Safe Babies, a program of ZERO TO THREE™

Infants and toddlers up to age 3 coming under court jurisdiction and their families; and professionals engaged in disciplines touching the lives of maltreated infants and toddlers

For children/adolescents ages: 0 - 3

For parents/caregivers of children ages: 0 - 3

Safe Babies, a program of ZERO TO THREE™ is a community engagement and systems change initiative focused on improving how the courts, child welfare agencies, and related child-serving organizations work together to improve and expedite services for young children who are under court supervision. Safe Babies is designed to:

• Protect babies from further harm and address the damage already done
• Expose the structural issues in the child welfare system that prevent families from succeeding

A Safe Babies team is convened by a judge with jurisdiction over foster care cases and by child welfare agency leaders, and includes other judges, child welfare staff, attorneys, service providers, and community leaders. Once convened, an agency in that area contracts with ZERO TO THREE to hire and supervise a dedicated community coordinator who staffs Safe Babies, oversees program implementation, and works collaboratively with the local leaders who make final decisions about what works in their community. Once the Safe Babies team is established, they work with individual families, learning important lessons that are applied to subsequent cases and to updating the policies, regulations, and laws governing child welfare practice, creating the basis for wider practice and systems change.

To facilitate the work of Safe Babies, ZERO TO THREE also provides the scientific context, a forum for system reform discussions, and increased national attention on infants and toddlers in foster care.

Jenifer Goldman Fraser, PhD, MPH

• Agency/Affiliation: ZERO TO THREE
• Website: https://www.zerotothree.org/our-work/safe-babies-court-team
• Email: jgoldmanfraser@zerotothree.org
• Phone: (202) 864-2952

The goals for the Safe Babies, a program of ZERO TO THREE™ are:

• Goal 1: Increase knowledge about the negative impact of abuse and neglect on very young children:
  • Objective #1: Provide training to judicial, legal, mental health, child welfare, and early childhood professionals on the social and emotional development of infants and toddlers, infant mental health, historical trauma, Fetal Alcohol Spectrum Disorders, the impact of substance use disorders on families, childhood sexual abuse and other issues of concern to the Court Teams.
  • Objective #2: Incorporate leaders of Safe Babies into the national learning community hosted by ZERO TO THREE.
• Goal 2: Change local systems to improve outcomes and prevent future court involvement in the lives of very young children:
  • Objective #1: Engage multi-disciplinary partners in the activities of each Court Team.
  • Objective #2: Improve/expedite services for children and families, using the active efforts standard applied to cases governed by the Indian Child Welfare Act:
    • All children monitored by Safe Babies are screened for developmental delays and receive appropriate services as needed.
    • No child in foster care experiences more than two changes in placement.
    • All children in foster care participate in two or more weekly supervised visits with their parents and one or more visits with siblings unless parent-child contact exacerbates the trauma that led to the child’s removal.
    • Within the first 60 days after the child’s removal from their parents, each case plan includes a concurrent plan for achieving permanency for the child with committed relatives or foster parents willing to assume a permanent role in the child’s life if the birth parents are unable to overcome the problems that led to the child’s removal.
    • The child and parents participate in a mental health assessment documenting strengths and weaknesses in their interactions and attachment to each other.
    • Permanency is achieved within 18 months of a child’s placement in foster care. Cases that require more than 12 months for the child to reach permanency will be reviewed for factors causing the extended period of foster care.

The essential components of Safe Babies, a program of ZERO TO THREE™ include:

