SafeCare Program

State: NY Type: Model Practice Year: 2019

Centrally located in upstate New York, rural Tompkins County covers 475 square miles at the southern end of Cayuga Lake, the longest of New York State's Finger Lakes. It is home to three institutions of higher education: Cornell University (23,600[1] students), Ithaca College (6,670[2] students), and Tompkins-Cortland Community College (2,464[3] students). The 2015 U.S. Census Bureau's American Community Survey population estimate for Tompkins County is 103,855. The median age is 29.5 years, the lowest in the state, with 17% of residents age 20-24 years[4]. The race and ethnicity of the population is 84% White, 11.8% Asian, 5.5% Black, 5.0% Hispanic, 1.6% Other, and 1% American Indian. About 20%, or one in five people in Tompkins County live below the poverty level. Of the families living below the poverty level, those with a female head of household, no husband present, and having related children under the age of 5 account for 51%. The percent of households receiving Federal Supplemental Nutrition Assistance Program (SNAP) is 9.5%[5]. Tompkins County Health Department, located in the county seat of Ithaca, NY has been in existence since 1947 as a full-service health department. Its mission is to strive to achieve a healthy community by protecting and promoting public health through education, training, advocacy, and the provision of services. Community Health Nurses on staff are well experienced home visitors typically serving maternal child health clients providing nursing assessments, health education as well as referrals to varied community resources. Public health issue: Parental substance abuse disorders have a negative impact on parental engagement and responsiveness to their children's physical and mental health needs as well as to the safety of their home environment. An increased local incidence of child neglect cases involving parental substance abuse occurred from 2009 to 2014 necessitating a public health response. Public health response: A unique community partnership was formed between Tompkins County Family Treatment Court (FTC), Tompkins County Department of Social Services (DSS) and Tompkins County Health Department to deliver SafeCare®, an evidence-based, behavioral parent-training program for parents of children ages 0-5 who have been reported for child neglect. SafeCare® was implemented specifically targeted to Tompkins FTC cases where parental substance abuse is a contributing factor to child neglect. SafeCare® goals: 1) Increase parents' ability to maintain a safe home environment 2) Increase parents' knowledge of and involvement in addressing child health and mental health needs 3) Increase quantity and quality of parent responsiveness and parent-child interactions Initially, Tompkins DSS requested the health department and several other local human service agencies partner with them to implement SafeCare®. SafeCare® home visitor training was provided on-site in Ithaca by National SafeCare Training and Research Center (NSTRC) staff. Frequent follow up phone consultations ensued by NSTRC staff with home visitors to ensure program fidelity. However, due to staff turnover and competing program priorities in participating human service agencies, the health department became the sole SafeCare® provider in 2016. Experienced Community Health Nurses in maternal child health were a natural fit for the program providing in-home instruction on three separate modules, parent-child/infant interactions, child health, and home safety. Each module includes a baseline assessment, multiple training sessions and an end-of-module assessment to monitor progress in parenting skill attainment which is reported monthly to Tompkins FTC and DSS. Successful completion of the SafeCare® program, which typically takes about 18 weeks, is crucial to the parent's FTC graduation. Since its initiation, 84 Tompkins FTC cases with children less than 5 years of age have been eligible for SafeCare® intervention. From October 2014 through September 2018, Tompkins FTC made 43 referrals (51%) for SafeCare® with 11 put on hold (i.e. rehab). Of the remaining 32 referrals, 28 completed SafeCare® training (87%), 23 graduated from FTC (82%), 23 had children returned to parental care (82%), and 4 had recurrence of neglect petition filed with FTC due to substance use (12.5%)[6]. The public health impact of SafeCare has realized a high family reunification rate (82%) and low recidivism rate of 12.5% over the course of its first three years in Tompkins County [7]. Specific local factors contributing to its success as a model practice include effective communication between community partners from initial referral through completion of all three SafeCare® modules as well as consistent delivery of SafeCare® by trained health department home visitors.
