Date of Award

Spring 5-13-2016

Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. John. R. Lutzker

Second Advisor

Dr. Betty Lai

Third Advisor

Dr. Brian Barger


INTRODUCTION: The burden of child maltreatment is substantial, highlighting the importance of identifying effective prevention programs in reducing occurrence and costs. The SafeCare® model was developed as a home-based service for high-risk parents in child protective services for child maltreatment. Although limited, studies that evaluate interventions for child maltreatment through a public health strategy can be achieved through administrative data and have a positive impact on population level reduction of abuse and neglect.

AIM: This current secondary analysis examines the effect of the statewide implementation of SafeCare compared to services as usual on the likelihood of out-of-home placement. The research question is “are there differences in out-of-home placement among families referred to SafeCare compared to families who received services as usual?”

METHOD: The original study was a cluster-randomized research design was implemented to evaluate SafeCare verses services as usual at the agency/region level including two urban and four rural child protective services administrative regions of Oklahoma. The secondary analysis sample included 2,175 families, prioritizing the primary caregiver for intervention. The Cox proportional-hazards regression model was used to estimate the relative risk for an out-of-home placement and participants were categorized according to intervention type group.

RESULTS: By the end of the 2.9-year follow-up, there were 283 first time occurrences of out-of-home placement. Families randomized to receive services as usual had no effect compared to families receiving SafeCare on the likelihood of out-of-home placement after adjusting for baseline family covariates.

DISCUSSION: These findings suggest that many chronic cases in the child welfare system may show limited change with services and may suggest a different service approach for reducing recidivism in out-of-home placement outcomes. Although limited, evaluating interventions for child maltreatment by using administrative data can be achieved through administrative data and have a positive impact on establishing effective prevention programs in reducing occurrence of abuse and neglect on a population level.