Mid-sized metropolitan areas face very different challenges and transportation planning issues than those faced by larger metropolitan areas. This is especially true in the area of safety conscious planning (SCP). Conflicting organizational cultures and limited staff and technical tools are major challenges in SCP efforts for mid-sized metropolitan areas (200,000 to 600,000 population). This study surveyed mid-sized metropolitan planning organizations (MPOs) and conducted seven case studies of mid-sized metropolitan areas to better understand the challenges and opportunities facing SCP in such a context. The national survey and case studies focused on long range planning, data collection, human resources, technical analysis, and collaboration aspects of SCP as applied today. The results indicate that the majority of mid-sized MPOs have incorporated safety consideration into their long range transportation plans vision, goals and objectives, but some mid-sized MPOs are more proactive in the quantitative analysis of project safety outcomes than others. The dissertation recommends that the institutional and technical issues faced by mid-sized MPOs can be overcome by engaging all government levels of planning in SCP efforts that identify a safety champion in the management ranks, encourage state departments of transportation to provide mid-sized MPOs with more tools and training in SCP, promote a stronger relationship between the Governor s Safety Representative and the MPO, and create a more comprehensive forum for collaboration among safety professionals.