SafeCare

About the program

SafeCare is a structured training program for parents of children aged 0 to 5 years, reported for child abuse and/or neglect.

SafeCare is premised on an eco-behavioural model to address the causes of physical abuse and neglect. This model recognises the need for interventions of differing levels to address maltreatment, and the need to target skills and behaviours in ways that serve to sustain change. This can involve ongoing measurement of observable behaviours, skills modelling, practice and feedback, and training parents to criterion in observable skills.

SafeCare is delivered by specifically trained personnel. The program has been tailored to different target groups, for example, fathers and rural families. These modifications introduce considerable variation to the program and limit comparability. To optimise fidelity, training can involve considerable monitoring of the service providers.

See also SafeCare+ Program Summary in the Preventing Child Maltreatment Evidence Review.

See also SafeCare+ and SafeCare Dad to Kids Program Summaries in the Reducing Child Harm and Maltreatment Evidence Review

Who does it work for?

Two studies of the standard SafeCare model were identified. Both were conducted in the USA.

One RCT analysed data from 41 families who had been referred to the program by child welfare services, and 41 matched families who had current substantiated reports of child abuse and neglect and were receiving family preservation services (Gershater-Molko et al. 2002). The study did not report demographic data.

The second study was a cluster randomised trial with a sample size of 289 caregivers who were receiving services (Whitaker et al. 2020). Most of the full sample was female (87%), the mean parent age was 29.5 years, and 74.6% were White.

Neither of the studies involved First Nations participants.

This review did not identify any evidence that the program has been evaluated in Australia.

What outcomes does it contribute to?

Positive outcomes:

Child abuse and neglect: Gershater-Molko et al. (2002) found that the intervention had a positive effect on child abuse and neglect reports made. The largest difference between the two groups was visible at 36 months after the beginning of the intervention, when 85% of the families who had received the intervention had no reports of child abuse and neglect, compared to 54% of the control group families.

Parental stress: Whitaker et al. (2020) demonstrated positive and significant improvement for parental stress outcomes for the intervention group. There was positive and significant reduction in dysfunctional interactions, parental distress and improvement in perception of child's temperament and behaviour.

Positive parenting: Whitaker et al. (2020) found significant effects on positive parenting behaviours for the intervention group, including supporting positive behaviour, proactive parenting, and setting limits.

No effect:

Neglectful parenting: Whitaker et al. (2020) found no significant effect for the intervention in emotional neglect, cognitive neglect and supervisory neglect.

Protective factors for child maltreatment: Whitaker and colleagues (2020) found no significant effect for the intervention group in family functioning, nurturing parenting, and parent knowledge.

Negative outcomes:

None.

Is the program effective?

Overall, the program had a positive effect on client outcomes.

How strong is the evidence?

Promising research evidence:

• At least one high-quality RCT/QED study reports statistically significant positive effects for at least one outcome, AND
• Fewer RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
• No RCT/QED studies show statistically significant adverse effects

How is it implemented?

SafeCare involves an 18 to 24-week program comprised of three modules: health training, safety training, and parenting skills. Although each module is typically offered in parents’ homes over six sessions, this can vary to reflect a parent’s preferred location and their progress. A parent’s progress is assessed via direct observation in role-play situations.

How much does it cost?

Information not available

What else should I consider?

The program has been adapted for different target groups, for example fathers and rural families. These modifications introduce considerable variation to the program and limit comparability. See SafeCare+ and SafeCare Dad to Kids Program.

Where does the evidence come from?

Two studies conducted in the USA:

• An RCT where 41 families were included in the analysis (Gershater-Molko et al. 2002)
• A cluster randomised trial with a sample of 289 caregivers (Whitaker et al. 2020)

Further resources

• https://safecare.publichealth.gsu.edu
• Gershater-Molko, RM, Lutzker, JR and Wesch, D 2002, ‘Using recidivism data to evaluate project Safecare: Teaching bonding, safety, and health care skills to parents’, Child Maltreatment, vol. 7, no. 3, pp. 277-285.
• Whitaker, DJ, Self-Brown, S, Hayat, MJ, Osborne, MC, Weeks, EA, Reidy, DE and Lyons, M 2020, ‘Effect of the SafeCare© intervention on parenting outcomes among parents in child welfare systems: A cluster randomized trial’, Preventive Medicine, vol. 138, no. 106167, pp. 1-8.