Public health issue: Parental substance abuse disorders have a negative impact on parental engagement and responsiveness to their children's physical and mental health needs as well as to the safety of their home environment. Considerable research has demonstrated that children with parents who are substance abusers experience a range of difficulties arising from physical and emotional neglect which can lead to poor health outcomes, antisocial behaviors, physical aggression, depression, a sense of hopelessness, low self-esteem, and low performance in school.[1] Prior to 2001, child neglect petitions were handled through Tompkins County Family Court. In April 2001, Tompkins County Family Treatment Court (FTC) was implemented under the supervision of Family Court Judge John C. Rowley who hears both the dependency case and the drug court matter. FTCs across the U.S. have shown positive results including increased parental engagement, retention in substance use disorder treatment, higher rates of family reunification, reduced time in out-of-home placements for children, less repeat child maltreatment and fewer re-entries into out-of-home care[2]. Parents enrolled in FTC often have neglected their own physical health as well as failed to address the medical, mental, social and academic needs of their children. From 2009 to 2014, Tompkins DSS noted a rise in child welfare cases due to parental substance use. Such cases were referred to Tompkins FTC for court supervision and comprehensive case management. In 2009 there were 8 new FTC cases, 9 new Foster Care admissions all ages and 7 new Foster Care admissions of children less than 5 years of age. In 2014, there were 55 new FTC cases, 70 new Foster Care admissions all ages and 24 new Foster Care admissions of children less than 5 years of age. Tompkins FTC struggled with effective and consistent strategies to systematically coordinate and oversee the assessment, service referral and linkage, and follow-up for parenting and child development services for FTC participants and their children. Although families were most often referred for these services, initial assessment to determine the most appropriate services for a family, as well as follow-up regarding progress, was inconsistent. Failure to effectively assist parents with young children, in improving their parent-child interactions and addressing their children's health and development needs was a significant limitation of Tompkins FTC at that time. Responsiveness: The formation of our unique community partnership was instituted to address specific challenges faced by Tompkins FTC parents of young children. This action was consistent with the county's Community Health Improvement Plan, 2013-2017, which identified promoting mental health and preventing substance abuse as one of its Prevention Agenda priorities. Tompkins DSS and FTC first successfully secured Prevention and Family Recovery (PFR) grant funding through the Doris Duke Charitable Foundation for training and implementation of an evidence-based program to strengthen affected families. Tompkins DSS and FTC were one of four national recipients for PFR funding for the three-year period 2014-2017[3]. Following a national search, Tompkins DSS and FTC selected SafeCare®, developed by the National SafeCare Training and Research Center at Georgia State University. SafeCare® is an evidence-based, behavioral parent-training program addressing three parental skill areas: Parent-Child/Infant Interaction, Health, and Home Safety. Research studies on the implementation of SafeCare® demonstrated that it reduces subsequent maltreatment and involvement with child welfare.[4] Lutzker and colleagues (Gershater-Molko, Lutzker, & Wesch, 2002; Wesch & Lutzker, 1991) compared families receiving SafeCare services to families receiving standard family preservation services in California, and found that SafeCare families were significantly less likely to have a recurrence of child maltreatment (15% over three years) compared to services-as-usual families (44% over three years).”[5] SafeCare is designed for parents of children ages 0-5 who are at-risk for or have been reported for child neglect or physical abuse and is applicable to parents with substance abuse disorders. SafeCare's structured three module program targets risk factors associated with neglect, physical abuse, medical neglect, environmental neglect and unintentional injury. Tompkins FTC handles cases where alcohol or substance abuse by a parent has contributed to the neglect of children. As of June 2017, near the end of the three-year Prevention and Family Recovery Grant, 147 participants were referred to FTC with 61% female, 39% male, 89% Caucasian, 8% African American, 3% Hispanic and 57% were between the ages 26-35. Of the 185 children of FTC participants, 101 (55%) were between ages 0-5. Of the 32 referrals to SafeCare, 28 completed SafeCare® training (87%), 23 graduated from FTC (82%), 23 had children returned to parental care (82%), and 4 had recurrence of neglect petition filed with FTC due to substance use (12.5%).