2  — Supported by Research Evidence
2  — Supported by Research Evidence
2  — Supported by Research Evidence
2  — Supported by Research Evidence
2  — Supported by Research Evidence
3  — Promising Research Evidence

About This Program

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

Program Overview

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.

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

Logic Model

The program representative did not provide information about a Logic Model for SafeCare®.

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 iPAT Assessment Form (infants 0-18 months) and the cPAT Assessment Form (children 18 months-5 years old)
    • 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 AssessmentForm
    • 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
    • Teach parents 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

Program Delivery

Parent/Caregiver Services

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

  • Poor parent-child interaction

Recommended Intensity:

Weekly sessions of approximately 1-1.5 hours each

Recommended Duration:

18-20 weeks

Delivery Settings

This program is typically conducted in a(n):

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


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-Infant/Child Interaction module sessions, safety hazard removal and maintenance between Safety sessions, and health care checklists practice between Health sessions.


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 session for the purpose of coaching) or Android or iOS devices that support the SafeCare mobile application unless SafeCare coach directly observes session
  • Dolls (used dolls are fine) to use during role-plays with the parents
  • Tape measure (used during the Safety module; provided by SafeCare)
  • No choke test tube (used during the Safety module; provided by SafeCare)
  • Bag or plastic bin (to carry and organize materials; bag provided by SafeCare)
  • 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)

Manuals and Training

Prerequisite/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.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contacts:
Training Type/Location:

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 or Trainer. 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 16 hours of workshop training over 2 days, plus a 4-5 day observation of a Provider Workshop.

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 collects information about the agency via conversations and an agency application, disseminates Implementation Planning Guides and discusses 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 - detailing the resources needed for SafeCare® implementation.

Additionally, NSTRC staff conducts an in-person orientation for every agency trained. NSTRC expects agency leadership and trainees to be present, and recommends referral agents and other stakeholders attend 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

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 Trainers support SafeCare Coaches by assessing the reliability of Coaches' fidelity, as well as the quality of the coaching session with the provider. NSTRC also provides technical assistance to agencies during the first year of implementation.

The SafeCare Portal is a web-based platform that assists in trainee certification and fidelity monitoring, as well as facilitating support for Providers from their Coach and Coaches from their trainer. 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

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). The Coach Manual includes fidelity monitoring tools and discussion of fidelity monitoring processes. The Trainer Manual includes guidelines and recommendations for training SafeCare® Coaches and Trainers. Samples of the materials are available either by visiting or by emailing

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, 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.
  • Self-Brown, S. R., Osborne, M. C., Rostad, W., & Feil, E. (2017). A technology-mediated approach to the implementation of an evidence-based child maltreatment prevention program. Child Maltreatment, 22(4), 344-353.
  • Whitaker, D. J., Ryan, K. A., Wild, R. C., Self-Brown, S., Lutzker, J. R., Shanley, J. R., Edwards, A. M., McFry, E. A., Moseley, C. N., & Hodges, A. E. (2012). Initial implementation indicators from a statewide rollout of SafeCare within a child welfare system. Child Maltreatment, 17(1), 96-101.

Relevant Published, Peer-Reviewed Research

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

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: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 82


  • Age — 0–5 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were families with a substantiated child abuse claim with the Department of Children and Family Services or were high-risk.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the 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 that 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 a lack of randomization of participants, the small sample size, and limited generalizability to other populations based on the lack of demographic collection from the sample group.

Length of controlled postintervention follow-up: Approximately 24 months.

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.

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


  • 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 basic study design, measures, results, and notable limitations)
The purpose of the study was to compare 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. Participants were randomized in a 2 X 2 randomized cluster design: Services As Usual/Uncoached, Services As Usual/Coached, SafeCare/Uncoached, and SafeCare/Coached. Measures utilized include the Child Abuse Potential Inventory, Family Resources Scale, Beck Depression Inventory, Social Provisions Scale, and the Diagnostic Interview Schedule. Results indicate 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 controlled postintervention follow-up: Approximately 6 years.

Chaffin, 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, 17(3), 242–252.

Type of Study: Randomized controlled trial
Number of Participants: 354


  • Age — Mean=29 years
  • Race/Ethnicity — 100% American Indian
  • Gender — 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 basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as Chaffin et al. (2012). The purpose of the study was to examine recidivism reduction equivalency and acceptability among American Indian parents participating in a statewide trial of SafeCare®. Participants were randomized to one of four conditions: 21% were assigned to Services As Usual/Uncoached, 22% to Services As Usual/Coached, 28% to SafeCare/Uncoached, and 28% to SafeCare/Coached. 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). Results indicate 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 indicate 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 a lack of information on any tribal differences.

Length of controlled postintervention follow-up: 6 years.

Hubel, G. S., Rostad, W. L., Self-Brown, S., & Moreland, A. D. (2018). Service needs of adolescent parents in child welfare: Is an evidence-based, structured, in-home behavioral parent training protocol effective? Child Abuse & Neglect, 79, 203–212.

Type of Study: Randomized controlled trial
Number of Participants: 294


  • Age — Mean=19.6 years
  • Race/Ethnicity — 64% White, 16% American Indian, 11% African American, 6% Hispanic, and 4% Other
  • Gender — 98% Female
  • Status — Participants were adolescent parents aged 21 or younger.

