SafeCare®

Scientific Rating:
2
Supported by 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® has been rated by the CEBC in the areas of: Interventions for Neglect, Prevention of Child Abuse and Neglect (Secondary) Programs, Parent Training Programs that Address Child Abuse and Neglect, Home Visiting Programs for Prevention of Child Abuse and Neglect and Interventions for Abusive Behavior.

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

For parents/caregivers of children ages: 0 – 5

Brief Description

SafeCare® is an in-home parent training program that targets risk factors for child neglect and physical abuse in which parents are taught skills in three module areas: (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. All three modules should be used in the implementation of SafeCare®; any modifications to or elimination of modules need to be discussed with the program developers.

SafeCare® is also rated in the Home Visiting Programs for Child Well-Being topic area. Click here to see that entry.

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

The essential components of SafeCare® include:

  • Parent-infant/child interaction assessment and training - Provides parent instruction on target behaviors that is designed to reduce child physical abuse and neglect risk by improving parent-child interactions and reducing difficult child behaviors:
    • Assess parent’s interactions using the cPAT Assessment form
    • Teach parent how to organize activities by preparing in advance, establish routines, explain expectations to a child and follow through, use good verbal and physical interactions, and transition between activities
  • Home safety assessment and training - Provides parent instruction on target behaviors that is designed to reduce the risk of unintentional injury by removing home hazards and improving parental supervision:
    • Assess accessible home hazards with the Home Accident Prevention Inventory Assessment form
    • Work with parents to remove identified hazards and implement child proofing strategies
    • Teach the importance of parent supervision according to the developmental age of the child and what this looks like for the family
  • Child health assessment and training - Provides parent instruction on decision making strategies aimed at reducing medical neglect:
    • Assess parent skills using the Sick or Injured Child Checklist Assessment form
    • Teach use of a decision making process to determine when to seek emergency services, seek nonemergency medical services, or when to care for a child at home
    • Parents learn how to use health reference materials and to keep good health records
  • Parent and Provider training follows this sequence:
    • Explaining and modeling of targeted skills
    • Role-play targeted skills
    • Assessment of targeted skills and ideally achievement of standardized criteria for completion
    • Monitor provider delivery for model fidelity
    • Booster training if performance falls below criteria

Parent/Caregiver Services

SafeCare® directly provides services to parents/caregivers and addresses the following:

  • Poor parent-child interaction

Delivery Settings

This program is typically conducted in a(n):

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

Homework

SafeCare® includes a homework component:

Parents are encouraged to practice skills between sessions. Providers work with parents to develop the practice plan around planned activities with child between Parent-Child Interaction module sessions, safety hazard removal and maintenance between Safety sessions, and health care checklists practice between Health sessions.

Languages

SafeCare® has materials available in languages other than English:

French, Hebrew, 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 SafeCare Provider
  • A SafeCare Coach
  • Transportation for in-home sessions
  • Audio recorders (one for each Provider so that they can audiotape each sessions for the purpose of coaching) or Android or iOS devices that support the SafeCare mobile application
  • Dolls (used dolls are fine) to use during role-plays with the parents
  • Tape measure (use during the Safety module)
  • No choke test tube (use during the Safety module
  • )
  • Bag or plastic bin (to carry and organize materials)
  • Clipboard (for assessments and taking notes)
  • Coloring sheets and crayons (for children during sessions)
  • Toys (for infants and children during sessions)
  • Safety First Kit (or cabinet latches, door knob holders, outlet covers)
  • Screwdriver (to assist family in installing safety latches)
  • No choke test tube/Small parts tester (to leave with family)
  • Digital thermometer with cover (to leave with family)

Minimum Provider Qualifications

A bachelor’s degree in human services is preferable [less education is acceptable with work experience in child development and parenting]. Also, staff should be comfortable delivering interventions to families in the home setting, open to learning and implementing new curricula or intervention programs, open to or has prior experience in delivering a highly structured intervention protocol, understands the importance of program fidelity, and open and responsive to coaching and constructive feedback.