[6] Innovation: SafeCare® is new to public health as an innovative home-visiting intervention specifically designed to build parent skills to improve quality of parent interactions with their children, to improve parental involvement in addressing child health and mental health needs, and to increase safety in the home environment. During each 60-90 minute in-home training session, home visitors follow the SafeCare4 model: Explain, Model, Practice and Feedback. Home visitors explain a concept, model the concept, have the parent practice the steps, and then provide feedback to the parent. Each module is accomplished in six sessions. The health department was a natural fit as a SafeCare® provider easily integrating it into its existing maternal child health home-visitation program. Community Health Nurses eagerly learned about SafeCare® and were excited to be given the opportunity to participate in the program as a provider. Already equipped with home visiting skills in their delivery of maternal child health care, they augmented their skills to deliver SafeCare® as home visitors during one-week training provided on-site. They then put their newly acquired skills to work by making home visits to FTC families to initiate SafeCare®. Each home visitor met weekly with the SafeCare® coach to review content of the home visit, to ensure fidelity with the program and to meet the requirements for certification as a home visitor. This process went smoothly without obstacles. Home visitors provide written monthly progress reports to FTC and DSS which they use to gauge readiness for reunification of parents and children. Upon completion of SafeCare®, parents have attained the necessary skills needed to actively engage with their children, to respond to their children's needs and to provide a safer home environment to prevent repeat incidences of child neglect. Attaining a high completion rate for SafeCare® means more families are reunited and no longer need child welfare service involvement. The public health impact of SafeCare®'s high reunification rate is substantial. Shannon R. Self-Brown, Ph.D., Professor, School of Public Health, Department Chair, Department of Health Policy and Behavioral Sciences, Co- Director, National SafeCare Training and Research Center, states Research suggests that youth who grow up in the foster care system, and especially those who age out of foster care” are at great risk for deleterious trajectories. They are at increased risk for health and mental health consequences, less likely to attend college, and more likely to be involved with the justice system. Thus, interventions that promote safe, stable, and nurturing family environment and prevent foster care placement greatly improve the long-term trajectories of children who may have been at risk for foster care placement. Secondly, the economic burden of foster care is substantial. The costs not only include the comprehensive care for the child during the years they are younger than 18, but also the societal costs that may be incurred as the result of increased health challenges, judicial involvement, and limited education/occupational opportunities of the foster youth. By implementing programs that can help sustain a family unit and maintain a child in the home, there are very significant long-term cost savings to the individual and state service systems.” [1] L. Johnson, Jeannette & Leff, Michelle. (1999). Children of Substance Abusers: Overview of Research Findings. Pediatrics. 103. 1085-99. [2] Bruns, E., Pullmann, M., Weathers, E., Wirschem, M., & Murphy, J. (2012). Effects of a multidisciplinary family treatment drug court on child and family outcomes: Results of a quasi-experimental study. [3] Prevention and Family Recovery, April 2017. [4] Gershater-Molko, RM, Lutzker, JR and Wesch, D. (2002). Using recidivism data to evaluate project SafeCare: Teaching bonding, safety and health care skills to parents. Child Maltreatment 7: 277-285. Chaffin, M, Hecht, D, Bard, D, Silovsky, JF, and Beasley, WH. (2012). A statewide trial of SafeCare home-based services model with parents in child protective services. Pediatrics 129: 505-515. Silovsky, J.F., et al. (2011). Prevention of child treatment in high-risk rural families: A randomized clinical trial with child welfare outcomes. Children and Youth Services Review, 33, 1435-1444. ???????[5] [6] Tompkins DSS
SafeCare® goals: 1) Increase parents' ability to maintain a safe home environment 2) Increase parents' knowledge of and involvement in addressing child health and mental health needs 3) Increase quantity and quality of parent responsiveness and parent-child interactions Prior to 2014, the health department and Tompkins FTC served families independently of each other and typically did not interact with one another. Tompkins DSS and the health department, however, had a strong working relationship serving families common to program areas in both departments. It was due to this long established positive relationship that Tompkins DSS proposed the health department become a SafeCare® provider. At the program's initiation in 2014, multiple community agencies including Tompkins Community Action, the Child Development Council, Cornell Cooperative Extension of Tompkins County and Tompkins County Health Department Early Intervention Program completed SafeCare® home visitor training. Unlike other human service agencies, the health department had a relatively stable work force with very low turnover. Participating community agencies experienced loss of staff as well as competing program priorities making it difficult to provide SafeCare®. Therefore, in 2016 it was determined that Tompkins County Health Department's Division for Community Health was best suited as the sole provider of SafeCare® due to its uniquely qualified Community Health Nurse work force already providing maternal child health home visits. This staff was knowledgeable in the tricks of the trade” to successfully connect with parents to arrange for and to conduct home visits. Tricks” included phone calls, text messages, coordination of home