On a chilly San Francisco winter evening, families slowly trickled into the Safe & Sound Family Resource Center, most coming directly from school or work. They were arriving for a family dinner that is held every Tuesday from 5 to 6 p.m. Volunteers provide food free of charge to any parent and child in the community, with 30 or so family members attending on a typical evening.

By 5:30, the room was packed and there was a buzz in the air as parents caught up with each other and children found their friends. Many parents who attend the dinners regularly provide informal support to one another. Almost all of the parents stayed after dinner for the Single Parents Network support group as their children joined Safe & Sound staff for fun activities in the playroom.

Safe & Sound was founded 45 years ago as the San Francisco Child Abuse Council, started by Dr. Moses Grossman, a pediatrician who wanted to bring into his community a public health approach to the prevention of abuse and neglect. Even though the community family dinner and many of Safe & Sound’s other programs have been around for decades, the way that Safe & Sound approaches the work continues to evolve with the changing times. As it remains true to its legacy of directly serving vulnerable families in the community, the agency has become a key player in a broader effort across San Francisco to end child abuse and neglect through a prevention-focused approach involving a collective of child-serving organizations, cross-system partners, and operators of community programs.

Safe & Sound currently serves 800 to 1,000 families per year, focusing most intensively on families with so-called “pink flags,” those who need support and services but are not in a situation where child abuse and neglect currently exists. The goal is to stabilize families to prevent child maltreatment and involvement with the child protection agency.¹

A warm welcome

When parents and caregivers first walk into Safe & Sound, whether for a parenting support class or temporary assistance during a crisis, an effort is made to immediately put them at ease. Staff orient families to Safe & Sound’s various services and supports, without pressure to sign up. Given that some families have had negative experiences with service providers in the past, families are encouraged to engage at their own pace and comfort level. Most families come to Safe & Sound from trusted sources in the community, such as teachers and doctors, as well as through word of mouth, other community groups, and the organization’s 24-hour, parental stress phone support TALK (Telephone Assistance in Living with Kids) Line. About 10% to 15% of families are involved with child welfare and have been ordered by a court to participate in Safe & Sound’s programs.

In keeping with a strengths-based, public health approach, Safe & Sound integrated the Center for the Study of Social Policy’s protective factors framework into its practice model and programming. All families that arrive at Safe & Sound receive an intake interview, which is organized around the five protective factors specified within the framework and allows families to identify what they perceive as their needs. The intake form asks questions to help provide a fuller picture of how the families are functioning, including their support network, what types of concrete supports they need, and what they see as their strengths.

Once the intake interview is complete, parents are engaged in a couple different ways. Those assessed at low risk for child abuse and neglect, or who are not open to engagement with a care coordinator, are encouraged to participate in one or more of Safe & Sound’s “light touch” services. Those assessed at high risk or experiencing other forms of crisis are assigned to a clinical care coordinator to receive more intensive integrated services.

“Light touch” services

The families assessed at low risk of abuse and neglect still need support to maintain stability and safety. For them, Safe & Sound offers an array of services designed to increase protective factors, including parenting and education classes, parenting support groups, counseling, and respite child care. One of Safe & Sound’s legacy programs is the 24-hour TALK Line, which is staffed by supervised volunteers, many with backgrounds in social work. The TALK Line often is the gateway into Safe & and Sound’s other programs, and also is a source for referrals to services beyond Safe & Sound.

Safe & Sound also offers evidence-based parenting classes and workshops that aim to build parental capacities and educate parents on appropriate child development. One such intervention, the Triple P Program, teaches parents strategies that promote self-regulation in their children, while also helping them become better equipped to handle the stresses of everyday child-rearing. This class is offered weekly over 12 weeks and is free to any community member.

There also are a number of weekly support groups and parent cafés, where parents in an informal setting can build social connections with one another. The groups and workshops are held during weekdays, evenings, and weekends. In addition to the weekly family dinners, there are regular parent cafés, where parents can share ideas and hopes for their families and have lightly facilitated conversations about the five protective factors.

In addition, a Parenting Young Children support group provides a space for parents to share challenges in a supportive environment, as well as learn skills to become more effective parents.

Safe & Sound’s Therapeutic Children’s Playroom offers supervised play structured to improve children’s social-emotional learning. Parents can send their children to the playroom whenever they are using services on site, or on a drop-in basis or by appointment.

Safe & Sound also facilitates and provides child care for Alcoholics Anonymous and Narcotics Anonymous groups.

Addressing the day-to-day needs of parents is considered a priority. Safe & Sound recognizes that families must achieve some level of stability before they can work on healing from trauma and learn how to safely care for their children. With that in mind, Safe & Sound also offers concrete supports to families in the form of food, diapers, clothes, bus tokens, and other items needed for survival.

Integrated support

The Integrated Family Services (IFS) program is a more intensive level of services offered to families living in conditions that create the highest risk for child abuse and neglect. More than 60% of the families in IFS have three or more adverse childhood experiences. Families in IFS are assigned to a clinical care coordinator who assesses family functioning using a series of factors adapted from the North Carolina Family Assessment Scale and the Parents Assessment of Protective Factors. Families are assessed every three months to see how they have progressed.