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:

To become a SafeCare Provider, the required training is conducted over 32 hours during 4 consecutive days of workshop training, followed by observations of at least nine sessions by a certified SafeCare Coach. To become a SafeCare Coach, one needs to be a certified SafeCare Provider and attend an additional 16 hours of workshop training over 2 days, plus observations of at least six coaching sessions by a certified SafeCare Trainer. To become a SafeCare Trainer, one needs to be a certified SafeCare Coach and attend an additional 24 hours of workshop training over 3 days, plus observation of training and support of new Providers by a Trainer from the National SafeCare Training and Research Center.

Implementation Information

Since SafeCare® is 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® as listed below:

The National SafeCare® Training and Research Center (NSTRC) conducts an implementation planning process to facilitate an agency’s readiness to implement SafeCare®. NSTRC disseminates Implementation Planning Guides and collects information about the agency and describe steps agencies should take prior to SafeCare® training. Agencies are provided with appropriate documents, asked to review, and then the documents are reviewed jointly during 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 a site visit for every agency trained. NSTRC expects agency leadership and trainees to be present, and it is recommended to invite referral agents as well. The site visit 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.

Formal Support for Implementation

There is formal support available for implementation of SafeCare® as listed below:

Certified SafeCare Coaches provide support for Providers. Home sessions are observed or listened to by the Coach to assess fidelity and guide feedback to the Provider in a Coaching call or meeting. SafeCare Coaches are supported by SafeCare Trainers, who assess the reliability of Coaches’ fidelity, as well as the quality of the Coaching session. NSTRC also provide technical assistance to agencies during the first year of implementation.

The SafeCare Portal is a web-based portal that assists in trainee certification and fidelity monitoring, as well as facilitating support for Providers from their Coach. The Portal also collects data on Provider demographics and certification progress.

Fidelity Measures

There are fidelity measures for SafeCare® as listed below:

There are three fidelity assessment forms that are used for each SafeCare® module to assess the Provider’s delivery of the program to a family. Each assesses approximately 30 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,” “not implemented,” or “not applicable” to that session. Coaching sessions are also rated for fidelity using a coach fidelity assessment form. The measures can be requested at safecare@gsu.edu.

Implementation Guides or Manuals

There are implementation guides or manuals for SafeCare® as listed below:

Manuals and implementation tools are provided with each training and implementation. 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® 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 "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. 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 — 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)
The purpose of this study was to assess the extent to which Project SafeCare® [now called SafeCare® ] improved parenting skills and reduced future occurrences of abuse and neglect with families who had abused and/or neglected their children. Participants were assigned to either Project SafeCare or a comparision group (Family Preservation program). Measures utilized include the Beck Depression Inventory, the Child Abuse Potential Inventory and the Parenting Stress Index. Results indicate families in the Project 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, the Project SafeCare families had no further reports of child abuse, compared with the Family Preservation families. Limitations include lack of randomization of participants, small sample size and limited generalizability to other populations based upon participation sample group.

Length of postintervention 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: Pretest-posttest study
Number of Participants: 41 families

Population:

  • Age — Children: 0-5 years, Parents: Not specified
  • Race/Ethnicity — Children: Not specified, Parents: Not specified
  • Gender — Children: Not specified, Parents: 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 postintervention 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, 129(3), 509-515.  doi: 10.1542/peds.2011-1840

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

Population:

  • Age — 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 - nonsexual 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 postintervention follow-up: Approximately 6 years.

Chafin, M., Bard, D., Bigfoot, D. S., & Maher, E. J. (2012). Is a structured, manualized, evidence-based treatment protocol culturally competent and equivalently effective among American Indian parents in child welfare? Child Maltreatment, 7(3), 277-285.

Type of Study: Subset of a Controlled Clinical Trial
Number of Participants: 354

Population:

  • Age — Approximately 29 years
  • Race/Ethnicity — 100% American Indian
  • Gender — 260 Male and 94 Female
  • Status — Participants were parents with a history of physically maltreating their child(ren) (abuse or neglect - non-sexual abusers) who were referred for services by the child welfare system.

