An in-home training program for parents of children up to age 5, at-risk of or have been reported for child neglect or physical abuse.
Evidence Summaries presented on this site were drawn from the best available evidence of the program’s effectiveness from this review. It may not necessarily reflect all the evidence about the program. The research was selected and assessed towards the evidence rating because it met selection criteria related to the specific topic area, study design and the outcomes of interest.
Overview
Evidence Rating
Pathway
- Early help
- Targeted and specialist
Australian Study
Risk of Bias
Cost
Target Age Group
About
An evidence summary for SafeCare® under the topic area Family Preservation and Reunification is also available.
SafeCare® is a home visiting parent training program that targets risk factors for child neglect and physical abuse. SafeCare® providers work with families in their homes to improve parents’ skills in 3 areas:
- Parent-infant/child interaction skills
- Health care skills
- Home safety.
Note: This summary considers an adapted and augmented protocol known as SafeCare+. SafeCare+ consists of the standard SafeCare® program with the addition of motivational interviewing, as well as training of home visitors on the identification of and response to imminent child maltreatment and risk factors of substance abuse, depression and intimate partner violence.
Aims
- Improve engagement in services
- Improve the quality of parent-child relationships
- Improve parenting skills
- Increase parents’ competence in managing behaviours problems
- Reduce out-of-home placement
- Reduce parents’ use of coercive and punitive methods of discipline
- Improve parents’ personal coping skills and reduce stress
- Improve parents’ problem-solving skills.
Impact
Evidence suggests that SafeCare delivered in the included study was effective in reducing child protection system contact. Parents who have successfully completed SafeCare+ self-reported decreased maltreatment and referrals to child welfare, and higher satisfaction with the program compared to those in the comparison group. The evidence for other outcomes were mixed and there was no effect for improving parents' mental health/functioning and their social support.
| Outcome domain | Outcome measured | Positive effect | No effect | Negative effect |
|---|---|---|---|---|
| System | Child protection system contact | Yes | Not found | Not found |
| Family | Functioning | Yes | Yes | Yes |
| Parent/caregiver | Mental health/functioning | Not found | Yes | Not found |
| Parent/caregiver | Parenting skills | Yes | Yes | Yes |
| Parent/caregiver | Social support | Not found | Yes | Not found |
| Implementation | Satisfaction | Yes | Not found | Not found |
How to read the table:
When ‘Yes’ is indicated for one of the three directions of effect, this means there is evidence of ‘positive’, ‘no effect’ or ‘negative effect’. Evidence is mixed and inconclusive when ‘Yes’ is indicated for two or more directions of effect. Further information about direction of effect can be found on the Using the Menu page.
SafeCare+ (the SafeCare® model described in the included study) has an evidence rating of Supported.
This means that SafeCare+ has evidence from one randomised controlled trial (RCT) or quasi-experiment (QE) demonstrating positive, short-term impact on at least one child and family outcome.
This assessment is based on one research output of RCT design. Another 3 RCTs were identified but did not count towards the evidence due to concerns with study quality. SafeCare+ has not received a Well-supported rating as it has not yet replicated its results in another RCT or QE with a different population or setting.
| Study design | Number of research outputs included (Note: Can include research outputs from the same study) |
|---|---|
| Systematic review with meta-analysis | Not identified or included |
| Randomised controlled trial | 1 |
| Quasi-experiment | Not identified or included |
The evidence has some concerns with risk of bias.
We can be reasonably confident about the results and quality of the evidence from the included study.
The study was conducted in the United States and does not include Aboriginal children and families. SafeCare® is delivered in Australia to Aboriginal children and families but local studies may not have met the inclusion criteria to be included on the Menu.
Aboriginal knowledge and evidence is critical to recognise, document and share practices that lead to improved outcomes for Aboriginal children and families. The department is consulting with the Aboriginal community and stakeholders on how Aboriginal knowledge and evidence is defined and included on the Menu.
Location
- The RCT was conducted in a rural county in Southwestern United States, which has a population of less than 100,000 people and fewer than 30,000 households. Almost 20% of the county’s population live below the federal United States poverty threshold.
Sample characteristics
- A total of 105 parents with young children under age 5 were enrolled in the trial.
- All but one of the enrolled primary caregivers were female. The sample of parents had an identifiable risk of depression, intimate partner violence or substance abuse. The families had an average of 2 children.
- Participants identified as White (71%), Black or African American (14%), American Indian or Alaska Native (10%) and Asian (1%).
