Daniel J. Whitaker, Ph.D. Director, NSTRC Shannon Self-Brown, PhD Associate Director, NSTRC

1. SafeCare® : History, evidence, and current implementation and research Daniel J. Whitaker, Ph.D. Director, NSTRC Shannon Self-Brown, PhD Associate Director, NSTRC John R. Lutzker, Ph.D. Director, Center for Healthy Development College of Health and Human Sciences Georgia State University

2. Overview of presentation • A bit of child maltreatment data • SafeCare® model • Evidence for SafeCare® • NSTRC training model and activities

3. Trends in Child Maltreatment in the U.S.

4. Child Maltreatment in 2006 • In 2006, 905,000 children experienced child maltreatment in the US (12.1 per 1,000) • 64% of CM is neglect • Neglect generally has the worst long-term outcomes compared to other forms of maltreatment • 1,530 children in the US died from maltreatment • 78% under age 4 • 44% under age 1

5. A very brief history of SafeCare • Project 12-Ways : 1979 • SafeCare development : 1994-1998 • CDC & Oklahoma Studies: 2001 • NSTRC birth: 2007 • Move to GSU: August 2008

6. SafeCare Model Overview • In-home parent-training model to prevent child maltreatment • Behavioral, skill-based model, that focuses on three skills • Health - teach parents to make health care decisions • Safety – create a safe home environment • Parent-child interactions - promote positive bonds and help parents manage day-to-day activities • Structured problem solving taught for other issues

7. SafeCare model overview • Each module is conducted over 5-6 sessions • Modules can be conducted in any order • Health is often first as it is the least evaluative • SafeCare® is typically 18-20 sessions • Can be integrated into other service models

8. SafeCare model overview Structure of each module • Initial assessment using structured checklists (1 session) • Skill training (4-5 sessions) • Explain—model—practice—feedback • Goal is to get parents to “master” the skill • Final assessment to gauge learning (1 session) The use of structured observational assessment allows the provider to “see” change Validated tools exist for measuring change

9. SafeCare Research • A number of lines of research support the efficacy/effectiveness of SafeCare® • Single Case Studies of Behavior Change • Non-experimental Group Studies of Behavior Change • Quasi-Experimental comparison studies • Site-Randomized & Case-Randomized Studies are in progress • Populations included in research • High-risk parents • Parents reported for child maltreatment • Children with autism and related disabilities • Adults with intellectual disabilities

10. SafeCare: Initial Research evidence Many single-case validation studies and social validity studies Safety • Tertinger, D.A., Greene, B.F. & Lutzker, J.R. (1984). Home safety: Development and validation of one component of an ecobehavioral treatment program for abused and neglected children. Journal of Applied Behavior Analysis, 17, 159-174. • Barone, V.J., Greene, B.F., & Lutzker, J.R. (1986). Home safety with families being treated for child abuse and neglect. Behavior Modification, 10, 93-114. • Mandel, U., Bigelow, K. M., & Lutzker, J. R. (1998). Using video to reduce home safety hazards with parents reported for child abuse and neglect. Journal of Family Violence, 13(2), 147-161. • Metchikian, K.L., Mink, J.M., Bigelow, K.M., Lutzker, J.R., & Doctor, R.M. (1999). Reducing home safety hazards in the homes of parents reported for neglect. Child and Family Behavior Therapy, 3, 23-34. Health • Delgado, L.E. & Lutzker, J.R. (1988). Training young parents to identify and report their children's illnesses. Journal of Applied Behavior Analysis, 21, 311-319. • Watson-Perczel, M., Lutzker, J. R., Green, B. F., & McGimpsey, B. J. (1988). Assessment and modification of home cleanliness among families adjudicated for child neglect. Behavioral Modification, 12(1), 57-81. • Bigelow, K. M., & Lutzker, J. R. (2000). Training parents reported for or at risk for child abuse and neglect to identify and treat their children’s illnesses. Journal of Family Violence, 15(4), 311-330. Parent-Child Interactions • Lutzker, J.R., Megson, D.A., Webb, M.E., & Dachman, R.S. (1985). Validating and training adult-child interaction skills to professionals and to parents indicated for child abuse and neglect. Journal of Child and Adolescent Psychotherapy, 2, 91-104. • McGimsey, J. F., Lutzker, J. R., & Greene, B. F. (1994). Validating and teaching affective adult-child interaction skills. Behavior Modification, 18(2), 198-213. • Bigelow, K. M., & Lutzker, J. R. (1998). Using video to teach planned activities to parents reported for child abuse. Child & Family Behavior Therapy, 20(4), 1-14.

11. Health care skills Home safety data Metchikian, K.L., Mink, J.M., Bigelow, K.M., Lutzker, J.R., & Doctor, R.M. (1999). Reducing home safety hazards in the homes of parents reported for neglect. Child and Family Behavior Therapy, 3, 23-34. Bigelow, K. M., & Lutzker, J. R. (2000). Training parents reported for or at risk for child abuse and neglect to identify and treat their children’s illnesses. Journal of Family Violence, 15(4), 311-330.