Location/Institution: System of home-based services implemented in community-based agencies in Oklahoma

Summary: (To include basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as Chaffin et al. (2012). The purpose of the study was to examine the effectiveness of SafeCare® with a diverse group of parents, which included adolescent parents under 21 years of age, a particularly at-risk group. Participants were randomly assigned to SafeCare® or home-based services as usual. Measures utilized include the Child Abuse Potential Inventory (CAPI), the Beck Depression Inventory (BDI), the Working Alliance Inventory (WAI), the Client Satisfaction Survey (CSS), the Client Cultural Competence Inventory (CCCI), as well as a measure for goal attainment, and child welfare administrative data. Results indicate that among the subsample of adolescent parents, the SafeCare® intervention did not result in significantly improved outcomes in terms of preventing recidivism or reduction in risk factors associated with child abuse and neglect as compared to child welfare services as usual. Further, no significant differences in program engagement and satisfaction between SafeCare® and services as usual were detected. Limitations include changing procedures and potential errors in data entry, the sample size for the subpopulation of adolescent-led families was much smaller than for the overall sample, and data used in this study originated from the original SafeCare® trial conducted ten years ago.

Length of controlled postintervention follow-up: 6 months.

Whitaker, D. J., Self-Brown, S., Hayat, M. J., Osborne, M. C., Weeks, E. A., Reidy, D. E., & Lyons, M. (2020). Effect of the SafeCare® intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial. Preventive Medicine, 138, Article 106167.

Type of Study: Randomized controlled trial
Number of Participants: 288


  • Age — Children: 0–5 years; Adults: Mean=29 years
  • Race/Ethnicity — Children: Not specified; Adults: 75% White, 13% Black, 7% Latino, and 5% Other
  • Gender — Children: Not specified; Adults: 87% Female
  • Status — Participants were child-welfare referred caregivers.

Location/Institution: Public and private child welfare agencies across the U.S.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the SafeCare© model to services as usual (SAU) for child-welfare referred caregivers. Participants were randomized to SafeCare© or to continue SAU. Measures utilized include the Parenting Young Children Scale (PYCS), the Parenting Stress Inventory-short form (PSI), the Mother-Child Neglect Scale (MCNS), and the Protective Factors Survey. Results indicate that SafeCare© had small to medium effects for improving several parenting outcomes including supporting positive child behaviors, proactive parenting, and two aspects of parenting stress. No differential change between groups was found for other indicators, including all indicators of neglect. Limitations include the group sample sizes were imbalanced, the sample was largely White, a high overall attrition rate (39%), and the lack of follow-up.

Length of controlled postintervention follow-up: None.

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(Suppl. 2), S167–S173.

The purpose of the study was to examine 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 (PAT) steps. Participants were randomly assigned to 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 utilized include 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. Results indicate that 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.

Lefever , J. B., Bigelow, K. M., Carta, J. J., Borkowski, J. G., Grandfield, E., McCune, L., Irvin, D. W., & Warren S. F. (2017). Long-term impact of a cell phone-enhanced parenting intervention. Child Maltreatment, 22(4), 305–314.

The study used the same sample as Carta et al. (2013). The purpose of the study was to assess whether a cellular phone-supported version (PCI-C) of the Parent-Child Interactions (PCI) module of SafeCare® intervention improved long-term parenting practices, maternal depression, and children’s aggression. Participants were randomly assigned to one of the three groups: PCI-C, PCI, and a wait-list control (WLC) group. Measures utilized include Keys to Interactive Parenting Scale (KIPS), the PCI Checklist Clean-Up, the Child Behavior Rating Scale (CBRS), the Behavior Assessment Scale for Children-2-Parent Report Scale (BASC-2-PRS), and the Beck Depression Inventory II (BDI-II). Results indicate that parenting improved in both intervention groups between baseline and 12-month follow-up compared to the WLC. Children in the PCI-C group were rated to be more cooperative and less aggressive than children in the WLC. Limitations include lack of strong measures of potential mechanisms for change and high rate of attrition during the intervention period. 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.

Silovsky, J., Bard, D., Owora, A. H., Milojevich, H., Jorgensen, A., & Hecht, D. (2023). Risk and protective factors associated with adverse childhood experiences in vulnerable families: results of a randomized clinical trial of SafeCare®. Child Maltreatment, 28(2), 384–395.

The purpose of the study was to test the effectiveness of a modified version of SafeCare in reducing adversity exposure and promoting child well-being. Participants were randomized to SafeCare augmented+Motivational Interviewing (SafeCare+) or to a services as usual group. Measures utilized include the Beck Depression Inventory – 2, Alcohol and Drug Modules from the Diagnostic Interview Schedule, Conflict Tactics Scale 2, the Family Resources Scale- Revised, and the Social Provision Scale Short Form. Results indicate that a significant program effect was found in favor of SafeCare+ for parental depression and social support, as well as within-group improvements for both groups in depression, intimate partner victimization, family resources, and social support. Limitations include an examination of culturally congruent services is warranted for Black, Indigenous, and other people of color. Note: This study was not used in the rating for the program since it combined SafeCare and Motivational Interviewing.

Additional 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(2), 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.). 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.

Contact Information

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

Date Research Evidence Last Reviewed by CEBC: December 2023

Date Program Content Last Reviewed by Program Staff: June 2018

Date Program Originally Loaded onto CEBC: June 2006