SafeCare

In-home Parent Skill-Based Supported

SafeCare is an in-home behavioral parenting program that promotes positive parent-child interactions, informed caregiver response to childhood illness and injury, and a safe home environment. SafeCare is designed for parents and caregivers of children birth through five who are either at-risk for or have a history of child neglect and/or physical abuse. The program aims to reduce child maltreatment. The SafeCare curriculum is delivered by trained and certified providers. The curriculum includes three modules: (1) the home safety module targets risk factors for environmental neglect and unintentional injury by helping parents/caregivers identify and eliminate common household hazards and teaching them about age-appropriate supervision; (2) the health module targets risk factors for medical neglect by teaching parents/caregivers how to identify and address illness, injury, and health generally; (3) the parent-child/parent-infant interaction module targets risk factors associated with neglect and physical abuse by teaching parents/caregivers how to positively interact with their infant/child, and how to structure activities to engage their children and promote positive behavior. Each module is designed to be delivered in 6 sessions (18 total), but some families may need fewer or more sessions to reach skill mastery. Each session typically lasts 50 to 90 minutes and is delivered in the family’s home or at another location of the parent’s choice. 


SafeCare is rated as a supported practice because at least one study carried out in a usual care or practice setting achieved a rating of moderate or high on design and execution and demonstrated a sustained favorable effect of at least 6 months beyond the end of treatment on at least one target outcome.

 

A re-review of SafeCare was conducted in March 2024 based on the availability of a new study (Study 15111) and a new research report for Study 10575. The design and execution rating for Study 10575 changed from Low to Moderate, but there were no moderately-rated contrasts with favorable findings. Study 15111 received a Moderate design and execution rating, but there were no moderately-rated contrasts with favorable findings. Therefore, the re-review did not affect the program or service rating. 


Date Research Evidence Last Reviewed: Mar 2024


Sources

The program or service description, target population, and program or service delivery and implementation information was informed by the following sources: The California Evidence-based Clearinghouse for Child Welfare, Home Visiting Evidence of Effectiveness, the program or service developer’s website, the program or service manual, and the studies reviewed.

 

Program/Service Description Updated: Week of August 24, 2020


This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, visit the Review Process page or download the Handbook.

Target Population

SafeCare is designed for parents/caregivers of children 0-5 who are either at-risk for or have a history of child neglect and/or abuse.

Dosage

SafeCare is designed to be completed in approximately 18 sessions, though some parents may need fewer or more sessions to master new skills. During this time, providers deliver three curriculum modules, with each module lasting for six sessions. Providers typically meet with clients weekly for about 50 to 90 minutes.

Location/Delivery Setting
Recommended Locations/Delivery Settings

SafeCare is delivered in the homes of participating parents/caregivers. If services cannot be delivered in the participating parent’s/caregiver’s home, an alternative setting can be used (e.g., clinic, shelter, family-based residential treatment center).

Location/Delivery Settings Observed in the Research

  • Home

Education, Certifications and Training

There are no educational requirements for SafeCare training. The National SafeCare Training and Research Center (NSTRC) provides training for providers. All providers are required to participate in 32 hours of workshop training and receive post-workshop coaching to promote fidelity and proficiency in delivering SafeCare to receive their certification. Ongoing coaching is required to keep provider certifications active. NSTRC also provides trainings for coaches and trainers.

Additional information about these trainings can be found on the NSTRC website.

Program or Service Documentation
Book/Manual/Available documentation used for review

Lutzker, J. R. (2016). SafeCare provider manual (version 4.1.1).

Available languages

Materials for SafeCare are available in French, Hebrew, and Spanish.

Other supporting materials

SafeCare Curriculum

Training Materials

Provider Workshop Reference Packet

For More Information

Website: www.safecare.org

Phone: (404) 413-1282

Email: safecare@gsu.edu


Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.

Results of Search and Review Number of Studies Identified and Reviewed for SafeCare
Identified in Search 8
Eligible for Review 5
Rated High 0
Rated Moderate 4
Rated Low 1
Reviewed Only for Risk of Harm 0
Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings
Child safety: Child welfare administrative reports -0.02
0
2 (7) 3655 Favorable: 0
No Effect: 6
Unfavorable: 1
Child safety: Maltreatment risk assessment -0.03
-1
1 (2) 861 Favorable: 0
No Effect: 2
Unfavorable: 0
Child permanency: Out-of-home placement 0.04
1
2 (5) 4109 Favorable: 1
No Effect: 4
Unfavorable: 0
Adult well-being: Parent/caregiver mental or emotional health -0.02
0
1 (4) 865 Favorable: 0
No Effect: 4
Unfavorable: 0
Adult well-being: Family functioning 0.07
2
2 (3) 1891 Favorable: 0
No Effect: 3
Unfavorable: 0

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.

