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 manuscripts. Planned Activities Training (a SafeCare module) and Cellular Phone Enhanced Planned Activities Training (a SafeCare module with an add-on) show evidence of effectiveness.

Implementation last updated: 2020

The information in this profile 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 research 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. Similarly, models described here may not all have impact studies, and those with impact studies may vary in their effectiveness. Please see the Effectiveness button on the left for more information about research on the effectiveness of the models discussed here.

Training to support implementation

Requirements for program certification

NSTRC works with agencies that are interested in implementing the SafeCare model to determine whether it fits their needs and resources and whether they are ready for implementation. Interested agencies must complete an application that includes questions related to the availability of resources, staffing, and operating policies and procedures. After reviewing the completed application, NSTRC schedules a follow-up call with the agency to (1) learn more about the agency’s SafeCare implementation plans and (2) discuss the conditions likely to lead to successful implementation (including staffing, referral bases, and coaching requirements).

Before initiating SafeCare training, NSTRC faculty and training specialists prepare sites through conference calls and an in-person orientation visit. The goal of these activities is to make sure agency management, staff to be trained, and county/state officials understand the training and implementation process.

To encourage successful implementation, NSTRC suggests that, before training, sites (1) identify the target population and referrals; (2) engage appropriate staff; (3) obtain the commitment of staff and management to SafeCare; (4) secure the infrastructure, support, and materials needed to implement SafeCare with fidelity; and (5) consider system-level factors that could affect implementation (such as funding streams or referral sources).

SafeCare sites are required to complete annual reaccreditation by documenting their compliance with NSTRC implementation standards. These standards require that agencies (1) implement the SafeCare model as prescribed to maintain fundamental structural, measurement, and mastery criteria; (2) conduct ongoing quality assurance of staff’s SafeCare responsibilities; and (3) have a minimum number of providers actively delivering SafeCare at the time of accreditation.

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Pre-service staff training

NSTRC requires all SafeCare providers to complete a multi-day provider workshop delivered by NSTRC training specialists. In addition, providers implementing SafeCare Augmented receive pre-service training in Motivational Interviewing from a member of the Motivational Interviewing Network of Trainers and training in identifying and responding to intimate partner violence.

After completing the workshop training objectives, the provider begins serving families, working closely with a coach to gain proficiency and competency in delivering the SafeCare model. The coach observes a live or recorded audio session, scores it for fidelity, and then conducts a coaching session with the provider before the provider’s next session with the family. As the provider prepares for certification, the coach continues to observe sessions and provide coaching as often as needed.

To achieve certification, the provider must demonstrate strong fidelity (85 percent or greater) in three sessions for each of the three modules (health, safety, and parent-infant/parent-child interactions [Planned Activities Training])—nine sessions total. If fidelity is low, an NSTRC training specialist reviews and provides feedback on additional sessions until strong fidelity is achieved in two consecutive sessions.

A provider must achieve certification within six months of completing the provider workshop. Providers who do not see families for a long period of time are required to complete a refresher training. Following certification, coaches monitor at least one session per month for two years and one session per quarter thereafter.

To become a coach, individuals must be certified as SafeCare providers and complete a two-day coaching workshop delivered by NSTRC training specialists. After the coaching workshop, NSTRC training specialists support coaches to achieve certification. To become certified, coaches must demonstrate reliability and fidelity to the coaching process over six live or recorded audio sessions with providers. Specifically, coaches must achieve (1) high reliability (85 percent or greater) in their scoring of a provider’s fidelity and (2) strong fidelity (85 percent or greater) in conducting a coaching session with the provider. To assess a coach’s reliability in scoring the provider’s fidelity, an NSTRC training specialist rates that provider’s fidelity independently and computes the percentage of consistent scores. To assess a coach’s fidelity in the coaching session, an NSTRC training specialist observes the subsequent coaching session between the coach and provider, scores the session for fidelity, and provides feedback to the coach. To maintain certification, coaches must pass reliability and fidelity checks conducted twice annually by an NSTRC training specialist.

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In-service staff training

NSTRC does not require SafeCare staff to receive ongoing training after they are certified. However, coaches continue to provide coaching support to providers monthly until providers pass 24 months of fidelity checks, after which the frequency of coaching support decreases to quarterly.

No information is available on the ongoing staff training requirements for SafeCare Augmented.

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Training materials

Training materials are available through NSTRC and are provided at trainings. Information on the training materials provided for SafeCare workshops can be found on NSTRC’s website.
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Qualified trainers

NSTRC training specialists conduct trainings for providers, coaches, and trainers. Members of the Motivational Interviewing Network of Trainers provide training in Motivational Interviewing techniques for providers implementing SafeCare Augmented.

Local implementing agencies can choose to select staff to become SafeCare trainers. To become a SafeCare trainer, individuals must be certified and have at least one year of experience in delivering SafeCare sessions and coaching. To receive certification, trainers must complete a three-day workshop and then demonstrate that they can successfully train others in accordance with the NSTRC training model. Once they are certified, SafeCare trainers can train individuals within their agency or organizations that are conducting the work of their agency.

To maintain their certification, trainers must complete a certification maintenance process each year in which they participate in two support calls, submit a training skills demonstration, and successfully complete a coaching session. The process is designed to accomplish several goals:

  • Ensure the highest quality of workshop delivery for providers and coaches;
  • Promote trainers’ support of coaches;
  • Facilitate an interactive online community among trainers;
  • Provide opportunities for trainers to obtain regular updates from NSTRC; and
  • Complement the accreditation process.
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Technical assistance

NSTRC gives local sites technical assistance with implementation and quality assurance.
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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 on February 21, 2020. HomVEE reserves the right to edit the profile for clarity and consistency.

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