• Judicial Leadership:
  • Before Safe Babies is introduced, there is a judge and/or a child welfare agency leader who is tired of seeing the children become the parents and then the grandparents of babies in foster care, who is passionate about doing right by babies, and who recognizes the importance of the child’s first three years.
  • They recognize the value in reforming the child welfare system’s response to the youngest children as an initial step in avoiding the next generation of child maltreatment.
  • Once the Safe Babies program is started, from the bench, the judge(s) set the tone of dignity and respect.
    • Their demeanor reflects an understanding of how traumatic experiences contribute to the parents’ behavior in hearings and interactions with social services.
    • Each judge sets an expectation that hearings are conducted in a caring and thoughtful manner, leading the effort to reduce the adversarial nature of court proceedings.
    • The judge keeps everyone focused on achieving timely permanency and resolving the issues that brought families into the system.
      • This approach reduces the stress level of both families and professionals in the court.
      • Off the bench, the judge also knows that their best efforts are insufficient if they aren’t combined with the work of the whole community.
      • The local judge in Safe Babies communities is the catalyst for change because of their unique position of authority in the processing of child welfare cases.
• Local Community Coordinator:
  • In each Safe Babies community, a local community coordinator with child development expertise works with the judge to lead the Safe Babies team.
  • The community coordinator, with technical assistance provided by ZERO TO THREE, coordinates services and resources for infants and toddlers and their families within the local community.
  • In addition, the community coordinator is responsible for staffing the stakeholder team, recruiting new members to the stakeholder team, entering data about the families served into the Safe Babies database, and representing the team in various community efforts as well as the national Safe Babies learning community.
    • The community coordinator should be employed full-time and due to the multiple responsibilities of the position that include developing the community team and resources, the team should adhere to a caseload limit of no more than 20 open cases at any one time.
    • Saturating the work with more than 20 families per coordinator dilutes the quality of work done with each family.
• Safe Babies Stakeholders Focused on the Big Picture:
  • The Safe Babies team is made up of key community stakeholders who commit to restructuring the way the community responds to the needs of maltreated infants and toddlers.
  • The Safe Babies team meets monthly to learn about the services available in the community, review data, identify gaps in services, and discuss issues and patterns raised by the cases that members of the team are monitoring.
  • Participation in the Safe Babies team is by open invitation.
• Targeting Infants and Toddlers in Out-of-Home Care/ Under the Court’s Jurisdiction:
  • Comprehensive services are offered to each child including:
    • Screening for developmental delays and disabilities
    • Medical care delivered in a medical home
    • Mental health services that focus on the parent-child relationship
• Valuing Birth Parents:
  • Because the first permanency goal is to help parents and children reunify, the Safe Babies team must respond to the needs of the birth parents and the wide variety of traumatic stressors present in the parents’ lives.
  • The families served by the team face an overwhelming number of risk factors in comparison to the general population.
  • Almost all of the parents of young children who enter the child welfare system have suffered their own history of trauma.
    • There are many forms of prejudice that families in the child welfare system confront because they are poor; unmarried; lesbian, gay, bisexual, or transgender; adhere to non-Christian religious beliefs, or lack education.
    • People of color bear the brunt of this oppression.
  • Members of each team must treat all parents with kindness, giving parents the dignity and respect they have so rarely experienced, to develop an emotional connection with families that permit them to build genuine relationships of concern and support.
• Placement and Concurrent Planning:
  • From the baby’s point of view, it would be ideal if the person who agrees to take physical custody of the child when they are removed from their parents’ care would also agree to become the child’s permanent parent if the birth parents are unable to overcome the challenges that led to the need for a foster care placement.
    • Very young children make sense of their world within the context of their relationships with a few cherished caregivers.
    • All too often the transition into foster care carries with it a number of transfers between foster homes.
  • Concurrent planning places equal emphasis on supporting a second permanent family in the event that reunification is ruled out.
    • It needs to begin at removal.
    • To be successful, the team must support a mindset about fostering that:
      • Values birth parents
      • Understands the importance of placement stability, and the complicated dynamics that can come into play between birth and foster parents.
    • Regardless of the final permanency outcome for the child — reunification, guardianship, or adoption — a relationship would ideally continue between the birth and foster parents after the child welfare case closes so that the child’s family expands to include all the people who love them.
• The Foster Parent Intervention, Mentors, and Extended Family:
  • Referred to by some experts as the primary intervention for children in foster care, foster parents play a pivotal role in determining how safe and nurtured young foster children feel. Their role is multifaceted:
    • To provide loving care for children placed with them
    • To advocate for the children in their homes