visits via DSS caseworker or FTC, and appointment text message reminders to name a few. As expected, SafeCare® had a slow start with 6 cases referred to the health department the first year. In calendar year 2017, 6 of 7 (86%) SafeCare® cases completed the program. January through October 2018, 14 SafeCare® cases received 157 home visits with 8 currently in process, 3 completed the program, and 3 did not complete the program for various reasons. From 2016-2018 the health department increased capacity to deliver SafeCare® by training five additional Community Health Nurses as home visitors and two Community Health Nurses as coaches. Each home visitor typically provides SafeCare® to 2-3 families at a time in addition to providing ongoing maternal child home visits to their assigned caseload as well as performing other core public health tasks. Each coach provides support to 2-4 home visitors by monitoring their performance in delivering SafeCare® to assure program fidelity. Presently, the health department capacity to deliver SafeCare® is 15 concurrent families. Though we have not reached 15 concurrent families to date, the health department is prepared and ready to do so as needed. Home visitors have directly observed the positive impact SafeCare® has had had on families and share the following observations. Gail Birnbaum, Community Health Nurse and home visitor states, It has been a rewarding experience to observe a parent transitioning from behaviors of punishing her child to now effectively redirecting and guiding him into more positive actions. This parent blossomed into a woman who now can express love and affection toward her three-year old. She now employs creative activities for them to do together joyfully. A key phrase learned in the program was, "every behavior is a communication" She is grateful to have perfected these skills and for the knowledge provided by the SafeCare curriculum. She stated on her end of program evaluation that "every parent should have access to SafeCare". Debora Axtell, Community Health Nurse and home visitor states, I am a new SafeCare® home visitor of less than 3 months. One of my clients referred herself to SafeCare® and now wants to refer a friend based on her positive visits with me! My other new SafeCare® client had a friend present at our first visit. After listening to me describe the program, the friend asked how she could get SafeCare®.” Celeste Rakovich, Community Health Nurse and home visitor states, Our SafeCare® clients are in the process of having their children placed back into their care. If they are early in the process, the time they are allowed to spend with their children is minimal; an hour or two a week that may also be supervised. I have had a mother in SafeCare® express disappointment and frustration that those visits are spent yelling and fighting with her toddler. What SafeCare® does is teach parents how to make EVERY interaction positive. We give parents the tools to plan an activity, set up expectations, praise, communicate with body language and engage with their children. That supervised visit can easily turn into the highlight of the week for both mother and daughter. This in turn can build a mother's confidence that a healthy and fulfilling relationship can continue to be fostered when her child is home full time.” Rachel Buckwalter, Community Health Nurse and SafeCare® coach states, In my work providing SafeCare® to families, I have seen first-hand the positive impact SafeCare® has on the parents' quality interactions with their children. Many of these parents have only parented in a state of crisis, or in a reactive way, focusing more on punishment and negative incentives. SafeCare® teaches parents a new way which is using positive incentives and promoting good behavior. I recently had a parent tell me that SafeCare®'s Parent Child Interaction module had really changed the way she approached parenting. She was now convinced that setting positive incentives for behavior worked better than the way she used to parent. She was thankful for the chance to change her approach with her children, and she felt more bonded to her children after we completed the module together. Helping these parents re-engage with their children in a positive way has been and continues to be one of the most rewarding parts of my job." Collaboration between stakeholders in this unique community partnership has been key to the success of the program. Before FTC makes a referral to SafeCare®, the parent must meet certain FTC milestones including evidence substantiating the parent has been clean and sober for three months, the parent is committed to recovery and they are fully participating in FTC. The FTC team with Judge Rowley as the lead, meet on a regular basis to review the parent's attainment of FTC milestones and to determine the parent's readiness to participate in SafeCare®. Once the FTC deems the parent is ready for SafeCare®, a referral is made to the health department. As home visitors deliver SafeCare®, if they encounter difficulties or obstacles in providing SafeCare® (i.e. not finding the parent present at the appointed home visit or repeated home visit cancellations), they communicate this to FTC and DSS. Sometimes the parent's circumstances necessitate FTC recommending suspending SafeCare®. Once the parent is determined to be ready again to participate, SafeCare® is restarted. This open communication between FTC, DSS and the health department supports successful parent participation in the program. As an active member of the partnership, the home visitors' perspective