Implementation
Delivery model, mode and setting
- SafeCare® is delivered in-person, to the parent only.
- It is delivered as a home-visiting program in the adoptive home, birth family home or in foster/kinship care.
Target cohort
- Families at risk of neglect and abuse
- Children up to age 5.
Program delivery
- SafeCare® can be delivered as a free-standing program or as a component of a broader home-visiting service. SafeCare+ consists of the standard SafeCare® model with the addition of motivational interviewing and training of home visitors. We found no specific details about the delivery of SafeCare+.
- Staff work with families in their home visits. A series of typically 4 training sessions follows, and Home visitors work with parents until they show mastery of module skills. A final observational assessment is used to assess parents’ uptake of skills.
- Parent-Child/Infant Interaction: Focuses on parent-infant interactions from birth to walking and parent-child interactions from walking up to child age 5, and targets risk factors associated with neglect and physical abuse.
- Health: Teaches parents to identify childhood illnesses and injuries and follow a structured process to determine when and how to care for the child to target risk factors for medical neglect. Parents are also taught to use health reference materials, including a validated SafeCare® health manual.
- Home Safety: Helps parents identify and eliminate common household hazards to target risk factors for environmental neglect and unintentional injury. Parents learn how to eliminate home hazards and are taught the importance of supervision.
- Family Engagement Skills: Teaches parents using a structured problem-solving process to solve many difficulties not addressed by SafeCare®. Good communication skills are emphasised to engage parents and build rapport.
- SafeCare® providers work with families in their homes to improve parents’ skills by:
- Explaining the skills and why they are important
- Demonstrating how to do each skill
- Having parents practice the skills
- Providing positive and corrective feedback to parents on their use of skills.
Duration and intensity
- In the standard SafeCare® model, weekly home visits last from 60 to 90 minutes each. The program typically lasts 18 to 20 weeks for each family.
- Each module is taught over the course of approximately 6 sessions. Each module begins with an observational assessment to determine parents’ current skills and areas needing improvement.
Manuals and guides
- There is an implementation manual to deliver SafeCare®.
- Agencies are assessed for their readiness before implementation and are provided with formal support to implement SafeCare® through several mechanisms including coaching and feedback, technical assistance on first year of implementation, fidelity monitoring and trainee certification via a web portal that collects data on Provider demographics and certification progress.
Additional information
- The SafeCare® website provides more information about the program and the core intervention components.
Staffing
- At a minimum, staff are required to have a bachelor's degree in human services.
- There are no minimum stipulations regarding the number of trained staff to deliver SafeCare®. However, for agencies to deliver SafeCare®, they do require a SafeCare® coach position to be available.
Training
- Provider agencies 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.
To our knowledge, SafeCare® is available in Victoria and New South Wales.
In Victoria, SafeCare® is delivered by Ozchild and Anglicare.
In New South Wales, SafeCare® is delivered through the Parenting Research Centre in partnership with the NSW Department of Communities and Justice.
Cost
According to the National SafeCare Training and Research Centre (NSTRC), the average cost of implementing SafeCare® in 2015 was $2,275 per family. That estimate includes the costs of:
- Compensation for providers, coaches, and administrative support staff
- Office space
- Operating expenses (such as technology, equipment, office supplies, insurance, and continuing education)
- Training conducted by NSTRC
- Variable costs of SafeCare® per family (such as materials, handouts, supplies for home safety).
References
Studies identified and included in the review
- Silovsky JF, Bard D, Chaffin M, Hecht D, Burris L, Owora A, Beasley L, Doughty D & Lutzker J (2011). Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Services Review, 33(8):1435-1444.
Studies identified but not counted towards the evidence rating due to study quality
Euser S, Alink LR, Stoltenborgh M, Bakermans-Kranenburg MJ & van IJzendoorn MH(2015). A gloomy picture: a meta-analysis of randomized controlled trials reveals disappointing effectiveness of programs aiming at preventing child maltreatment. BMC Public Health, 15:1068.
Guastaferro K, Lai BS, Miller K, Shanley Chatham J, Whitaker DJ, Self-Brown S, Kemner A & Lutzker JR (2018). Braiding two evidence-based programs for families at-risk: Results of a cluster randomized trial. Journal of Child and Family Studies, 27(2):535-546.
Self-Brown S, Osborne MC, Lai BS, De Veauuse Brown N, Glasheen TL & Adams MC (2017). Initial findings from a feasibility trial examining the SafeCare Dad to Kids program with marginalized fathers. Journal of Family Violence, 32(8):751-766.