutzker, J. R., Shanley, J. R., ... Hodges, A. E. (2012). Initial implementation indicators from a statewide rollout of SafeCare within a child welfare system. Child Maltreatment, 17(1), 96-101. doi:10.1177/1077559511430722

    Relevant Published, Peer-Reviewed Research

    This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

    Child Welfare Outcomes: Safety and Child/Family Well-Being

    Show relevant research...

    Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2002). Using recidivism data to evaluate Project Safecare: Teaching bonding, safety and healthcare skills to parents. Child Maltreatment, 7(3), 277-285.

    Type of Study: Matched comparison group design
    Number of Participants: 41 SafeCare participants, 41 Family Preservation participants

    Population:

    • Age range — Families with children aged 0 to 5.
    • Race/Ethnicity — Not Specified
    • Gender — Not Specified
    • Status — All families had a substantiated child abuse claim with the DCFS or were high-risk.

    Location / Institution: Not Specified

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    This study examined recidivism [habitual relapse] in a sample of families referred to the study by the local child welfare system due to recent substantiated reports of child abuse and/or neglect. The control group was matched based on child's birth date and geographical location from a sample of families participating in a Family Preservation program. Families in the SafeCare® group had significantly lower rates of re-abuse reporting during the 24-month follow-up period than the control group. At 36 months after the intervention 85% of the SafeCare® families had no further reports of child abuse, compared with 54% of the Family Preservation families. One limitation noted was that only those families who had completed all components of SafeCare®, including post-training data collection using the Beck Depression Inventory, Child Abuse Potential Inventory, and Parenting Stress Index were included in the treatment group, while there was no comparable assurance of level of service provided for the Family Preservation group, which makes the comparison less generalizable.

    Length of post-intervention follow-up: A minimum of 24 months.

    Gershater-Molko, R., Lutzker, J. R., & Wesch, D. (2003). Project SafeCare: Improving Health, safety and parenting skills in families reported for and at-risk for child maltreatment. Journal of Family Violence, 18(6), 377-386.

    Type of Study: Pre/post test
    Number of Participants: 41 families completed all three training components

    Population:

    • Age range — Families with children 0-5
    • Race/Ethnicity — Not Specified
    • Gender — Not Specified
    • Status — Participants were families with recent reports of child maltreatment and those referred by social workers due to the risk factors of parents' age, low level of education, and lack of social support.

    Location / Institution: Not Specified

    Summary: (To include comparison groups, outcomes, measures, notable limitations)
    Parents were trained in treating children's illnesses and maximizing their own healthcare skills (Health), positive and effective parent-child interaction skills (Parenting), and maintaining low-hazard homes (Safety) during a 24-week program. The effectiveness of these training components was evaluated as the change in the parents' scores on role-play situations for child health problems, hazards present in the home, and the frequency and quality of parent-child interactions during activities of daily living. Statistically significant improvements were seen in Health, Safety, and Parenting over baseline measures. However, the authors note that there was a high level of attrition from the program [decrease in using program components] among those who were referred, with only 10% completing all of the training components. This is cited as typical for maltreating and at-risk families referred to interventions with possible contributing factors including family stressors, involuntary referrals, and lack of resources or motivation.

    Length of post-intervention follow-up: Not Specified

    References

    Edwards, A., & Lutzker, J. R. (2008). Iterations of the SafeCare® model. An Evidence-based Child Maltreatment Prevention Program. Behavior Modification, 32, 736-756.

    Hecht, D. B., Silovsky, J. F., Chaffin, M., & Lutzker, J. R. (2008). Project SafeCare®: An evidence-based approach to prevent child neglect. APSAC Advisor, 20(1), 14-17.

    Lutzker, J. R., Bigelow, K. M., Doctor, R. M., & Kessler, M. L. (1998). Safety, health care, and bonding within an ecobehavioral approach to treating and preventing child abuse and neglect. Journal of Family Violence, 13, 163-185.

    Contact Information

    Name: John R. Lutzker, PhD
    Title: Executive Director
    Agency/Affiliation: Center for Healthy Development
    Website: www.safecarecenter.org
    Email:
    Phone: (404) 413-1284
    Name: Daniel J. Whitaker
    Agency/Affiliation: Georgia State University
    Department: Center for Healthy Development
    Website: www.safecarecenter.org
    Email:

    Date Research Evidence Last Reviewed by CEBC: September 2013

    Date Program Content Last Reviewed by Program Staff: March 2014

    Date Program Originally Loaded onto CEBC: March 2006