on a parent's progress in SafeCare® is well documented in monthly progress reports and is essential information to the FTC team. Judge Rowley has reported that he finds the information on the monthly reports useful as he discusses the family's overall progress toward successfully graduating from Family Treatment Court. The Honorable Judge John C. Rowley states The addition of Public Health Nurses through the SafeCare program has added significant value to our Family Treatment Court and makes our families more likely to achieve reunification with their children. The education the Public Health Nurses provide through the evidenced based SafeCare program helps our families grow together and provide safer environments for the children. Our participants have reported high satisfaction with the program and I see the Public Health Nurses as a vital component of our Family Treatment Court. Simply put, more parents are graduating from our Family Treatment Court because of this partnership.” To foster ongoing collaboration between key stakeholders, home visitors attend quarterly meetings at DSS to talk about SafeCare® with FTC caseworkers. These face-to-face meetings help raise awareness of the benefits of the program and promote good communication between partners. Local stakeholders involved in SafeCare® include: Tompkins County DSS Commissioner, Patricia Carey – directed DSS staff to research an evidence-based model and to pursue Prevention and Family Recovery grant funding for three-year period 2014-2017; committed to utilizing child welfare funds to support SafeCare® home visits 2018 and into future Tompkins County DSS Deputy Commissioner, Deana Bodnar– identified SafeCare® as an evidence-based model; secured Prevention and Family Recovery grant funding for training/implementation of SafeCare® 2014-2017; secured Substance Abuse and Mental Health Services Administration (SAMHSA) grant funding 2017 to present; reports SafeCare® program statistics to the Tompkins FTC Advisory Board Tompkins County FTC Judge John C. Rowley – involved in planning and implementation of SafeCare® as the FTC Judge, directs FTC cases to participate in SafeCare® Tompkins County Health Department Public Health Director, Frank Kruppa – directed health department nursing staff in Early Intervention & Community Health to become SafeCare® home visitors Tompkins County Health Department Children with Special Care Needs Director, Sylvia Allinger – initially involved with start-up of SafeCare®, supported one staff nurse trained as a home visitor Tompkins County Health Department Director of Community Health, Karen Bishop - supportive of the initiative, directed five Community Health Nurses to attend week long training to become certified home visitors and two Community Health Nurses to obtain certified training as coaches, ensures staff maintain SafeCare® standards, applies for annual SafeCare® accreditation SafeCare® training costs have been covered through grant funding 2014-2017 secured through the Prevention and Family Recovery grant from the Doris Duke Foundation administered by Children and Family Futures. From 2017 to present, Tompkins FTC secured a Substance Abuse and Mental Health Services Administration (SAMHSA) Family Treatment Court Enhancement Grant. Tompkins DSS reimburses Tompkins County Health Department on a per visit rate negotiated annually. SafeCare® visit cost is covered by the SAMHSA grant and child welfare funds as all FTC participants have open child welfare cases with Tompkins DSS. Training Costs[1]: Provider Training (Total $18,462) National SafeCare® Training and Resource Center (NSTRC) sent two trainers to Ithaca, New York to conduct a provider workshop for up to four trainees. The workshop was conducted over four days and NSTRC supplied all training manuals and materials needed. Provider training costs included: Personnel time (includes fringe) = $13,635 Travel = $4,302 Supplies, manuals, materials, and communications = $525 Coach Training (Total $4,742) NSTRC sent one trainer to Ithaca, New York to conduct one-day coaching workshop, approximately 6 months after the provider workshop. The workshop included one staff member who had successfully completed the SafeCare® provider implementation period and who was ready for coach training. The coach assumed support of all providers going forward. Coach training costs included: Personnel time (includes fringe) = $2,944 Travel = $1,535 Supplies, materials, and communications = $263 Monthly Technical Assistance – New Providers (Total $8,996; billed $818 per month for 10 months and $816 for the final month). NSTRC trainers and faculty provided regular, ongoing coaching and technical assistance remotely for eleven months of the contract. Included coaching of providers and shadowing of coaching staff, any refresher training (conducted remotely) technical assistance as needed, and monthly conference calls with all providers. Monthly technical assistance costs included: Personnel (includes fringe) = $794 per month Supplies and communication = $24 per month Monthly Technical Assistance – Trained Providers (Total $1,200; billed $200/month/provider for 6 months. NSTRC trainers and faculty provided ongoing coaching and technical assistance remotely for 6 months for trained providers. This included coaching of providers, any refresher training (conducted remotely) technical assistance as needed, and monthly conference calls with all providers. Costs for monthly technical assistance include: Personnel (includes fringe) = $200 per month [1] Tompkins County Department of Social Services.
