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SafeCare®

Yes (SafeCare Augmented only) <p><em>A SafeCare module, Planned Activities Training, and a module with an add-on, Cellular Phone Enhanced Planned Activities Training, also show evidence of effectiveness.</em></p>

In Brief

Last Updated

July 2018

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Evidence of Model Effectiveness

An adaptation of SafeCare, called SafeCare Augmented, meets the criteria established by the Department of Health and Human Services (HHS) for an “evidence-based early childhood home visiting service delivery model” for the general population, but it does not meet the criteria for tribal populations. In addition, a module of SafeCare, Planned Activities Training, and a module with an add-on, Cellular Phone Enhanced Planned Activities Training, demonstrate evidence of effectiveness.

SafeCare does not meet the HHS criteria for the general population or for tribal populations.

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Model Description

SafeCare aims to prevent and address factors associated with child abuse and neglect among the clients served. Eligible clients include families with a history of child maltreatment or families at risk for child maltreatment. SafeCare is an adaption of Project 12-Ways. SafeCare was developed to offer a more streamlined and easy-to-disseminate intervention based on three key modules of Project 12-Ways.

SafeCare typically provides 18 to 22 weeks of training to parents with children from birth to age 5. Trained SafeCare providers conduct 50- to 90-minute weekly or biweekly home visits involving three modules: (1) Planned Activities Training, which focuses on parent-child/parent-infant interactions, (2) infant and child health, and (3) home safety. Each of the three SafeCare modules typically includes a baseline assessment and observations of parental knowledge and skills, four parent training sessions, and a follow-up assessment to monitor change. During the parent training sessions, SafeCare providers explain the rationale for a particular concept, model the concept, have the parent practice the steps, and then provide feedback. SafeCare providers are not required to meet specific education requirements.

Project 12-Ways, the precursor to SafeCare, offers training in twelve key topic areas: (1) parent-child interaction, (2) stress reduction for parents, (3) basic skills training for children, (4) money management, (5) social support, (6) home safety, (7) multi-setting behavior management, (8) infant and child health and nutrition, (9) problem solving, (10) marital discord counseling, (11) alcohol abuse referral, and (12) pre- and post-natal prevention services for young and unwed mothers. Direct services are delivered to families in their homes by highly-trained counselors, most of whom are advanced graduate students with specialized training.

This report includes reviews of two adaptations of SafeCare: (1) SafeCare Augmented and (2) an Australian adaptation of a version of SafeCare, the University of California, Los Angeles (UCLA) Parent-Child Health and Wellness Project. SafeCare Augmented adds Motivational Interviewing—a technique that explores and builds on an individual’s motivation to change—and additional training of providers on the identification and response to imminent child maltreatment and risk factors, such as substance use and depression. SafeCare Augmented was adapted for high-risk, rural communities. The Australian adaptation of the UCLA Parent-Child Health and Wellness Project adapted the UCLA Health and Safety interventions (created collaboratively with the SafeCare model developer, with identical goals and methods) for the Australian context (e.g., language was changed to reflect Australian usage). The goal of the intervention is to equip parents of young children with the knowledge and skills necessary for managing home dangers, accidents, and childhood illnesses. The intervention consists of 10 lessons over a 10- to 12-week period.

This report also includes reviews of a module of SafeCare, Planned Activities Training, and a module with an add-on, Cellular Phone Enhanced Planned Activities Training. The Planned Activities Training module of SafeCare focuses on skills such as engaging in positive interactions and establishing rules and limits, and is administered to mothers during five home visiting sessions. Cellular Phone Enhanced Planned Activities Training is an add-on to the Planned Activities Training module that adds encouragement and skill reinforcement via text messages and phone calls between in-home Planned Activities Training parent training sessions.

For more information, please read the Model Overview.

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Extent of Evidence

Results of Research and ReviewNumber of Studies for SafeCare/Project 12-WaysNumber of Studies for SafeCare AugmentedNumber of Studies for Australian Adaptation of UCLA Parent-Child Health and Wellness ProjectNumber of Studies for SafeCare/Project 12-Ways: Home Safety ModuleNumber of Studies for SafeCare: Planned Activities Training ModuleNumber of Studies for SafeCare: Cellular Phone Enhanced Planned Activities Training Module
Released from 1979 to 2017 68211104
Eligible for review 1611192
     Rated high 010022
     Rated moderate 001100
     Rated low 1200060
     Additional sources1 400010

1Additional sources overlap with another study and are not rated.

The UCLA Parent-Child Health and Wellness Project was created collaboratively with the SafeCare model developer, with identical goals and methods.

For more information, see the study database. For more information on the criteria used to determine the study ratings, please read Producing Study Ratings.

