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

• DOI: 10.1542/peds.2011-1840
• Publication Date: 2012-02-21
• Authors: Debra Hecht; Jane F. Silovsky; William H. Beasley; David Bard; Mark Chaffin
• Keywords: Male; Parents; Urban Population; Incidence; 05 social sciences; Child Welfare; 16. Peace & justice; Home Care Services; Risk Assessment; United States; House Calls; Child Rearing; Child, Preschool; Confidence Intervals; Humans; Female; 0501 psychology and cognitive sciences; Child Abuse; Child Care; Parent-Child Relations; Child; Needs Assessment; Proportional Hazards Models; Recidivism; Child neglect

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.