Abstract Sanjana S. Mammen Examining the SafeCare Parent-Infant Interaction Module’s Impact on the Quantity and Content of Maternal-Infant Directed Utterances (Under the direction of Shannon Self Brown, PhD) Positive parenting skills reduce risk for child maltreatment. The Parent-Infant Interaction (PII) module of SafeCare was designed to promote positive parent-child relationships; however, little research has examined its impact on parent-infant utterances. Past research has indicated that a rich parent-child language environment predicts literacy skills and academic achievement, so the present research studies how PII impacts positive maternal infant-directed utterances. Three dyads with various risk levels with infants aged younger than 9-months were offered PII training and a short video modeling positive parent-infant communication. Multiple-probe, single-case experimental design yielded data with several positive trends for maternal-infant utterances, but findings were inconsistent during all conditions. Conversely, following the video, improved utterances were demonstrated consistently across all activities and dyads. These pilot data render several future studies relevant to further our understanding of PII’s impact on maternal-infant communication broadly, including more rigorous research designs and measures to further study this important outcome.

Child maltreatment affects millions of children annually, and evidence-based home visiting programs, such as SafeCare®, help increase parenting skills and, ultimately, the well-being of children. Although effective at reducing maltreatment when participants complete services, high attrition rates in home visiting services may reduce this effectiveness. Using a sample of all clients receiving SafeCare services in Georgia (n=93) from October 2013 to February 2015, we evaluated individual characteristics, information seeking behaviors, and programmatic factors in order to understand the relationships, if any, with participant program completion. During this evaluation cycle, SafeCare reports a completion rate of 43%. The race of the primary guardian significantly relates to program completion (p=0.02). This evaluation can assist those implementing SafeCare to anticipate the needs of their target population.

Child maltreatment is a serious public health problem that leads to psychological, physical, behavioral, and economic burdens for children and broader community. Current data suggest that child maltreatment has declined over the past 20 years with the smallest declines in child neglect. In 2013, medical neglect represented approximately 31% of all substantiated cases of child maltreatment. SafeCare® is an evidence-based home visiting program that targets risk factors for child maltreatment by providing three modules: home safety, health, and parent-child interaction, or parent-infant interaction for children who are not walking. The SafeCare health module aims to teach parents how to identify and treat their children when they become ill, reducing the potential for medical neglect. Previous SafeCare research demonstrated that incorporating cell phones into training improves home safety and parent-child interaction outcomes. The current research evaluated the SafeCare health module and the effect cell phone enhancements had on parents’ child health knowledge. Data reaffirm the value of the SafeCare health module to increase parental child health skills and that incorporating cell phone technology may promote generalization and may engage participants and increase effectiveness.

Child maltreatment is a significant public health problem that increases when children live in homes in which intimate partner violence (IPV) is present. Child maltreatment and IPV often co-occur, and the sequelae of IPV frequently appear in both the victimized mother and her children. Home visitation programs, such as SafeCare®, are used as intervention strategies to reduce the risk of child maltreatment, but rarely are these programs adapted for Latino populations. The importance of cultural sensitivity in parenting programs has been highlighted as a means of producing successful outcomes when working with Latino families. The present single-case research design study evaluated the efficacy of SafeCare's Parent-Infant Interaction (PII) module when delivered in Spanish to a Latino mother with prior experiences of IPV. Observational data were used to document changes in parenting behaviors, while self-report measures assessed exposure to IPV and changes in mental health, parenting stress, and the risk of child maltreatment. Qualitative data provided suggestions for culturally adapting PII for Latino families. Data from this study suggest that PII improves parent-infant interactions when delivered in Spanish and reduces the risk of child maltreatment. Additionally, self-report measures indicate that IPV, parent mental health distress, and the risk of child maltreatment co-occur. This study also shares with the field the importance of providing culturally adapted programs when working with Latino families.

Child maltreatment is a significant public health problem that increases when children live in homes in which intimate partner violence (IPV) is present. Child maltreatment and IPV often co-occur, and the sequelae of IPV frequently appear in both the victimized mother and her children. Home visitation programs, such as SafeCare®, are used as intervention strategies to reduce the risk of child maltreatment, but rarely are these programs adapted for Latino populations. The importance of cultural sensitivity in parenting programs has been highlighted as a means of producing successful outcomes when working with Latino families. The present single-case research design study evaluated the efficacy of SafeCare's Parent-Infant Interaction (PII) module when delivered in Spanish to a Latino mother with prior experiences of IPV. Observational data were used to document changes in parenting behaviors, while self-report measures assessed exposure to IPV and changes in mental health, parenting stress, and the risk of child maltreatment. Qualitative data provided suggestions for culturally adapting PII for Latino families. Data from this study suggest that PII improves parent-infant interactions when delivered in Spanish and reduces the risk of child maltreatment. Additionally, self-report measures indicate that IPV, parent mental health distress, and the risk of child maltreatment co-occur. This study also shares with the field the importance of providing culturally adapted programs when working with Latino families.

