Results Summary
What was the research about?
State child protective services, or CPS, agencies provide services to parents who are reported for child abuse or neglect. These services try to improve the relationship between the parent and child. They also encourage positive behaviors to prevent abuse or neglect.
In this study, the research team compared a program called SafeCare with the usual services parents receive from CPS agencies. SafeCare taught parents how to
- Identify and treat symptoms of illness and injury
- Remove home hazards
- Build a positive parent-child relationship
What were the results?
After six months, parents who received SafeCare and parents who received usual services didn’t differ in
- Parenting knowledge and stress
- Positive parenting behaviors
- Quality of parent-child relationships
- Parent and child well-being
- How structured home life was
- How often the family met its social, medical, and financial needs
However, four of the nine agencies in the study had serious problems offering SafeCare and enrolling parents. In interviews, some agency staff said SafeCare didn’t meet the needs of parents. Also, some agencies had little support for offering SafeCare. Parent feedback about SafeCare was mostly positive. Many parents noted that the sessions helped them practice new skills.
Who was in the study?
The study included 285 parents receiving services from one of nine agencies in four states. Of these parents, 75 percent were white, 13 percent were black, and 7 percent were Latino. The average age was 30, and 87 percent were women. All parents had at least one child under age five.
What did the research team do?
The research team assigned service providers, by chance, to receive training on SafeCare or continue usual services. Parents received SafeCare or usual services based on their provider’s assignment.
Service providers visited the homes of parents in SafeCare. Home visits occurred every one to two weeks for a total of 18 to 20 education sessions. SafeCare taught parents skills about child health, home safety, and the parent-child relationship. Parents receiving usual services met with service providers every one to two weeks, as needed. Meetings took place in parents’ homes or at the agency. Providers gave support and referrals. They also helped parents address day-to-day problems.
Parents took a survey about parenting skills at the start of the study and again six months later. The research team also interviewed agency staff and parents about SafeCare.
Parents, social workers, and CPS staff helped plan the study and enroll parents.
What were the limits of the study?
Because of the problems in offering SafeCare, results may not be certain. Also, 39 percent of parents didn’t fill out the survey at the end of the study. These problems may have made it hard to see differences between parents who were and weren’t in SafeCare.
Future research could look at other ways to support parents receiving services from CPS agencies.
How can people use the results?
CPS agencies can use these results when considering ways to support parents who receive services.
Professional Abstract
Objective
(1) To understand implementation challenges of a behavioral parenting program called SafeCare©; (2) To understand parent reactions to both SafeCare and usual services; and (3) To examine effectiveness of SafeCare on improving parenting-related outcomes and parent and child well-being
Study Design
| Design Elements | Description |
|---|---|
| Design | Cluster randomized trial |
| Population | 285 parents receiving services from 9 CPS agencies |
| Interventions/ Comparators |
|
| Outcomes |
Primary: parenting knowledge, parenting stress, parenting behaviors, quality of the parent-child relationship, parent well-being, child well-being Secondary: caregiving behaviors, home environment, family resources |
| Timeframe | 6-month follow-up for primary outcomes |
This cluster randomized trial examined the effectiveness of SafeCare and usual services in improving parenting, parent-child interaction, and well-being outcomes. SafeCare is a structured behavioral parenting program focused on promoting positive parenting behaviors, including identifying and treating symptoms of illness and injury, identifying home hazards, and building a positive parent-child relationship. Service providers visited the parents’ homes weekly or biweekly for a total of 18 to 20 education sessions. Usual services from child protective services (CPS) agencies were unstructured and nondirective. These services focused on case management, support, parenting education, and service referrals and were typically provided weekly or biweekly.
Researchers randomized 32 teams of 237 service providers at agencies either to implement SafeCare or continue usual services. Parents in the study received services based on their provider’s randomization.
The study included 285 parents receiving services from one of nine agencies in four states. Of these parents, 75% were white, 13% were black, and 7% were Latino. In addition, 87% were female, and the average age was 30. All parents in the study had at least one child under age five.
Parents completed a survey to assess primary and secondary outcomes at baseline and again six months later. Researchers conducted 18 focus groups with 84 providers and 57 interviews with agency administrator staff to learn about barriers and facilitators of SafeCare implementation. In addition, researchers interviewed 71 parents to assess their perceptions of SafeCare.
Parents, social workers, advocates, and CPS staff helped design the study and suggest measures and recruitment strategies and address implementation challenges.
Results
Intent to treat analyses showed no significant differences between groups in primary or secondary outcomes. In examining challenges to implementation, researchers found that four of the nine sites had difficulty implementing the SafeCare program and enrolling parents in the study. Qualitative data suggest that implementation challenges were related to several factors, including low buy-in among providers, a lack of sustained support for SafeCare within agencies, and changes in organizational structure. Parent perceptions of SafeCare were mostly positive, and many parents noted that the hands-on curriculum provided opportunity to model and practice new skills.
Limitations
Because of implementation barriers, limited site participation, and lack of data on intervention fidelity, results may not be conclusive. In addition, 39% of parents did not complete a follow-up survey.
Conclusions and Relevance
In this study, challenges implementing the SafeCare program made it difficult for researchers to examine differences between parents in that program and parents who received usual services.
Future Research Needs
Future research could examine other ways to support parents receiving services from CPS agencies.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:
- Due to challenges implementing the original study design, the research plan was significantly restructured. The reviewers recommended that the researchers explain the restructuring early in the report to set up the description of the methods. The researchers added a section to the background describing the original study design and the reason for the overall changes. The researchers also described specific additional changes in the methods, believing this approach provided the most clarity.
- The reviewers asked for more information about the control arm approach of Supportive Case Management (SCM), particularly because the researchers had so much trouble getting clinicians to change their behavior and use the SafeCare approach in place of SCM. The researchers expanded their description of the SCM approach but noted that they also had difficulty collecting data from providers during the study. The researchers posited that providers’ resistance to the new approach may have contributed to problems in implementation.
- The reviewers said the stakeholder selection process was problematic and should be justified. In particular, they noted that inclusion of only three patient partners seemed insufficient. The researchers expanded the section about stakeholder selection. They did acknowledge that they recruited patient and stakeholder partners based on practicality and on keeping the research team at a manageable size while still bringing in a variety of perspectives.
- Some reviewers wondered about the reasons for different levels of recruitment in the two study arms. The researchers said the participation rates were higher for the SafeCare arm than for the SCM arm. They suggested this was because of stronger recruitment efforts by the SafeCare providers. The researchers observed that many families referred to the SCM arm may not have been well informed about the study and thus, were less likely to participate.