Author ORCID Identifier

Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Shannon Self-Brown

Second Advisor

Daniel Whitaker

Third Advisor

Kelley Fong


Background: The COVID-19 pandemic impacted aspects of everyday life and increased stressors for families. Preventing child maltreatment (CM) remains of utmost importance. CM Prevention services, typically delivered via home visiting, pivoted to virtual delivery in order to continue serving families while adhering to the COVID-19 public health guidelines of social distancing. SafeCare® is a structured, empirically supported home visiting program that addresses proximal behaviors that can lead to the perpetration of child neglect and physical abuse. In March 2020, most SafeCare agencies began delivering services virtually. The aims of the current study are to examine the impacts of the shift to virtual delivery of the SafeCare program and consider how home visiting programs might deliver services to reach families most effectively in the future. The research questions are as follows: (1) What were SafeCare Providers general experiences with delivering SafeCare through a virtual platform? (2) What were SafeCare Providers experiences regarding how virtual delivery impacted program fidelity? And (3) Did SafeCare Providers perceive shifts or changes in client engagement and outcomes after the onset of the pandemic?

Methods: We analyzed data from a June 2020 survey of SafeCare Providers to understand how they were responding to the transition of virtual program delivery while maintaining program fidelity. Next, we conducted focus groups of SafeCare Providers in Fall 2021 to further investigate emerging themes and determine how Providers’ experiences with virtual program delivery may have changed over time. Data were analyzed using a modified grounded theory approach to identify emerging themes. An inter-rater reliability score was calculated.

Results: Findings demonstrated that SafeCare Providers developed several adaptations to address the challenges of virtual program delivery, including modified delivery practices to ease the difficulty of virtual delivery. Providers also developed innovative techniques for rapport building and client engagement that adhered to safe social distancing practices. Providers found maintaining program fidelity and ensuring client skill mastery to be somewhat challenging when delivering the program through virtual platforms, though perspectives varied according to the SafeCare module being delivered. Provider perceptions regarding participant outcomes varied. Some reported quicker module completion, while others reported concern about client skill mastery.

Discussion: The study has multiple implications for the field of evidence-based home visiting services targeting child maltreatment prevention. Recommendations include a call for virtual delivery resource development (e.g., modeling videos for parents and activities for children) and tools to support the reach of virtual delivery (e.g., internet hotspots for rural families). Future research should compare the effectiveness of in-home, virtual, and hybrid program delivery methods through randomized controlled trials. These studies should focus on which delivery methods work best for specific groups of participants, such as caregivers with low literacy skills or intellectual disabilities.


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