A Statewide Trial of the SafeCare Home-based Services Model With Parents in Child Protective Services

TLDR

SafeCare is a home‑based behavioral skills training model for neglecting or maltreating parents. This trial compared CPS recidivism outcomes between the SafeCare model and comparable home‑based services, with and without coached implementation. The study was a statewide, 2×2 randomized cluster experiment enrolling 2,175 maltreating parents and 219 home visitors, followed for an average of six years to assess recidivism. SafeCare significantly reduced recidivism (hazard ratios 0.74–0.83), especially among parents meeting inclusion criteria, while coached implementation had smaller but sometimes significant effects and may benefit cases with weaker client‑model fit, supporting SafeCare’s adoption in CPS home‑based services.

Abstract

In this trial, we compared Child Protective Services (CPS) recidivism outcomes between the home-based SafeCare (SC) model for child neglect and comparable home-based services, but without SC modules, for parents in the CPS system across 2 quality control strategies: coached (C) and uncoached implementation. SC is a home-based behavioral skills training model designed for neglecting or maltreating parents. The study was conducted in a scaled-up, statewide implementation setting.Two thousand one hundred seventy-five maltreating parents, treated by 219 home visitors, were enrolled and treated in a 2 × 2 (SC versus services as usual × C versus uncoached implementation strategy) randomized cluster experiment. Cases were followed for an average of 6 years for CPS recidivism events. Subpopulation analyses were conducted for parents meeting customary SC inclusion criteria.Consistently significant main effects in favor of SC were found across simple and more complex modeling approaches (hazard ratios = 0.74-0.83). Larger effects were found among the subpopulation meeting customary SC inclusion criteria. C implementation yielded smaller and occasionally significant effects in analyses that included more diverse cases falling outside customary SC inclusion criteria.Findings support the adoption and use of SC within CPS home-based services systems. C implementation may be especially valuable for cases where the client-model fit is less strong.