Outcome Effect Size Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
Child safety: Child welfare administrative reports -0.02
0
2 (7) 3655 Favorable: 0
No Effect: 6
Unfavorable: 1
-
Study 15111 - SafeCare vs. TAU (Lewis, 2023)
True Findings from Allegations 0.04
1
- 3078 - 6
True Findings from Allegations -0.38 *
-14
- 2284 - 12
True Findings from Allegations -0.11
-4
- 1458 - 18
True Findings from Allegations Null
not calculated
- 3286 - 29
Study 10784 - SafeCare vs. Child Welfare Services as Usual Matched Comparison (Quick, 2018)
Subsequent Child Protective Services Referral 0.07
2
- 369 - 12
Subsequent Child Protective Services Assessment 0.16
6
- 369 - 12
Subsequent Child Protective Services Founded Assessment 0.48
18
- 369 - 12
Child safety: Maltreatment risk assessment -0.03
-1
1 (2) 861 Favorable: 0
No Effect: 2
Unfavorable: 0
-
Study 10575 - SafeCare vs. SAU (Moreland, 2022)
Child Abuse Potential Inventory: Abuse 0.02
0
- 861 - 0
Child Abuse Potential Inventory: Abuse -0.07
-2
- 861 - 3
Child permanency: Out-of-home placement 0.04
1
2 (5) 4109 Favorable: 1
No Effect: 4
Unfavorable: 0
-
Study 15111 - SafeCare vs. TAU (Lewis, 2023)
Foster Care Entry 0.07
2
- 3740 - 0
Foster Care Entry 0.02
0
- 3078 - 6
Foster Care Entry 0.04
1
- 2284 - 12
Foster Care Entry -0.05
-2
- 1458 - 18
Study 10784 - SafeCare vs. Child Welfare Services as Usual Matched Comparison (Quick, 2018)
Subsequent Out-of-home Placement 1.69 *
45
- 369 - 12
Adult well-being: Parent/caregiver mental or emotional health -0.02
0
1 (4) 865 Favorable: 0
No Effect: 4
Unfavorable: 0
-
Study 10575 - SafeCare vs. SAU (Moreland, 2022)
Beck Depression Inventory 0.05
2
- 865 - 0
Beck Depression Inventory -0.04
-1
- 865 - 3
Child Abuse Potential Inventory: Distress 0.01
0
- 861 - 0
Child Abuse Potential Inventory: Distress -0.10
-3
- 861 - 3
Adult well-being: Family functioning 0.07
2
2 (3) 1891 Favorable: 0
No Effect: 3
Unfavorable: 0
-
Study 15111 - SafeCare vs. TAU (Lewis, 2023)
Family Advocacy and Support Tool: Caregiver's Advocacy Status 0.09
3
- 1632 - 2
Family Advocacy and Support Tool: Family Together 0.03
1
- 1632 - 2
Study 10910 - SafeCare vs. Services as Usual (Whitaker, 2020)
Parenting Stress Index – Third Edition, Short Form: Difficult Child 0.11
4
- 259 - 2

*p <.05

Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Section 5.10.4 and may not align with effect sizes reported in individual publications. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.

Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.

Full citations for the studies shown in the table are available in the "Studies Reviewed" section.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated Moderate

Study 10784

Quick-Beachy, K., Lee, C., McConnell, L., Orsi, R., Timpe, Z., & Winokur, M. (2018). SafeCare Colorado program evaluation report 2014-2017. Denver, CO: Colorado Office of Early Childhood.

Study 10910

Whitaker, D. (2016). Comparative effectiveness trial to reduce child maltreatment, improve client outcomes and examine client burden: Research protocol. Patient Centered Outcomes Research Institute.

Whitaker, D. J., Self-Brown, S., Hayat, M. J., Osborne, M., Weeks, E., Reidy, D., & Lyons, M. (2020). Effect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial. Preventative Medicine, 138. https://doi.org/10.1016/j.ypmed.2020.106167

Study 10575

Chaffin, M., Hecht, D., Bard, D., Silovsky, J. F., & Beasley, W. H. (2012a). 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

Chaffin, M., Bard, D., Bigfoot, D. S., & Maher, E. J. (2012b). 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. doi:10.1177/1077559512457239

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. doi:10.1016/j.chiabu.2018.02.005

Moreland, A., Crum, K., Rostad, W.L., Stefanescu, A., & Whitaker, D. (2022). Examining an in-home behavioral parent training protocol among parents who use substances involved child welfare: Effectiveness of SafeCare. Child Maltreatment, 27(4), 671-682. https://doi.org/10.1177/10775595211046940

Study 15111

Lewis, K., Ashby, K., McKelvey, L., & Fitzgerald, S. (2023). Arkansas Family First Prevention Services Act evaluation. SafeCare model. University of Arkansas for Medical Sciences. https://medicine.uams.edu/familymedicine/wp-content/uploads/sites/7/2023/08/SafeCare-Report_Aug-2023.pdf


Studies Rated Low

Study 10577

Gershater-Molko, R. M., Lutzker, J. R., Wesch, D. (2002). Using recidivism data to evaluate project SafeCare: Teaching bonding, safety, and health care skills to parents. Child Maltreatment, 7(3), 277-285. https://doi.org/10.1177/1077559502007003009

This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.


Studies Not Eligible for Review

Study 10576

Damashek, A., Bard, D., Hecht, D. (2012). Provider cultural competency, client satisfaction, and engagement in home-based programs to treat child abuse and neglect. Child Maltreatment, 17(1), 56-66. https://doi.org/10.1177/1077559511423570

This study is ineligible for review because it does not report program or service impacts on an eligible target outcome (Study Eligibility Criterion 4.1.5).

Study 10783

Churchill, G. (2015). SafeCare: Evidence from a home based parenting programme for neglect. NSPCC.

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).

Study 10896

Gallitto, E., Romano, E., & Whitaker, D. (2020). Investigating the impact of the SafeCare program on parenting behaviours in child welfare-involved families. Child & Adolescent Social Work Journal, 38, 115-126. https://doi.org/10.1007/s10560-020-00672-6

This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).