    • To nurture healthy relationships between the children in their care and birth parents, siblings, and extended family
• Balancing these roles requires training and support from the child welfare agency prior to and — just as importantly — while foster parents are engaged with a child and their family. They should be regarded as respected members of the SBCT who participate in family team meetings, court hearings, and community training.
  • Pre-Removal Conferences and Monthly Family Team Meetings:
    • Every day that babies spend in foster care limbo is a day the Safe Babies team should be trying to resolve the issues that led to the child’s removal from home.
    • With Pre-Removal Conferences (PRC) the Safe Babies teamcan begin their work before the child is removed from the home.
      • Structured in much the same way family team meetings (FTM) are organized, the parents are invited and asked to bring with them anyone they consider to be members of their support network.
      • The meeting is facilitated by a trained mediator, either someone engaged by the child welfare agency or the community coordinator.
      • It is at the PRC that a substitute caregiver is identified from within the parents’ extended family and friends (if possible) and that the parent learns when they will be able to see their child(ren).
      • The PRC sets the tone for the FTMs that occur monthly.
      • Parents and their chosen circle of support are key participants in these meetings.
  • Parent-Child Contact (Visitation):
    • A Safe Babies team sees parent-child contact as a critical way to help the child and parents experience one another as loving partners in their relationship.
      • Each family has their own strengths and challenges when it comes to spending time together, and plans for supporting their relationship must be formed on an individualized basis.
      • Very young children become attached to their parents whether the parents are able to provide consistent loving care or not.
      • While the quality of that attachment may be insecure or even disorganized, separating a young child from their parents is still painful.
      • The goal of parent-child contact is to permit the child and parent to keep the other a living presence in their lives and to improve the parent’s responsiveness to the child’s needs.
      • The number of visits per week is not limited since this increased contact may lead to faster permanency for the child.
  • Continuum of Mental Health Services:
    • Infants and toddlers who have experienced trauma may benefit from mental health services that work with them and their parents and/or foster parents to learn to trust again and form secure attachments and relationships with their birth parents and/or foster parents.
    • Parents who maltreat their very young children need some level of intervention to help them understand their children’s needs and learn ways to build strong supportive bonds.
    • The intensity of the intervention should mirror the specific characteristics of the parent and child, the level of pre-existing trauma in their relationship, and the level of trauma in the parent’s own childhood experiences.
    • In order of intensity, recommended interventions include:
      • An assessment of the parent-child relationship:
        • Relationship assessments include two primary procedures:
          • A structured interactional play assessment that reveals how the caregiver behaves with the child
          • An interview with the adult to understand the adult’s “working model of the child.”
        • This allows the clinical evaluator to assess the adult’s ability to provide appropriate care to the child.
    • Teachable moments:
      • Taking advantage of in-the-moment opportunities to help parents successfully respond to their child’s behavior.
    • Visit coaching:
      • Visit coaches can come from a range of professions including child welfare case workers, in-home service providers, and CASA volunteers.
      • Safe Babies coaches receive training about child development and supervision regarding each specific family they support.
      • They work closely with the parents to make each visit a good experience.
  • Psychoeducational parenting intervention:
    • In individual sessions with parents and their young child, a trained professional shares information on child development and how best to meet the child’s needs while assisting the parents in utilizing newly acquired information and skills.
  • Child-Parent Psychotherapy (CPP):
    • In CPP, the clinician seeks to heal the relationship between the child and the parent by helping the parent develop a realistic assessment of the child’s needs and abilities.
    • Sitting with the parent and child, the therapist is able to draw out the parent’s early experiences that may be affecting their interactions with their young child.
  • Training and Technical Assistance:
    • ZERO TO THREE staff and consultants provide training and technical assistance to the Safe Babies community on topics such as:
      • Infant and toddler development
      • Parenting interventions
      • Services available to foster children in the community
      • Children and trauma
      • Pparental substance abuse
      • Racism
      • Domestic violence
      • Mental illness
      • Poverty.
    • Through weekly team meetings and individual supervisory calls, Safe Babies project leadership staff provides support and direction to each of the community coordinators.
    • By participating in ZERO TO THREE’s annual Scientific Meeting and annual conference and in the Safe Babies annual Cross Sites meeting, the community coordinators, judges, and key members of the Safe Babies team are integrated into the larger framework of ZERO TO THREE’s efforts on behalf of infants and toddlers.
  • Understanding the Impact of the SBCT‘s Work:
    • Each Safe Babies team evaluates its work.
    • The approach is focused on bringing key participants into continuous quality improvement (CQI) and evaluation planning.
    • CQI is a process for identifying areas of strength to build on in future work and challenges to address through deliberate action.

