The Evidence Portal


About the program

SafeCare+ is an adaption of SafeCare® for high-risk families in rural populations.

SafeCare+ consists of the original SafeCare® program with the addition of motivational interviewing and training home visitors to identify and respond to imminent child maltreatment and risk factors of substance abuse, depression, and intimate partner violence.

The original program: SafeCare® is a behavioral parent training program delivered through home visiting. It targets parental risk factors for child physical abuse and neglect. SafeCare® was designed to be implemented with families at risk for maltreatment. The program is designed for parents of children ages 0–5 years and teaches a variety of skills focused on positive parenting, home safety, and child health.

See also SafeCare, SafeCare+ and the SafeCare Dad to Kids Program Summaries in the Reducing Child Harm and Maltreatment Evidence Review.

Who does it work for?

SafeCare+ is designed for multi-problem at-risk families with young children involved in the child welfare system in rural communities.

The program has only been tested in the USA (Silovsky et al. 2011).

A randomised control trial was conducted with 105 people (48 people were in the intervention group and 57 people were in the control group). On average, parents were 27 years old. Most parents were Caucasian, and household income was not reported.

SafeCare+ has not been tested in Australia, or with Aboriginal Australians.            

What outcomes does it contribute to?

Positive outcomes:

  • Child abuse reports (substantiated/unsubstantiated): there are fewer child abuse reports in families who have received the augmented version of SafeCare.

No effects:

  • Child abuse potential: the program shows no significant effect on child abuse potential in families.
  • Intimate partner violence: the program shows no significant effect on rates of domestic violence victimisation.
  • Parent’s mental health: the program shows no significant effect on a decrease in parent’s depression rates.
  • Parent’s social support: the program shows no significant effects in the adequacy of resources in households.
  • Positive parenting behaviours: the program shows no significant effects on the number of non-violent discipline episodes in families.

Negative outcomes:

  • No negative effects were found.

How effective is it?

Overall, the SafeCare+ has mixed effect on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

  • At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
  • An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
  • No RCT/QED studies show statistically significant adverse effects.

How is it implemented?

SafeCare+ is implemented using the standard SafeCare® program protocol. It consists of three core modules: parent-child interaction, home safety and child health. In addition to these three modules, SafeCare+ includes motivational interviewing and home visitors are trained to identify and respond to imminent child maltreatment and risk factors of substance abuse, depression, and intimate partner violence.

SafeCare+ is typically conducted in weekly home visits lasting from 60-90 minutes each. The program typically lasts 18-20 weeks for each family.

Each module is taught over approximately 6 sessions. Each module begins with an observational assessment to determine parents’ current skills and areas in need of improvement. A series of training sessions follows and home visitors work with parents until they show mastery of module skills. A final observational assessment is used to assess parents’ uptake of skills. Parenting skills are taught by:

  • explaining the skills and why they are important
  • demonstrating how to do each skill
  • having parents practice the skills
  • providing positive and corrective feedback to parents on their use of skills

A structured problem-solving process is used to teach parents to solve many difficulties. Good communication skills are emphasised to engage parents and build rapport.

Parent-Child Interaction Module: targets risk factors associated with neglect and physical abuse. Parents learn to increase positive interactions with their child, structure daily activities by providing engaging and stimulating activities, and prevent difficult child behavior. The content is tailored to the age of the child.

Child Health Module: targets risk factors for medical neglect. This module teaches parents to identify childhood illnesses and injuries, and then follow a structured process to determine when and how to care for the child. Parents learn when and how to care for a child at home, when to see a doctor, and when to seek emergency help. Parents are also taught to use health reference materials, including a validated SafeCare health manual.

Home Safety Module: targets risk factors for environmental neglect and unintentional injury. This module focuses on helping parents identify and eliminate common household hazards. They are also taught the importance of supervision.

How much does it cost?

Not Reported

What else should I consider?

The SafeCare+ program is specifically targeted at at-risk families in rural communities.

Where does the evidence come from?

One Randomised Controlled Trial with 105 participants in the USA, involving 105 participants (Silovsky et al. 2011).

Further resources

Silovsky et al. (2011), Prevention of child maltreatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Child and Youth Services Review, Vol. 33, No. 8, pp. 1435-1444.

SafeCare website:

SafeCare model fact sheet:

Last updated:

24 Feb 2023

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