Location/Institution: University of Oklahoma Health Sciences Center

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses a subsample of subjects from Chaffin, Hecht, Bard, Silovsky, & Beasley, 2012 above. This study examined recidivism reduction equivalency and acceptability among American Indian parents participating in a statewide trial of SafeCare. Measures utilized include the Beck Depression Inventory-2, the Child Abuse Potential Inventory, the Working Alliance Inventory, the Client Cultural Competency Inventory, and the Client Satisfaction Survey (CSS). Outcomes were 6-year recidivism, pre/post/follow-up measures of depression and child abuse potential, and posttreatment consumer ratings of working alliance, service satisfaction, and cultural competency. Results indicated that recidivism reduction among American Indian parents was found to be equivalent for cases falling within customary SafeCare inclusion criteria. In addition, when extended to cases outside customary inclusion boundaries, there was no apparent recidivism advantage or disadvantage. Results also indicated that SafeCare had higher consumer ratings of cultural competency, working alliance, service quality, and service benefits. Limitations include the lack of randomization at the client or worker level and lack of information on any tribal differences.

Length of postintervention follow-up: 6 years.

The following studies were not included in rating SafeCare® on the Scientific Rating Scale...

Carta, J. J., Lefever, J. B., Bigelow, K., Borkowski, J., & Warren, S. F. (2013). Randomized trial of a cellular phone-enhanced home visitation parenting intervention. Pediatrics, 132(Supplement 2), S167-S173.

This randomized controlled trial examines parent and child outcomes for dyads who completed the Parent-Child Interaction module of SafeCare (one of the three SafeCare modules). The Parent-Child Interaction module is based on parent training in ten Planned Activities Training steps (PAT). Parent-child dyads were randomly assigned to one either PAT, a cellular phone-enhanced version (CPAT), or a waitlist control (WLC) to examine changes in parent and child outcomes at 6 months posttreatment. Measures included the PAT Checklist, the Keys to Interactive Parenting Scale, the Beck Depression Inventory-II, the Parenting Stress Index-Short Form, the Behavior Assessment Scale for Children-2-Parent Report Scale, and the Child Behavior Rating Scale. Mothers receiving PAT and CPAT demonstrated more frequent use of parenting strategies and engaged in more responsive parenting than mothers in the WLC. Mothers receiving CPAT used more PAT parenting strategies than mothers in the other 2 groups and experienced greater reductions in depression and stress. Children of mothers receiving PAT and CPAT demonstrated higher rates of positive engagement, and children of CPAT mothers demonstrated higher levels of adaptive behaviors than children in the WLC. Importantly, changes in parenting, depression, and stress predicted positive child behaviors. Limitations include the use of research staff to deliver the intervention and the narrow age range of the children in the study. Note: Since this study utilized only one of the three modules of SafeCare, it was not used in the rating of the overall SafeCare program.

References

Guastaferro, K. M., Lutzker, J. R., Graham, M. L., Shanley, J. R., & Whitaker, D. J. (2012). SafeCare: Historical perspective and dynamic development of an evidence-based scaled-up model for the prevention of child maltreatment. Psychosocial Interventions, 21, 171-180.

Self-Brown, S., McFry, E., Montesanti, A, Edwards-Guara, A., Lutzker, J., Shanley, J, & Whitaker, D. (2014). SafeCare: A prevention and intervention program for child neglect and physical abuse. In R. Reece, R. Hanson, & J. Sargent (Eds). Treatment of child abuse: Common ground for mental health, medical and legal practitioners (2nd ed.).  Baltimore: John Hopkins University Press.

Silovsky, S. F., Bard, D., Chaffin, M, Hecht, D., Burris, L., Owora, A., … Lutzker, J. (2011). Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Review, 33, 1435-1444. doi:10.1016/j.childyouth.2011.04.023

Contact Information

Name: Daniel J. Whitaker, PhD
Title: Director, National SafeCare Training and Research Center
Agency/Affiliation: Georgia State University
Website: www.safecare.org
Email:
Phone: (404) 413-1282

Date Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: July 2016

Date Program Originally Loaded onto CEBC: March 2006