Child/Adolescent Services

Safe Babies, a program of ZERO TO THREE™ directly provides services to children and addresses the following:

• The parent-child relationship, mental health problems caused by maltreatment and the experience of removal from their parents' care and placement with other adults, developmental delays and disabilities, racial equity and historical trauma, Fetal Alcohol Spectrum Disorders, and the intersection with Neonatal Abstinence Syndrome.

Parent/Caregiver Services

Safe Babies, a program of ZERO TO THREE™ directly provides services to parents/caregivers and addresses the following:

• The parent-child relationship, mental health problems that impinge on their abilities to safely parent their children, substance abuse, complex trauma, racial equity and historical trauma, Fetal Alcohol Spectrum Disorders, and basic needs: food, shelter, employment, and medical care.

Recommended Intensity

For family team meetings/court hearings, these occur monthly and length of time varies as needed. For parent/child contact, this should occur at least twice a week for a minimum of 1 hour, but preferably much more often. For sibling contact, this should occur at least once a week for a minimum of 1 hour.

Recommended Duration

Until permanency is achieved in accordance with federal standards established through the Adoption and Safe Families Act of 1997 and the Child and Family Services Reviews conducted by the U.S. Children’s Bureau. Permanency and case closure is estimated to be reached within 12 months after a child is removed from their parents’ care for reunification or relative custodian to be obtained, or 18 months for adoption or non-relative guardian to be obtained.

Delivery Settings

This program is typically conducted in a(n):

• Adoptive Home
• Birth Family Home
• Community-based Agency / Organization / Provider
• Foster / Kinship Care
• Group or Residential Care
• Hospital
• Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

This program does include a homework component.

Every participant in the monthly family team meetings (FTM) has assignments to complete before the next FTM. For example, the parent might be required to record themself reading a book aloud to their child and give the recording to the foster parent. The foster parent would then be assigned the responsibility of holding the child and turning the pages while the parent’s voice reads the book. The caseworker might be required to arrange three visits for themself and the parent to the potential child care providers. One of the attorneys might be assigned the responsibility for filing a motion to permit an extended holiday weekend visit. The ZERO TO THREE Community Coordinator might be assigned to make contact with the Child-Parent Psychotherapy Intake Coordinator.

Languages

Safe Babies, a program of ZERO TO THREE™ has materials available in the following languages other than English:

• Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

• A local agency that hosts a full-time Community Coordinator whose position is funded by a local source of funding that equips them with a laptop computer and support by an information technology provider
• Space for family team meetings
• Funding for training consultants, conference participation, and ZERO TO THREE technical assistance

Prerequisite/Minimum Provider Qualifications

Safe Babies is a program that functions at both the direct service (provider) and community/systems level, involving key roles across different sectors: the judge, child welfare agency staff (e.g., administrative, supervisory, and frontline), attorneys (e.g., child, parent, agency), and a unique role called the Community Coordinator that supports both the family and system change in the community. Site implementation teams develop specific job descriptions for the Community Coordinator role based on a sample job description that is provided by ZERO TO THREE (i.e., the education and skills/experience below are taken from the sample job description).

Education:

• Minimum undergraduate degree in child development, social work, or related field
• Master’s degree preferred

Skills & Experience:

• Knowledge of local community resources including early care and education, health, mental health, child welfare, early intervention, and behavioral health
• Ability to work collaboratively with multidisciplinary group
• Knowledge of issues related to child abuse and neglect
• Knowledge of juvenile and family court functioning
• Knowledge of intellectual disabilities and their impact on family functioning
• Background in infant/early childhood development or related field
• Facilitate working with people of diverse educational, professional, and socioeconomic backgrounds
• Experience with systems change and community collaboration
• Ability to work effectively across agencies and disciplines
• Minimum 5 years of relevant work experience

Preferred:

• Knowledge of infant/toddler social-emotional development and impact of abuse and neglect
• Experience working with juvenile and family court judges

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

ZERO TO THREE provides a comprehensive repository of written and audiovisual resources to support professionals implementing Safe Babies practices and activities at both the direct service and community/systems level. Accordingly, ZERO TO THREE offers a comprehensive repository of written and audiovisual implementation support resources for the different professional roles involved in implementing the approach. Key implementation support resources include:

• The Safe Babies Overview
• Definitional Tools that describe the essential functions for key roles
• A Case Mapping Tool
• An Implementation Progress Toolkit
• A Family Team Meeting Toolkit

All implementation support materials are available through an online learning management system managed by ZERO TO THREE.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

Training Type/Location:

ZERO TO THREE serves as a national resource center providing Training and Technical Assistance (TTA) to local communities and/or to state-level implementation support teams (see Safe Babies States and Sites | ZERO TO THREE).