12. Project 12-ways: Outcome evaluation • Examined over 700 families receiving SafeCare or other CPS services from 1979-1984 • Examined recidivism rates • SafeCare families = 21.3% • Other CPS services = 28.5 • 25% reduction in recidivism • Other analyses suggest that SafeCare families were more difficult than non-SafeCare families Lutzker, J. R., & Rice, J. M. (1987). Using recidivism data to evaluate project 12-ways: An ecobehavioral approach to the treatment and prevention of child abuse and neglect. Journal of Family Violence, 2(4), 283-290.

13. SafeCare: Outcome evaluation • CA ’94; SC vs. family preservation • All CPS referred families • Reports after 3 years: • SC = 15% • FP = 44% • 75% reduction in child maltreatment reports Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2002). Using Recidivism to Evaluate Project SafeCare: Teaching Bonding, Safety, and Health Care Skills to Parents. Child Maltreatment, 7(3), 277-287

14. More SafeCare research • Many other studies of SafeCare in progress • Oklahoma statewide trial • Oklahoma prevention trial • Wayne State computerized trial • Kansas cell phone study • San Diego diffusion study • Georgia Training study

15. National SafeCare® Training and Research Center • Formed in 2007 • Initial funding came from the Doris Duke Charitable Foundation • Currently supported by: • Doris Duke Charitable Foundation • Centers for Disease Control and Prevention • Department of Justice • State of Georgia, Dept of Human Resources • United Way of San Diego • Administration for Children and Families • Washington State Dept of Social Services • Annie E. Casey Foundation

16. National SafeCare® Training and Research Center Georgia State University College of Health and Human Sciences Center for Healthy Development John R. Lutzker, PhD. Executive Director NSTRC Daniel Whitaker, PhD, Director Shannon Self-Brown, PhD, Assoc Director Center for Leadership in Disabilities Daniel Crimmins, PhD, Director SafeCare Trainings EPIC – Yakima Washington United Way – San Diego County GA DHR Catalyst for CARE (GA) Washington State, DSS Rady Children’s hospital Kennedy Krieger Institute Research collaborations OUHSC UC San Diego University of Kansas Wayne State University University of Georgia

17. Goals of NSTRC • Increase awareness and use of SafeCare • Standardize training methods and develop train-the-trainer model • Implementation/translation research • Empirical test aspects of training model • Use technology to increase efficiency of training and fidelity monitoring • Understand what factors influence organizational, provider, and family uptake of SafeCare.

18. NSTRC Training model philosophy • Balance of rigor & disseminability • Training sites must be able to self-sustain SafeCare • Must be able to monitor their own performance • Need to be able to train new staff • Fidelity monitoring/quality assurance is needed at every level • Without fidelity monitoring, model will not be implemented as designed • Home visitors need ongoing coaching in the model • And coaches need support from SafeCare trainers

19. Trainer Coach HV training SafeCare Training Model: 3 levels • Home visitor – provides SafeCare services • Coach – provides ongoing coaching for HV to ensure fidelity to the model • Coaching required for SafeCare implementation • Trainer – trains new HV and coaches • Trainers must practice SafeCare and coaching • Trainers support coaches who monitor the fidelity of home visitors

20. NSTRC Training support model NSTRC to supports external trainers For broad dissemination, we need SafeCare trainers that provide initial and ongoing support To train and support coaches, we need Coaches that monitor HV performance and provide feedback To get HV to deliver SafeCare as designed, we need: Home visitors that deliver SafeCare as designed To reach goal, we need: Goal: Reduce families risk for child maltreatment

21. Where is SafeCare?

22. NSTRC implementation research • Cascading diffusion in San Diego (CDC; with OUHSC) • GA study of Trainer training models (CDC) • Technology based training and fidelity monitoring (submitted to CDC) • Adaptations teams (submitted; UCSD) • Test of coaching models (to be submitted)

23. SafeCare Center: Future directions • Refine training model • Research grants to test aspects of model • Understand adaptions for cultural groups • Build web-based data system for tracking trainees and to assist with QC • Use web to build a community of SC practitioners • Use technology to make training & implementation cheaper • Understand fit of SafeCare with other EBP • Understand policy aspects of increasing EBP in child welfare settings

24. Contacts Daniel J. Whitaker, PhD Dwhitaker@GSU.EDU Director, NSTRC, CHD, GSU Shannon Self-Brown, PhD SSelfBrown@GSU.EDU Associate Director, NSTRC CHD, GSU John R. Lutkzer, PhD, Jlutzker@GSU.EDU Director, Center for Healthy Development, GSU Web site: www.NSTRC.org