Safer kids can't wait : evaluating a parenting program to prevent child abuse

<p dir="ltr">Background: Millions of children across the world are exposed to violence in the home during their upbringing. While behavioral parenting programs are supported by research as effective in preventing child abuse, few trials include families with suspected abuse - particularly with follow-ups extending beyond one year. In routine services, interventions are often delayed, posing risks, as abuse can escalate and lead to long- term harm. Moreover, many parents decline or discontinue available interventions, underscoring the need for approaches that are not only timely and effective, but also acceptable to families.</p><p dir="ltr">Aim: This thesis evaluated the feasibility, effectiveness, and parental experiences of Safer Kids, a behavioral parenting program designed for rapid delivery following a child abuse report. Study I assessed feasibility and preliminary effectiveness of Safer Kids in preventing outcomes related to child abuse. Study II evaluated short-term outcomes via a randomized controlled trial (RCT), while Study III examined long-term effects. Study IV explored parents' experiences with the program.</p><p dir="ltr">Methods: Two studies were conducted with families involved in Swedish child welfare services due to suspected emotional or physical harsh treatment or violence against children (in the studies defined as child abuse, regardless of severity). Families were allocated to either Safer Kids or intervention as usual (IAU). IAU consisted of available standard interventions after reported child abuse at the participating child welfare service agencies. Primary outcomes were new official child welfare reports and scores on the Brief Child Abuse Potential Inventory (BCAP), which aims to assess the self- reported risk for abuse. Secondary outcomes included caregiver and child mental health, parental anger, and parent-child relationship quality. Study I employed a non- randomized controlled design with follow-ups at 4, 7, and 18 months. Studies II-III comprised an RCT, with assessments at baseline and at 4, 7, 18, and 30 months. Study II analyzed RCT data up to 7 months, and Study III up to 30 months. Between-group effectiveness was primarily analyzed using multilevel and linear mixed models, and Cox proportional hazards models for new report incidence. Study IV included semi- structured interviews with parents that took part in Safer Kids in the RCT, analyzed using reflexive thematic analysis.</p><p dir="ltr">Results: Study I enrolled 67 families (104 caregivers). Most caregivers completed Safer Kids. Families assigned to the program had a lower risk for further child welfare reports than those assigned to IAU. Changes in BCAP and secondary outcomes did not differ significantly between groups, except for a larger reduction in parental depression at 7 months for caregivers who received Safer Kids. The RCT (Study II-III) enrolled 112 families (194 caregivers). Both groups showed improvements in self-rated outcomes at 7 months, with no significant between-group differences. Interestingly, a between-group effect in favor of Safer Kids appeared for child mental health symptoms at 30 months, since the control group's levels returned to baseline between 18 and 30 months. No significant group differences were found in the proportion of families re-reported or in the time to the first new report. However, families in the Safer Kids group accumulated fewer total reports over the 30-month follow-up period. Furthermore, satisfaction was higher among parents and social workers in the Safer Kids group compared to IAU. All except one family who started Safer Kids completed. Additionally, 41 of 42 social service agencies that participated in the trials continued using Safer Kids 2-2.5 years after ending study recruitment. In Study IV, fifteen parents were interviewed, who mostly reflected positively on their experiences with Safer Kids. Parents described improved abilities to handle anger, greater emotional presence, and stronger relationships with their children.</p><p dir="ltr">Conclusions: Safer Kids was not consistently more effective than standard interventions, though some findings suggest modest additional benefits beyond the services typically offered following a report of child abuse in Sweden. The program appeared feasible within the Swedish social service context and well accepted by caregivers and staff. Further research is needed both to confirm its effectiveness and to investigate whether reducing delays between abuse reports and intervention onset can improve outcomes for children.</p><h3>List of scientific papers</h3><p dir="ltr">I. <b>van </b><b>Leu</b><b>ven, L.</b>, Lalouni, M., Enebrink, P., Sorjonen, K., & Forster, M. (2022). Feasibility and implementation of Safer Kids - A parenting program to reduce child abuse. Child Abuse & Neglect. 123. 105434. <a href="https://doi.org/10.1016/j.chiabu.2021.105434">https://doi.org/10.1016/j.chiabu.2021.105434</a></p><p dir="ltr">II. <b>van </b><b>Le</b><b>uven, L.</b>, Enebrink, P., Ghaderi, A., Sorjonen, K., Lalouni, M., & Forster, M. (2023). A randomized controlled trial of Safer Kids - A program for parents reported for child abuse: Short-term effects on further reports of child abuse and related risk factors. Child Abuse & Neglect. 143, p. 106329. <a href="https://doi.org/10.1016/j.chiabu.2023.106329">https://doi.org/10.1016/j.chiabu.2023.106329</a></p><p dir="ltr">III. <b>van </b><b>Le</b><b>uven, L.</b>, Enebrink, P., Lalouni, M., & Forster, M. (2025). Preventing Child Abuse Through a Brief, Rapid-Response Parenting Intervention: 2.5 Year Outcomes from the Safer Kids Randomized Controlled Trial. [Manuscript]</p><p dir="ltr">IV. <b>van </b><b>Leuv</b><b>en, L.</b>, Västhagen, M., Forster, M., & Lindberg, L. (2025). Parents' experiences of parent training after reported child abuse: A qualitative study. Child Abuse & Neglect. 161, p. 107252. <a href="https://doi.org/10.1016/j.chiabu.2025.107252">https://doi.org/10.1016/j.chiabu.2025.107252</a><br></p>