SafeCare
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 download the Handbook of Standards and Procedures, Version 1.0
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
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
 and Implied Percentile Effect
|
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
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| 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.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 10784 - SafeCare vs. Child Welfare Services as Usual Matched Comparison | ||||||
| Characteristics of the Children and Youth | ||||||
| Colorado, USA | 2014 | Age range: 0-5 years | -- | -- | -- | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Colorado, USA | 2014 | -- | -- | -- |
100% Parents and/or caregivers; 100% Past child welfare involvement |
-- |
| Study 15111 - SafeCare vs. TAU | ||||||
| Characteristics of the Children and Youth | ||||||
| Arkansas, USA | -- | Average age: 6 months |
58% White 37% Black 4% Hispanic or Latino |
49% Female | -- | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Arkansas, USA | -- | Average age: 28 years | -- | -- | Families receiving child protective services due to child at risk of maltreatment | $38,650 Median household income |
| Study 10575 - SafeCare vs. SAU | ||||||
| Characteristics of the Children and Youth | ||||||
| Oklahoma, USA | 2003 | Age of youngest child in the household: 76.3% Preschool age, 22.9% School age, 0.7% Teenager | -- | -- | -- | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Oklahoma, USA | 2003 | Average age: 29.3 years |
67% White (Non-Hispanic) 16% American Indian/Native American 9% African American (Non-Hispanic) 4.7% Hispanic 2.3% Other 0.4% Asian American |
91% Female 9% Male |
100% Substantiated cases of child maltreatment; Mean number of prior reports to child welfare services: 2.9; 100% Parents; 22.9% Met criteria for a substance use disorder |
82% Below the poverty line |
| Study 10910 - SafeCare vs. Services as Usual | ||||||
| Characteristics of the Children and Youth | ||||||
| United States of America | 2015 | Average age: 28 months; Age range: 0-5 years | -- | -- | -- | -- |
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| United States of America | 2015 | Average age: 29 years |
75% White 13% Black 7% Latino 5% Other |
87% Female 13% Male |
100% Substantiated or suspected physical abuse or neglect; None had a primary allegation of sexual abuse; 100% Caregivers; 26% Victim of physical partner violence past 12 months |
32% Monthly income above $1,250 34% Monthly income $600-$1250 35% Monthly income less than $600 51% Not working 49% Working |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated Moderate
Study 10784Quick-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.
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)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
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)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
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)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
This study was conducted in a usual care or practice setting (Handbook Section 6.2.2)Studies Rated Low
Study 10577Gershater-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).