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Summary of Findings



SafeCare/Project 12-Ways
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness Not measured Not measured
Child Health Not measured Not measured
Family Economic Self-Sufficiency Not measured Not measured
Linkages and Referrals Not measured Not measured
Maternal Health Not measured Not measured
Positive Parenting Practices Not measured Not measured
Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured Not measured

SafeCare Augmented
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness Not measured Not measured
Child Health Not measured Not measured
Family Economic Self-Sufficiency

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 4
Unfavorable or ambiguous: 0

Linkages and Referrals

Favorable: 1
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Maternal Health

Favorable: 0
No effect: 2
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 4
Unfavorable or ambiguous: 0

Positive Parenting Practices Not measured Not measured
Reductions in Child Maltreatment

Favorable: 0
No effect: 3
Unfavorable or ambiguous: 0

Favorable: 1
No effect: 5
Unfavorable or ambiguous: 0

Reductions in Juvenile Delinquency, Family Violence, and Crime

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 3
Unfavorable or ambiguous: 1


Australian Adaptation of UCLA Parent-Child Health and Wellness Project
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness Not measured Not measured
Child Health Not measured Not measured
Family Economic Self-Sufficiency Not measured Not measured
Linkages and Referrals Not measured Not measured
Maternal Health Not measured Not measured
Positive Parenting Practices

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 24
Unfavorable or ambiguous: 0

Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured Not measured

SafeCare/Project 12-Ways: Home Safety Module
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness Not measured Not measured
Child Health Not measured Not measured
Family Economic Self-Sufficiency Not measured Not measured
Linkages and Referrals Not measured Not measured
Maternal Health Not measured Not measured
Positive Parenting Practices

Favorable: 1
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured Not measured

SafeCare: Planned Activities Training Module
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness

Favorable: 0
No effect: 1
Unfavorable or ambiguous: 0

Favorable: 1
No effect: 5
Unfavorable or ambiguous: 0

Child Health Not measured Not measured
Family Economic Self-Sufficiency Not measured Not measured
Linkages and Referrals Not measured Not measured
Maternal Health

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 0
No effect: 5
Unfavorable or ambiguous: 0

Positive Parenting Practices

Favorable: 2
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 4
No effect: 0
Unfavorable or ambiguous: 0

Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured Not measured

SafeCare: Cellular Phone Enhanced Planned Activities Training Module
Outcomes Primary Outcome Measures Secondary Outcome Measures
Child Development and School Readiness

Favorable: 1
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 3
No effect: 3
Unfavorable or ambiguous: 0

Child Health Not measured Not measured
Family Economic Self-Sufficiency Not measured Not measured
Linkages and Referrals Not measured Not measured
Maternal Health

Favorable: 0
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 4
No effect: 1
Unfavorable or ambiguous: 0

Positive Parenting Practices

Favorable: 2
No effect: 0
Unfavorable or ambiguous: 0

Favorable: 4
No effect: 0
Unfavorable or ambiguous: 0

Reductions in Child Maltreatment Not measured Not measured
Reductions in Juvenile Delinquency, Family Violence, and Crime Not measured Not measured
Table Help
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This table summarizes the effects found in research across outcome domains. Outcomes with a favorable impact are listed in green and outcomes with an unfavorable or ambiguous impact are listed in red. Outcomes that have high attrition or lack of baseline equivalence are excluded from this report.

Favorable Impact: A statistically significant impact on an outcome measure in a direction that is beneficial for children and parents. This impact could statistically be positive or negative, and is determined “favorable” based on the end result. For example, a favorable impact could be an increase in children’s vocabulary or daily reading to children by parents, or a reduction in harsh parenting practices or maternal depression.

Unfavorable or Ambiguous Impact: A statistically significant impact on an outcome measure in a direction that may indicate potential harm to children and/or parents. This impact could statistically be positive or negative, and is determined “unfavorable or ambiguous” based on the end result. NOTE: While some outcomes are clearly unfavorable, for other outcomes it is not as clear which direction is desirable. For example, an increase in children’s behavior problems is clearly unfavorable, while an increase in number of days mothers are hospitalized is more ambiguous. This may be viewed as an unfavorable impact because it indicates that mothers have more health problems, but it could also indicate that mothers have increased access to needed health care due to their participation in a home visiting program.

Primary Outcome Measure: For the HomVEE review, an outcome measured through direct observation, direct assessment, or administrative data; or self-reported data collected using a standardized (normed) instrument.

Secondary Outcome Measure: For the HomVEE review, most self-reported data, excluding self-reports based on a standardized (normed) instrument.

Please read Describing Effects for more information on these categories. Only results from studies that meet the standards for the high or moderate ratings are included above.

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Criteria Established by the Department of Health and Human Services

 SafeCare/Project 12-WaysSafeCare AugmentedAustralian Adaptation of UCLA Parent-Child Health and Wellness ProjectSafeCare/Project 12-Ways: Home Safety Module²SafeCare: Planned Activities Training Module²SafeCare: Cellular Phone Enhanced Planned Activities Training Module²
Information Based on Comprehensive Review of All High- and Moderate-Impact Studies for this Model
High- or moderate-quality impact study? NoYesYesYesYesYes
Across high- or moderate-quality studies, favorable impacts in…
 
   at least two outcome domains within one sample
 
   OR
 
   the same domain for at least two non-overlapping samples?
YesYesNoNoYesYes
Favorable impacts on full sample? NAYesNoYesYesYes
Any favorable impacts on outcome measures sustained at least 12 months after model enrollment?1 NoYesNoNoYesYes
One or more favorable, statistically significant impact reported in a peer-reviewed journal?1 NoYesYesYesYesYes

NA = not applicable.

1This information is reported for all models, but the requirements for sustained findings and inclusion in a peer-reviewed journal only apply to models for which all findings are from randomized controlled trials.

2As part of our review of SafeCare, HomVEE reviewed studies about two SafeCare modules: home safety and Planned Activities Training. HomVEE also reviewed studies about a SafeCare module with an add-on: Cellular Phone Enhanced Planned Activities Training. The information in this table does not necessarily reflect a comprehensive review of all high- and –moderate impact studies about the two modules and the module with an add-on.

Please read the HHS Criteria for Evidence-Based Models for more information.

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