(c) Dean Fixsen, Karen Blase, Robert Horner, George Sugai, 2008 Horner, George Sugai, 2008
SafeCare: An Evidence-based Widely Disseminated Parent Trianing Program to Prevent Child Maltreatment
SafeCare®: An Evidence-basedWidely Disseminated ParentTraining Program to PreventChild MaltreatmentJohn R. Lutzker, Ph.D.Director, Center for Healthy DevelopmentAssociate Dean for Faculty Developmentand Professor of Public HealthGeorgia State University
NCANDS, 2011Data from Exhibit 4-F681,000 substantiated cases of child maltreatment
SafeCare Protocols• Parent-Child Interactions+ Parent-Infant Interactions+ Planned Activities Training (another evolution)• Home Safety+ Removal of hazards+ Removal of filth and clutter• Child Health Care+ When to call a doctor+ When to self-treat+ When to visit emergency room* Counseling and problem solving skills* Round 3 Content Validations
Project 12-Ways• 1979 - present• Over $20 million funding• Over 3000 families served• Hundreds of staff trained• Referrals: DCFS-homogenous• Service area: 10-12 counties, ruralsouthern Illinois
Original Project 12-Ways Services Alcohol abuse referral Job finding Money management Health and safetytraining Multiple settingbehavior management Prevention Parent-child training Stress reduction Self-management forparents Basic skill training forchildren Activities planning Relationshipcounseling
Project 12-WaysOutcomesThree studies showed that Project12-Ways families•Had significantly less childmaltreatment•Were more difficult thancomparison families
SafeCare• Urban: San Fernando Valley in Los Angeles, CA• Hispanic/Latino participants• Diverse• Succinct(5 sessions permodule)• Staff not“behavioral”
Evaluation• Outcome evaluations• Social validation• Goals• Process• OutcomeGershater-Molko, R., Lutzker, J.R., &Wesch, D. (2002) Using Recidivism data toevaluate Project SafeCare: Teaching“bonding”, safety and healthcare skills toparents. Child Maltreatment,1, 277-285.
Oklahoma Statewide Trial(PI: Mark Chaffin)• 6 service regions in OK assigned to SafeCare or SAU Providers receive SC training or do SAU Regions 1,2, & 3 = SafeCare; 4,5 & 6 = SAU• Half of each got “fidelity monitoring” or coaching• Outcomes: CPS referrals + intermediate variables• Economic evaluation to test cost effectiveness ofcoaching
OK Statewide Trial: Sample• N = 2175• 91% women• 67% white, 16% American Indian, 9%African American• Mean of 2.8 children• 82% below poverty line• 4.7 prior CPS reports
OK Statewide SC trial: Resultss}SafeCareSurvival• SafeCare decreased re-reports by 26% for families with children 0-5• With a re-report rate of 45% annually, SC prevented 64-104 reports• ROI analyses, suggest $14 return for every $1 invested in SC• Other research: much lower attrition for SafeCare providers}SAU
The National SafeCare® Training andResearch CenterBorn: October 2007Delivered by: The Doris Duke CharitableFoundation
Home Safety DataJabaley, et al (2011). Journal of Family Violence.
SafeCare Service Completion• RCT comparing SC to usualservice in-home behavioralhealth services (N=398)• SafeCare families assignedmore likely to enroll (80%vs. 49%) and completeservices (49% vs. 21%).• Service satisfaction higheramong SC families as wellDamashek, A., Doughty, D., Ware, L., & Silovsky, J. (2011). Predictors of Client Engagementand Attrition in Home-Based Child Maltreatment Prevention Services. Child Maltreatment,16(1), 9-20.
Research Question & HypothesesDoescombining PAT+ SafeCareresult in betteroutcomes forfamilies?Compared to those receivingPAT, those receiving PAT +SafeCare, will:1. Produce even betterparenting outcomes2. Produce children withbetter developmentaloutcomes and schoolreadiness3. Show lower risk of childmaltreatmentPATSCH = Parents as Teachers and SafeCare at Home
RESEARCH PRACTICEWhy Focus on Implementation?IMPLEMENTATION“Children and families cannot benefit frominterventions they do not experience.”
Lessons learned in related effortsCritical considerations in bringing implementing EBP:•Initial and ongoing training•Quality control•Organizational context and commitment•Ongoing monitoring of fidelity•Reliance on special people•Staff training, selection, qualifications•Blending Research and Service•Certification/National Centers
Organizational readiness for EBP• Leadership and staff support and endorsement• Time for planning and implementation (i.e., regular and ongoing meetings)• Good communication from the beginning• Staff buy-in and concerns• Fit with mission and community need• Commitment to ongoing evaluation• Financial support• Political support• Community support• Technology• Economic Issues• Implementation Issues• Balance between structure and fidelity• Clear role definitions for HVs, Coaches, and Trainers
Training costs: includes training, NSTRC travelto site, materials and 1 year supportImplementation costs:•Estimated $1900 - $2300 per family.•Very few unique costs to SafeCare.
Technology• iPhones• Tablets• Webcams• Digital Frames• Cell Phones• ?????