Using findings from the various assessments in combination with the family’s self-identified needs, the clinical care coordinator then designs a service plan in partnership with the family. The first priority is to stabilize the family. Recognizing that many have complex needs and are often in the midst of a crisis, the clinical care coordinator works to stage interventions based on the most pressing needs. “It is almost impossible for parents to focus on parenting skills if they are homeless or on the verge of becoming homeless,” says Malcolm Gaines, senior clinical projects director at Safe & Sound. In these crisis situations, initial concrete supports are integral to success.

Once concrete needs are addressed, the clinical care coordinator works with the family to develop a tailored action plan. Some services, such as counseling and parent education classes, are provided within Safe & Sound, but the coordinator also helps parents connect to other resources within the community. “Care coordinators are tasked with not only referring families to services in the community, but also following up to make sure they actually are receiving them,” Gaines says. Once families’ protective factors improve, they “graduate” from IFS but often continue to receive less intensive services.

While each family is different, most spend between one year and 18 months in the IFS program, with about 50 to 60 families participating each year. About 90% of the families that participate in IFS for more than a year see improvements in their protective factors.

Better together

As Safe & Sound’s continuum of services has evolved, so too has the organization’s mission. Safe & Sound’s leadership began examining the issue of child abuse and neglect in San Francisco at a macro level, and ultimately recognized the need to broaden its efforts. About two years ago, the organization adopted a new vision to help eliminate child abuse and neglect in San Francisco within the next 50 years. As a result, Safe & Sound has taken on a leadership role within the service community, regularly bringing together a variety of stakeholders, such as other family resource centers, schools, public agencies, and community-based organizations, to craft a coordinated response, share resources, and track progress. “Child abuse and neglect is a complex problem,” says Katie Albright, Safe & Sound’s chief executive officer. “And it’s going to take a complex solution to end it — a solution that will happen if we all work together.”

One of the primary vehicles to eliminate abuse and neglect in the community is through the First 5 San Francisco Family Resource Center Initiative, which brings together three different government agencies in San Francisco (First 5; Department of Children, Youth & Their Families; and Human Services Agency) to fund 26 different family resource centers that provide strengths-based, trauma-informed prevention and support services. Each neighborhood center identifies its target population and customizes the services it offers based on the unique needs of its community. All centers funded by the initiative also offer a continuum of less intensive, prevention-focused services to more intensive, intervention services provided as a ready response to child welfare system referrals. These services, Differential Response Case Management and Supervised Visitation for Family Reunification, were intensively evaluated between 2009 and 2013 and found to be effective in improving indicators of emotional well-being and risk for abuse, as well as rates of family reunification and permanency.

The San Francisco Family Resource Center Initiative is committed to evaluating the overall effectiveness of the various service constellations and family support experiences offered within family resource centers. To this end, all 26 centers funded by the initiative have utilized a standard intake survey at the start of service participation and every three months thereafter. The survey examines protective factors and other family factors that have been shown to have a strong correlation with improved kindergarten readiness. To date, the survey indicates positive trends in parent attitude, perceptions, coping and social connections, as well as parent/child connections. As the sample sizes increase, future analysis will apply greater statistical rigor to pre/post comparisons and comparisons across participant subgroups.²

Safe & Sound serves as a model across the county, co-leading prevention alliances outside of San Francisco. At home, Safe & Sound advocates for an alliance of the 26 local family resource centers, helping them develop a common policy agenda. Safe & Sound also is the fiscal sponsor and lead trainer for the San Francisco Family Support Network, a coalition of more than 60 family-serving agencies in the Bay Area. In this way, Safe & Sound is helping build capacity for child maltreatment prevention across the entire county. “Collaborative partnerships are part of our DNA,” Albright says. “It is how we were founded and what we do every day.”

Since the family resource center initiative began in 2009, including with other interventions in child welfare and demographic changes, San Francisco has seen a reduction in the rate of children in foster care by 52% and the rate of substantiated child maltreatment has dropped by more than 60%.

Safe & Sound also raises awareness and advocates for laws, policies, protocols, and evidence-informed practices that advance the prevention of child abuse and neglect. Safe & Sound, in partnership with the University of California, Berkeley’s Hass School of Business, recently published “The Economics of Child Abuse: California & its Counties,” finding that the cumulative financial impact on the state for the 59,971 verified child abuse victims in 2020 was $23.9 billion — a sum that could send 2 million children to preschool. The study computed costs of child welfare, special education, incarceration, health care, and loss of productivity. The report also identifies risk factors that can be mitigated and protective factors that can be promoted throughout the state, advocating for the importance to come together to protect children, strengthen families, and build communities.

1 Information in this brief was obtained during a February 19, 2019, site visit to the Safe & Sound Family Resource Center that included interviews with Chief Executive Officer Katie Albright, Chief Development Officer Shannon White Cogen, and Senior Clinical Projects Director Malcolm Gaines.
2 O’Brien-Strain, M., Gunther, K., Rosenberger, A., and Theobald, N. (2012). San Francisco Family Resource Center Initiative Year 2 Evaluation 2010-11. San Francisco, CA: Mission Analytics Group.