Implementing SafeCare®

Entries in this row combine information across all versions of SafeCare. Only SafeCare Augmented meets HHS criteria for an evidence-based home visiting model. For SafeCare itself, there are no manuscripts about high- or moderate-quality impact studies. Some other versions of SafeCare have at least one such manuscript. Planned Activities Training (a SafeCare module) and Cellular Phone Enhanced Planned Activities Training (a SafeCare module with an add-on) show evidence of effectiveness.

Model implementation summary last updated: 2020

The information in this implementation report reflects feedback, if provided, from this model’s developer as of the above date. The description of the implementation of the model(s) here may differ from how the model(s) was implemented in the manuscripts reviewed to determine this model’s evidence of effectiveness. Inclusion in the implementation report does not mean the practices described meet the HHS criteria for evidence of effectiveness. Please see the Effectiveness button on the left for more information about any research on the effectiveness of the model, including any version(s) of the model with effectiveness research. Versions of the model that are described in the Adaptations and enhancements section of this implementation report may include (1) versions that were identified by the model’s developer and (2) versions that have been implemented by researchers and have manuscripts that HomVEE rated high or moderate, but that are not supported by the model’s developer.

Model overview

Theoretical approach

SafeCare is a structured parenting intervention that is designed to address behaviors that can lead to child neglect and abuse. The model emphasizes learning in a social context and uses behavioral principles for parent training. SafeCare is an adaptation of Project 12-Ways that includes a subset of the Project 12-Ways modules. SafeCare was developed to offer a more easily disseminated and streamlined intervention to parents at risk for child abuse and neglect.

Project 12-Ways, the model SafeCare was based on, employs an ecobehavioral approach to the treatment and prevention of child abuse and neglect. Ecobehavioral refers to the multifaceted in-home services provided to families.

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Implementation support

The National SafeCare Training and Research Center (NSTRC) provides implementation support, including training, technical assistance, and quality assurance to all agencies and systems that deliver the SafeCare model. NSTRC is housed within the Mark Chaffin Center for Healthy Development in the School of Public Health at Georgia State University in Atlanta, Georgia.
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Intended population

SafeCare serves families with young children from birth through age 5 years. The model is designed to benefit families with risk factors for child maltreatment. Populations served include young parents; parents with multiple children; parents with a history of depression, other mental health problems, substance use, or intellectual disabilities; foster parents; parents involved with the child protective system for neglect or physical abuse; parents being reunified with their children; parents recently released from incarceration; and parents with a history of domestic violence or intimate partner violence. The model also serves parents of children with developmental or physical disabilities or mental health, emotional, or behavioral issues. SafeCare is intended to complement the more specialized intervention services these families might be receiving from other agencies.

SafeCare has been used with culturally diverse populations.

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Targeted outcomes

SafeCare aims to improve (1) parental health decision making skills, including identifying symptoms of illness or injury and seeking appropriate treatment; (2) the safety of the home environment by removing home hazards and addressing parental supervision; and (3) parenting skills and parent-infant/parent-child interactions during daily routines and play activities.

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Model services

SafeCare includes one-on-one home visits between home visitors (referred to as providers) and families. SafeCare includes three modules: (1) infant and child health, (2) home safety, and (3) parent-infant/parent-child interactions (Planned Activities Training). The health module trains parents to use health reference materials, record health information, use basic health supplies (such as a thermometer), prevent illness, identify symptoms of childhood illnesses or injuries, and provide or seek appropriate treatment. The safety module helps parents identify and eliminate safety and health hazards and teaches parents how to appropriately supervise their young children. The parent-infant/parent-child interactions (Planned Activities Training) module aims to teach parents how to provide engaging and stimulating activities, increase positive interactions, and prevent challenging child behaviors.

The three SafeCare modules typically include a baseline assessment and observation of parents’ knowledge and skills, followed by four parent training sessions, and conclude with a follow-up assessment to monitor change. Providers use a four-step approach during parent training sessions to instill target behaviors: (1) describe and explain the rationale for each behavior, (2) model that behavior, (3) ask the parent to practice the behavior, and (4) provide positive and constructive feedback. This approach is designed to help parents generalize skills across time, behaviors, and settings.

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Model intensity and length

NSTRC recommends that SafeCare providers conduct weekly or biweekly sessions for approximately 60 minutes each. Sessions must be provided no more than twice a week and no less than every two weeks to optimize skill acquisition and retention.

SafeCare is typically delivered in 18 or fewer sessions, depending on the parents’ initial skills observed at the baseline assessment and how quickly they master the target skills. In some SafeCare programs, the model is integrated with other case management efforts, which can extend program delivery. Providers work with parents until they meet a set of skill-based criteria for each of the three modules (health, safety, and parent-infant/parent-child interactions [Planned Activities Training]).

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NSTRC has trained SafeCare providers in 27 states. Internationally, NSTRC has trained SafeCare providers in Australia, Belarus, Canada, Israel, Japan, Spain, Taiwan, and the United Kingdom.
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Adaptations and enhancements

SafeCare Augmented is an adapted version of SafeCare that incorporates additional training for providers in Motivational Interviewing—a technique that explores and builds on an individual’s motivation to change—and ongoing consultation for providers from local experts in intimate partner violence. SafeCare Augmented has also been adapted for use with high-risk, rural families who do not have a long history of involvement with child welfare services.

Cellular Phone Enhanced Planned Activities Training is an add-on to SafeCare’s parent-infant/parent-child interactions (Planned Activities Training) module that incorporates cellular telephones to promote family engagement between home visits. Specifically, providers send families daily text messages and occasional voice messages to encourage and reinforce newly learned parenting strategies.

Dads to Kids (Dad2K) is an adaptation of the SafeCare parent-infant/parent-child interactions (Planned Activities Training) module for fathers. It includes video-based learning, Motivational Interviewing techniques, and a co-parenting curriculum.

An adaptation team of experts at NSTRC must discuss and approve any potential adaptations to the base SafeCare model.

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Implementation notes

The information contained on this page was last updated in June 2020. Recommended further reading lists the sources for this information. In addition, the information contained in this profile was reviewed for accuracy by the National SafeCare Training and Research Center in February 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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