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.

Final Research Report

View this project's final research report.

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.

Conflict of Interest Disclosures

Project Information

Daniel Whitaker, PhD
Georgia State University
Comparative Effectiveness Trial to Reduce Child Maltreatment, Improve Client Outcomes and Examine Client Burden

Key Dates

April 2015
July 2019

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 25, 2023