Programs that Work
Healthy and Safe Children
Children not experiencing physical, psychological or emotional abuse
Age of Child
Early Childhood (0-8)
Type of Setting
Type of Service
Type of Outcome Addressed
Child Abuse and Neglect
Evidence Level (What does this mean?)
SafeCareŽ is a home visiting program for parents of children ages 0-5 years who are at risk for child maltreatment or have been reported to Child Protective Services (CPS) for child maltreatment. The program aims to reduce subsequent child maltreatment by educating parents on home safety and organization skills, child health and nutrition management, and parent-child interaction skills. SafeCare uses trained home visitors to educate parents on these components such that their skills are generalizable across settings, time, and behaviors (Lutzker and Bigelow, 2002).
SafeCare was designed for use among parents of children ages 0-5 years who are at risk for child maltreatment or parents who have been reported for child maltreatment.
Several studies have evaluated the effectiveness of SafeCare. Only one study assessed the effect of SafeCare using a randomized controlled design where intervention participants were compared with control participants (Chaffin et al., 2012). Other studies assessed the impact of SafeCare without a control comparison group or without randomization of participants to intervention and control groups. The results of the study by Chaffin et al. (2012) that meets Promising Practices Network (PPN) criteria are presented here.
Chaffin et al. (2012) assessed the impact of SafeCare among 2,175 parents referred for home-based services by CPS over a three-year period between September 30, 2003, and October 1, 2006, after being reported for child maltreatment in two urban and four rural CPS regions within one state. Families were eligible for participation if all children were 12 years of age or younger, at least one parent had been reported for maltreatment, and no parents had been reported for sexual abuse. The 2,175 parents were assigned to one of 219 home visitors. Home visitors were randomly assigned at the region level to provide intervention or control services to the parents they served. There were 1,153 parents in the SafeCare intervention group and 1,022 parents in the control group. Control parents received the standard home visiting program provided by CPS, which included six months of unstructured services provided at a minimum of once a week. Parents in the intervention group received weekly visits for six months from home visitors who had received SafeCare training. The intervention group's home visits were structured following the SafeCare model, which focuses on behavior skills, training to address parent-child interactions, basic caregiving, parenting routines, home safety, and child health. Parents' CPS reports were collected from a statewide CPS database for an average of six years after study enrollment. Parents were determined to have had a subsequent maltreatment event if there was any report in the CPS system after study enrollment.
There were significant baseline differences between the intervention and control participants on several characteristics. Significantly more intervention parents than control parents were American Indian (19% vs. 14%); had preschool-aged children (79% vs. 72%); lived in a community with a population greater than 75,000 people (29% vs. 26%); had a higher baseline risk estimate for child maltreatment based on a number of factors, including demographics, previous CPS referrals, score on the Family Resources Scale, substance use screen score, and depression screener scale; and had a higher per capita child maltreatment report rate in the county of residence (45 vs. 41 per 1,000 children). Significantly fewer intervention parents than control parents were non-Hispanic white (64% vs. 70%). Intervention parents also had fewer prior CPS reports on average (4.41 vs. 5.07), were more likely to complete the home visiting program (90% vs. 86%), and had a shorter average follow-up time (6.15 years vs. 6.25 years). Among the home visitors, there were significant differences between the intervention and control groups on gender (85% female vs. 91% female), average age (40.4 years vs. 36.3 years), years on the job (7.1 years vs. 4.1 years), percentage American Indian (18% vs. 10%), percentage Hispanic (2% vs. 7%), percentage non-Hispanic white (60% vs. 66%), licensure for home visiting (15% vs. 20%), attainment of any graduate education (23% vs. 42%), and average number of study cases (16.8 vs. 18.5). These differences across both parents and home visitors were accounted for in the analysis by a technique called propensity score weighting.
Key Evaluation Findings
The study assessed time from study enrollment until a subsequent maltreatment event as determined by a report in the CPS system. There was a significantly lower risk of a subsequent CPS report among families in the intervention group compared with families in the control group. Specifically, for every 1,000 cases treated, SafeCare would prevent between 64 and 104 recurrences of reported maltreatment in the first year compared to the standard CPS intervention.
