SafeCare^®

SafeCare aims to improve (1) parental health decision making skills, (2) the safety of the home environment, and (3) parenting skills and parent-infant/parent-child interactions. SafeCare serves families with young children from birth through age 5 years. It was specifically designed to benefit families with risk factors for child maltreatment. SafeCare is an adaption of Project 12-Ways that includes a subset of the Project 12-Ways modules. SafeCare was developed to offer a more streamlined and easy-to-disseminate intervention.

SafeCare is typically delivered in 18 or fewer sessions. Trained SafeCare providers conduct 60-minute weekly or biweekly home visits involving three modules: (1) infant and child health, (2) home safety, and (3) parent-infant/parent-child interactions (Planned Activities Training). Each of the three SafeCare modules typically includes a baseline assessment to observe parents’ 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 each target behavior, model that behavior, ask the parent to practice the behavior, and then provide feedback. SafeCare providers are not required to meet specific education requirements.

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 for providers on identifying and responding 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 modified that program’s health and safety interventions (created collaboratively with the SafeCare model developer, with identical goals and methods) to fit an Australian context (for example, 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 SafeCare’s parent-infant/parent-child interactions (Planned Activities Training) module and an add-on to that module, Cellular Phone Enhanced Planned Activities Training. The parent-infant/parent-child interactions (Planned Activities Training) module focuses on skills such as engaging in positive interactions and establishing rules and limits, and is administered to mothers during five sessions at families’ homes. Cellular Phone Enhanced Planned Activities Training adds encouragement and skill reinforcement via text messages and phone calls between in-home parent-infant/parent-child interactions (Planned Activities Training) sessions.

For more information, see the research database. For more information on the criteria used to rate research, please see details of HomVEE’s methods and standards.

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.

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.

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.

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. Providers observe parents during daily routines and parent-infant/parent-child play. Providers reinforce positive behaviors with parents and address problematic ones. In addition, providers offer parents activity cards to encourage skill acquisition.

SafeCare providers follow structured protocols that cover the model’s three modules. Each module is designed to be implemented in 6 or fewer sessions (for a total of about 18 sessions). 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.

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]).

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.

A variety of agencies have implemented SafeCare, including county and state public health departments, departments of family and children’s services, Head Start programs, intensive family preservation services, agencies working with parents with intellectual difficulties, criminal justice programs that serve parents recently released from jail, drug courts, and private agencies that receive referrals from state or local departments of family and children’s services.

There are no specific requirements governing the type or characteristics of agencies that can implement the model. However, there is a pre-implementation process to confirm both model fit and agency readiness.

NSTRC requires providers and their coaches to meet a set of ongoing fidelity guidelines. Please contact the model developer for additional information about these guidelines.

SafeCare sites are required to have two primary staff positions: (1) SafeCare providers who deliver home-based services and (2) SafeCare coaches who monitor the fidelity of SafeCare implementation, conduct coaching for providers, and may also deliver services to families. Some local implementing agencies select staff to become certified SafeCare trainers. Certified SafeCare trainers can train providers and coaches within their agency or organizations that are conducting the work of their agency. NSTRC does not require implementing agencies to have SafeCare program coordinators or senior leadership staff.

NSTRC does not have educational requirements for providers or coaches implementing SafeCare. NSTRC recommends that local implementing agencies train staff who have good communication and interpersonal skills and are comfortable delivering interventions to families in the home setting, responsive to coaching and constructive feedback, motivated to implement SafeCare with fidelity, open to new service models, and interested in using a structured protocol for service delivery. NSTRC can guide local implementing agencies in selecting appropriate candidates for each type of staff position.

Coaching involves rating model fidelity and providing feedback to the provider and may differ from staff supervision. NSTRC requires that certified SafeCare coaches provide coaching to providers regularly and conduct monthly team meetings to discuss cases and SafeCare implementation. Coaches are required to regularly monitor the quality of SafeCare sessions either in person or through audio or video recordings.

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. To become a coach, individuals must be certified as SafeCare providers and complete a two-day coaching workshop delivered by NSTRC training specialists. Please contact the model developer for additional information about the pre-service training requirements.

NSTRC does not require SafeCare staff to receive ongoing professional development.

National SafeCare Training and Research Center

Mark Chaffin Center for Healthy Development
School of Public Health
Georgia State University
P.O. Box 3995
Atlanta, GA 30302-3995

Phone: (404) 413-1387
Email: safecare@gsu.edu
Website: www.safecare.org