SafeCare® objectives were to: 1) Increase parents' ability to maintain a safe home environment 2) Increase parents' knowledge of and involvement in addressing child health and mental health needs 3) Increase quantity and quality of parent responsiveness and parent-child interactions Tompkins DSS tracked data using an excel spreadsheet capturing referral date, start date, and completion date. Child welfare outcome data was collected from Tompkins FTC legal unit including the final disposition of a case and child placement. Data is shared with team members and twice a year with the Tompkins FTC Advisory Committee consisting of representatives from DSS, FTC, Health Department, Mental Health Department, Human Services Coalition, Alcohol and Drug Council, Cayuga Addiction and Recovery Services, Advocacy Center and Southern Tier AIDS Program. Of the 32 families who were referred to the SafeCare® program from 2014 through September 2018, 28 (87%) completed all three modules, 4 (12.5%) dropped out of the program, 23 (82%) had their children returned to their care, 23 (82%) graduated from FTC, and 4 (12.5%) had a recurrent child neglect petition[1]. When all three modules are completed, SafeCare® objectives have been met. For the parent this means they successfully gained skills in several at-risk categories to prevent reoccurrence of child neglect. Their reward is reunification with their children. Modifications were made to the practice during year two of the PFR grant to discontinue multiple human service agency provision of SafeCare® to a sole provider, the health department. With a stable work force already experienced in delivering home visits to families with young children, the health department as sole SafeCare® provider was a logical modification to the practice. Additionally, the health department was well suited to commit additional staff for training as home visitors and coaches in order to increase its capacity to sustain the practice beyond the PFR grant. Challenges experienced at first by SafeCare® home visitors involved trying to effectively and efficiently communicate with multiple DSS caseworkers regarding SafeCare® cases. Since DSS caseworkers spend most of their day out of the office, it was nearly impossible to reach them directly by phone on the first try. This resulted in significant lapses of time occurring before both parties successfully reached one another. In response to this identified challenge, Tompkins DSS created a new position in 2016, Child-Family Liaison, a central point of contact for SafeCare® referrals and communication with the health department. With the initiation of this new position, the communication challenges previously experienced were resolved. The SafeCare® coach and Child-Family Liaison established weekly phone calls which has facilitated effective and efficient two-way communication between both entities. Frequent regular partner communication has fostered a mechanism for timely referrals to SafeCare®, for providing case updates, and for discussing any challenges or obstacles encountered in providing SafeCare® to a family. With a high completion rate to date of 87%, participation in SafeCare® has equipped parents with the skills they need to successfully parent their children going forward. Further evidence of SafeCare's effectiveness, is direct feedback received by parent participants via the home visitor's pre-and post-module survey results. After each SafeCare® module, parents are asked to complete a survey rating the module in several areas. Survey respondents consistently rate that they agree or strongly agree that interacting with their child has become easier and routine activities, like feeding their child and bathing him/her, have become easier. They also rate that their home has become safer and making health decisions regarding their child has become easier. Parent comments written on the surveys include: Communication has improved significantly in my family! Love the modules! Thanks!” We love coming to SafeCare with you. You are very caring and have been very helpful. Thank you!” My SafeCare provider was a very positive person who was patient and knowledgeable. This program should be open to all! Thank you!” It's very useful.” I had a great time learning and it would be great for younger parents or new parents. I had an amazing SafeCare provider.” My SafeCare provider was amazing, very helpful: will be missed. Thanks!” I enjoyed SafeCare and learned a lot of new ways to interact with my daughter. It was very helpful. The provider was very nice and had lots of patience.” My SafeCare provider was fabulous. I enjoyed our time together; she was excellent at explaining everything, was very thorough and a great listener. Thank you so much—got some great tips—I'm definitely a better mommy because of her.” My SafeCare provider was great to work with and very insightful. She was a wonderful help and I learned a lot of good ways to interact and play with my son.” [1] Tompkins County Department of Social Services.
