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SafeCare®

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
High

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The SafeCare® program has been rated by the CEBC in the areas of: Interventions for Neglect, Parent Training, Prevention of Child Abuse and Neglect (Secondary) and Home Visiting for Prevention of Child Abuse and Neglect.

  • Types of Maltreatment: Physical Abuse, Physical Neglect
  • Target Population: Parents at-risk for child neglect and/or abuse and parents with a history of child neglect and/or abuse

SafeCare® is an in-home parenting model program that provides direct skill training to parents in child behavior management and planned activities training, home safety training, and child health care skills to prevent child maltreatment.

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 Component

SafeCare® was designed with a child component that addresses the following presenting problems and symptoms:

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

Age range: 0 – 5

Developmental Delays:

This program was developed for children with developmental delays, and has been tested for children with developmental delays.

Relevant research studies:

Shipley-Benamou, R.,Lutzker, J. R., & Taubman, M. (2002). Teaching daily living skills to children with autism through instructional video modeling. Journal of Positive Behavior Interventions, 4, 165-175, 188.

Huynen, K. B., Lutzker, J. R., Bigelow, K. M., Touchette, P. E., & Campbell, R. V. (1996). Planned activities training for mothers of children with developmental disabilities: Community generalization and follow-up. Behavior Modification, 20, 406-427.

Parent / Caregiver Component

SafeCare® was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

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

Group Format

SafeCare® was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster Home

Homework

SafeCare® includes a homework component:

Planned activities, safety, and health care checklists.

Languages

SafeCare® has materials available in a language other than English:

Spanish

For information on which materials are available in this language, 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 Contacts:
Training is obtained:

Provided onsite by certified trainers.

Number of days/hours:

1.5 training hours per week.

Implementation Information

Since SafeCare® 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 Assessments

To be given to organizations or providers in order to measure organizational or individual readiness:

Yes, the National SafeCare® Training and Research Center (NSTRC) readiness checklist is a document that describes steps agencies should take prior to SafeCare® training. Agencies are sent the document, asked to review, and then the document is reviewed in a phone call with NSTRC prior to initiating a training contract. The document focuses 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 on-site orientation for every agency trained. NSTRC expects agency leadership and trainees to be present, and we recommend inviting referral agents as well. The orientation will provide an overview of SafeCare®, and typically includes breakout sessions with agency management and trainees to discuss and problem solve typical implementation challenges.

The NSTRC readiness form can be obtained at http://chhs.gsu.edu/safecare/SafeCare_Readiness_Guide_new.pdf, or by emailing SafeCare@gsu.edu.

Implementation Tools — for the program (e.g., implementation guides or manuals)

Yes, 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.

Manuals are not publicly available, but sample session outlines are available from NSTRC. Requests can be sent to SafeCare@gsu.edu.

Fidelity Measures

Fidelity measures are included with each training. 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.

Fidelity tools are generally not publicly available, but can be requested from NSTRC at SafeCare@gsu.edu.

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. Please see the Scientific Rating Scale for more information.

Child Welfare Outcomes: Safety, Permanency 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

Chaffin, M., Hecht, D., Bard, D., Silovsky, J. F., & Beasley, W. H. (2012). A statewide trial of the SafeCare home-based services model with parents in child protective services. Pediatrics. Advance online publication. doi: 10.1542/peds.2011-1840

Type of Study: Randomized controlled trial (clusters)
Number of Participants: 2,175

Population:

  • Age range — Mean 29.4 years
  • Race/Ethnicity — 67% White non-Hispanic, 16% American Indian, 9% African American, and 5% Hispanic
  • Gender — 91% female
  • Status — Study participants were all parents with a history of physically maltreating their child(ren) (abuse or neglect - non-sexual abusers) referred for services by the child welfare system.

Location / Institution: Oklahoma

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This trial compared child protective services (CPS) recidivism outcomes between SafeCare® and comparable home-based services (Services as Usual) for parents in the CPS system across two quality control strategies: Coached and Uncoached implementation. The study was conducted in a scaled-up, statewide implementation setting. Maltreating parents were enrolled and treated in a 2 X 2 (SafeCare® vs. Services As Usual X Coached vs. Uncoached implementation strategy) randomized cluster experiment. Cases were followed for an average of six years for CPS recidivism events. Subpopulation analyses were conducted for parents meeting customary SafeCare® inclusion criteria. Analysis showed effectiveness for SafeCare®, especially in participants meeting customary SafeCare® inclusion criteria (i.e., young, first-time mothers). The analysis on coached implementation showed that it had positive effects especially on those participants falling outside customary SafeCare® inclusion criteria. Limitations include the cluster design, with a small number of clusters.

Length of post-intervention follow-up: Approximately 6 years.

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

Date Reviewed: February 2012 (originally reviewed in March 2006)