Child Protective Services and home visiting agencies
Parents often receive SafeCare services through a referral from their Child Protective Services worker. However, SafeCare has been implemented in public health organizations, as well as a prevention model by several organizations.
SafeCare is a home visiting intervention through which parents of children ages 0-5 years are educated on home safety and organization skills, child health and nutrition management, and parent-child interaction skills during weekly visits (Chaffin et al., 2012).
SafeCare home visitors participate in a one-week workshop training followed by fieldwork support for certification determined by demonstrating fidelity of 85 percent or greater across several SafeCare sessions. After certification, they receive monthly fidelity monitoring and coaching.
Home visitors trained on the SafeCare program provide parenting education on health, home safety, parent-child interactions, and problem solving. Home visitors provide 18 to 20 weeks of trainings to parents via weekly or biweekly home visits, lasting one or two hours. SafeCare aims to train parents in such a way that their skills are generalizable across settings, time, and behaviors. More information is available about the SafeCare curriculum through the program's website: http://www.safecare.org
Issues to Consider
This program was given a "promising" rating. The randomized controlled evaluation of SafeCare conducted by Chaffin et al. (2012) took place within six CPS regions of one state. There were significant baseline differences between intervention and control parents and between intervention and control home visitors. These differences were accounted for in the analysis using propensity score matching. As implemented, this technique meets Promising Practices Network criteria for a "promising" program.
Several other studies of SafeCare have been conducted (Damashek, Bard, and Hecht, 2012; Gershater-Molko, Lutzer, and Wesch, 2002; and Gershater-Molko, Lutzer, and Wesch, 2003). Only the study presented here, Chaffin et al. (2012), meets Promising Practices Network evidence criteria, including study design, effect size, and statistical significance.
Oklahoma Child Protective Services
Georgia Department of Human Services
Parent Aid Arizona
Riverside County Public Health
Safe Kids California Project
John Lutzker, Ph.D.
Center for Healthy Development
Georgia State University
P.O. Box 3995
Atlanta, Georgia 30302
Daniel Whitaker, Ph.D.
National SafeCare Training and Research Center
Center for Healthy Development
Georgia State University
P.O. Box 3995
Atlanta, Georgia 30302
More information about SafeCare is available through the SafeCare website: http://www.safecare.org
Chaffin, Mark, Debra Hecht, David Bard, Jane F. Silovsky, and William Howard Beaseley, "A Statewide Trial of the SafeCare Home-Based Services Model with Parents in Child Protective Services,"
Vol. 129, No. 3, 2012, pp. 509-515.
Gershater-Molko, Ronit M., John R. Lutzker, and David Wesch, "Project SafeCare: Improving Health, Safety, and Parenting Skills in Families Reported for, and At-Risk for Child Maltreatment," Journal of Family Violence, Vol. 18, No. 6, December 2003, pp. 377-386.
Gershater-Molko, Ronit M., John R. Lutzker, and David Wesch, "Using Recidivism Data to Evaluate Project SafeCare: Teaching Bonding, Safety, and Health Care Skills to Parents," Child Maltreatment, Vol. 7, No. 3, August 2002, pp. 277-285.
John R. Lutzker and Kathryn M. Bigelow, Reducing Child Maltreatment: A Guidebook for Parent Services, New York: Guilford Press, 2002.
Programs to Treat Child Abuse and Neglect," Child Maltreatment, Vol. 17, No. 1, February 2012, pp. 56-66.
Silovsky, Jane F., David Bard, Mark Chaffin, Debra Hecht, Lorena Burris, Arthur Owora, Lana Beasley, Debbie Doughty, and John Lutzker, "Prevention of Child Maltreatment in High-Risk Rural Families: A Randomized Clinical Trial with Child Welfare Outcomes," Children and Youth Services Review, Vol. 33, 2011, pp. 1435-1444.