When SafeCare® was initiated in Tompkins County, it was a collaboration between DSS, FTC, Tompkins Community Action, Child Development Council, Cornell Cooperative Extension of Tompkins County and Tompkins County Health Department's Early Intervention Program. It soon became evident that having one trained SafeCare® home visitor at four separate human service agencies without on-site coach support allowed for a slow program uptake with inconsistent program delivery. Tompkins County Health Department had stable staff resources in the Division for Community Health readily available and already engaged in delivering maternal child home-visiting services. Over a two-year period five Community Health Nurses were trained as SafeCare® home visitors. In addition, two of these nurses advanced and completed SafeCare® coach training which eliminated the need for remote coaching by the National SafeCare Training and Research Center. Essential for the success of SafeCare®, coaching provides continuous feedback and quality improvement to the program. With two coaches currently on staff at the health department, home visitors are better supported on an ongoing basis to continue providing SafeCare® to families while confidently maintaining the fidelity of the program. Karen LaCelle, Community Health Nurse and SafeCare® coach states, When functioning in my role of SafeCare® coach, I listen to an audio recording of the home visitor's SafeCare® session with their client. We then meet to discuss what went well and to identify areas for improvement. This is a wonderful way to maximize the impact of the curriculum, and to personalize it for each family. Coaching insures thoughtful processing of concerns, planning ways to circumvent barriers. A parent who already knew it all” when it came to making health decisions for their child became more receptive to using the health manual when the home visitor adjusted her approach following a coaching session. Another parent opened up and talked more when their home visitor was encouraged by the coach to use more reflective listening and open-ended questions. Parents become the recipients of high quality home visits through the use of the coach-home visitor model.” It is the vision of the health department that eventually, one of the coaches will become a SafeCare® trainer who will be responsible for training new home visitors and coaches as needed when internal staff changes occur. Having all three levels of SafeCare® trained staff including home visitor, coach and trainer on staff, will adequately resource the health department to sustain SafeCare® well into the future. An extensive local cost/benefit analysis has not been accomplished to date. However, in September 2017 the Washington State Institute of Public Policy found that SafeCare® yields $20.25 in benefits for every dollar spent on implementation.[1] There is sufficient stakeholder commitment to sustain SafeCare® locally. FTC has realized the positive impact SafeCare® has had on strengthening families with 82% reunification of affected families and successful graduation from FTC. Tompkins DSS has committed child welfare funds on an annual basis to support sustaining SafeCare® as an intervention for FTC cases. The health department has successfully trained a sufficient pool of home visitors to deliver SafeCare® with two on-site coaches to ensure program fidelity and support of home visitors. The knowledge of the benefits of SafeCare® has extended beyond FTC to other units within Tompkins DSS. This was recently evidenced by a parent of a child neglect case who requested SafeCare® to help increase her parenting skills so that she could be successfully reunited with her child. All stakeholders involved are committed to sustaining SafeCare® for FTC cases as well as considering expanding it to reach other at-risk parents. As an innovative model practice, SafeCare® has proven itself as a worthwhile project in response to the increased incidence of child neglect cases involving parental substance abuse. Upon completion of SafeCare® modules, we have demonstrated the impact on the intended target population with a high family reunification rate and low recidivism rate. The high family reunification rate signifies improved parental engagement and responsiveness to their children's needs and to their home safety. Through the in-home module instruction, the parents practice and demonstrate these skills. We are confident going forward that the public health impact of not only sustaining but also expanding SafeCare® will continue to positively affect the lives of participating families with young children. The health department has committed to be an ongoing provider of SafeCare® while maintaining high implementation standards and has achieved annual accreditation from the National SafeCare Training and Research Center, Georgia State University since 2017. [1]
Colleague in my LHD