Innovative handheld technologies are changing the possibilities for delivering public health interventions. The present research describes a preliminary examination of the effects of iPhone™ both as an assessment tool for data collection and as an enhancement to an in-home child safety intervention. Three families with children under age seven were trained to use an iPhone to video targeted rooms in their homes following SafeCare® safety module intervention implementation during which rooms were secured for accessible safety and health hazards. The iPhone was used to communicate feedback, logistical information, and clarification of safety content. The effectiveness of iPhone and iPhone video was examined using a multiple baseline design across settings replicated across families. All rooms across subjects demonstrated significant decreases in home hazards. Face-to-face (F2F), in-home time of the home visitor was progressively reduced and replaced by video data collection over the course of the intervention. These data suggest that handheld technology tools are a promising means of data collection for in situ safety interventions and for augmenting interaction during intervention. Implications of these findings for reducing costs of F2F intervention as high-quality handheld video capabilities become increasingly ubiquitous and for engaging and retaining participants are discussed.

As more evidence-based programs are implemented in community settings, there is a strong need to ensure those models are implemented with integrity. Implementation of programs should be evaluated for fidelity, the degree of adherence to treatment protocols, and competence, the level of skill in implementation (Schoenwald et al., 2011). The purpose of this study was to review audio recordings of SafeCare home visiting sessions to discover the relationship between the measures of fidelity and competence. Six coders were assigned 209 SafeCare home visiting audiotapes to be coded for fidelity and competence. A sample of audios were double coded to evaluate fidelity and competence scores for inter-rater reliability. Fidelity and competence items were classified into process and content categories, forming the six main variables of process fidelity, content fidelity, total fidelity, process competence, content competence, and total competence. Total fidelity correlated with total competence at a level of .615, with process fidelity and process competence correlating at a much lower level than content items. The total correlation level can be interpreted as that fidelity and competence are strongly related measures, but are not identical constructs. The goal for SafeCare coders would be to continue refining competence definitions and attempting to remove the subjective nature from the competence coding process. With these two efforts, competence reliability should increase to an acceptable level. Given the main fidelity and competence correlation level, it is advisable for SafeCare coders to continue to code both fidelity and competence to avoid missing valuable components of the session. Additional research may be needed once the competence scale becomes better established.

Inappropriate parental expectations of age-appropriate behaviors and unawareness of developmental milestones can increase instances of child maltreatment. Additionally, experiences of child maltreatment can have a negative impact on the developmental trajectory of a child. The present research describes a parental aide, the tDevelop, delivered to parents at risk for child maltreatment through SafeCare Parent-Child Interaction (PCI) training with the aim of increasing identification of developmental milestones and age-appropriate activities. Two high-risk families with children close to 24-months of age were recruited from a residential program for young mothers working to develop self-sufficiency skills. The families were presented with the tDevelop along with traditional PCI information, including Planned Activities Training and age-appropriate activities. Data from a multiple-probe, single-case experimental design, suggest that mothers are able to recognize developmental milestones with increased accuracy upon intervention with the tDevelop. These findings suggest that the enhanced PCI protocol may enhance parental identification of developmental milestones.

Family level data was collected from those served in a state-wide rollout of SafeCare® in Georgia between January of 2010 and November of 2011. Families who received SafeCare were trained in the intervention’s three modules: Parent-Child or Parent-Infant Interaction, Home Safety, and Child Health. The purpose of this study was to measure changes in parental skill demonstration by analyzing pre- and post-training assessments. Additionally, parental demographic characteristics were also assessed for associations with skill acquisition within each module. Follow-up analysis concluded that families displayed increases in parenting skills among all SafeCare modules. Moderator analysis showed that those with only one child showed greater decreases in home hazards as did those with two children. Also, it was found that income level moderated performance in the Parent-Child Interaction module with participants below the median income level exhibiting a greater increase in PCI skill demonstration than those above the median income level. Further research should consider modeling multiple parental characters (e.g. CPS status and income) with skill performance over time. Lastly, additional research should aim to determine if those who exhibit increases in parenting skills are also less likely to experience future child maltreatment reports.

Child maltreatment is a serious and pervasive public health problem in the United States. In 2008, there were 772,000 children who were substantiated victims of maltreatment and 1,740 children died as a result of maltreatment. Approximately 33 percent of maltreatment victims were under the age of four. Among numerous other negative sequelae, children who have been maltreated have an elevated incidence of language delay and poor cognitive functioning, both strong predictors of literacy skills and later academic achievement. Further, maternal language input is critical to a child’s cognitive development and language acquisition. Maltreating mothers provide their children with far less verbal stimulation and are less likely to engage their children in learning opportunities. Home visiting programs are effective means of preventing child maltreatment or further maltreatment by parents and may be better utilized to improve language of children. SafeCare® represents one such program. It is an evidence-based program for the treatment and prevention of child maltreatment, consisting of four modules: Parent- Infant Interaction (PII), Parent-Child Interaction (PCI), Health and Safety. The purpose of the proposed research is to determine whether PII or a language-enhanced version of the module is effective in increasing the number of maternal utterances with her infant and the frequency of incidental teaching. The enhanced PII segment was created, not only to be an effective tool for promoting language, but also to be succinct enough to imbed into the extant protocols so as not to add a cumbersome burden to SafeCare home visitors or parents participating in the program.