TTA is provided in the form of site visits to local communities, virtual engagements, and regional and national in-person learning opportunities. The TTA is provided via different formats (e.g., universal webinars, constituency-focused Communities of Practice, and targeted/individualized support) and emphasizes role-specific support (e.g., for Community Coordinators, judicial officers, attorneys, child welfare professionals) as well as peer-to-peer sharing of strategies, solutions, and innovations. ZERO TO THREE hosts an annual national “Cross Sites Meeting” that provides an important learning platform for sites and state teams to share implementation strategies and early childhood systems change efforts and innovations to advance prevention and promotion for babies, toddlers, and their families involved with the child welfare system or at risk of involvement.

Number of days/hours:

Number of days/hours:

Training is flexible and responsive to the needs of real-world professionals working in the varied landscape of child welfare systems across the U.S. and other countries. The unique role of the Community Coordinator requires the most intensive training, including participation in a virtual synchronous Community Coordinator Academy and monthly Community of Practice calls. The Community Coordinator Academy (CCA) consists of:

• 16 hours of training over an 8-week period
• 1-hour introductory call (optional)
• 1 hour (required) and up to 4 reflective practice sessions
• Bi-weekly support calls

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Safe Babies, a program of ZERO TO THREE™ as listed below.

ZERO TO THREE utilizes a two-step process for assessing a community’s readiness for program implementation. In the first pre-implementation step, a Fit and Feasibility Assessment Tool is used during early discussions with community partners exploring the approach. During this initial step, a particular focus is on establishing the commitment of a judge and child welfare agency leader to support implementation of the approach and that funding is secured for the Community Coordinator role.

In the second pre-implementation step, ZERO TO THREE utilizes an Exploration Inventory Assessment Tool to identify site and community strengths and needs as pertains to Safe Babies implementation. Specifically, the inventory highlights areas of alignment with recommended practices and core components of the approach along with potential barriers to implementation and strategies to address them. With this information, ZERO TO THREE, together with the site implementation team (and state team, if applicable), creates a tailored TTA plan to build capacity in the Installation phase that will move the site into Initial Implementation.

Formal Support for Implementation

There is formal support available for implementation of Safe Babies, a program of ZERO TO THREE™ as listed below:

ZERO TO THREE serves as a national resource center providing formal implementation support to local communities and/or to state-level teams who are supporting implementation of and coordinating sites in their state (for example, see Washington State Early Childhood Courts – Structure and Roles). Formal implementation support provided by ZERO TO THREE is optional; however, most communities and/or states seek out and rely on ZERO TO THREE for TTA. This support begins with building relationships, assessing readiness, and engaging partners; is followed by multidisciplinary training and onboarding of Community Coordinators (a full-time role-specific position); followed by co-development, in partnership with a local site implementation team (and state team, if applicable), of an implementation plan tailored to the community’s needs. Throughout all stages of implementation, ZERO TO THREE’s implementation support ensures flexibility and responsiveness to the local community’s needs and capacity and is informed by implementation science.

Support is offered through site visits, virtual engagements, email communications, and in-person learning opportunities. The TTA is (1) designed for different audiences and takes different formats (e.g., universal webinars, constituency-focused Communities of Practice, targeted consultation), and (2) emphasizes role-specific support (e.g., for Community Coordinators, judicial officers, attorneys, child welfare professionals) as well as peer-to-peer sharing. Topics cover a wide range of practice areas including the unique developmental needs of infants and toddlers, strengths-based family engagement, trauma-responsive care, and collaborative teaming. TTA also focuses on early childhood systems change to increase the coordination and integration of care for very young children and their families who are involved with the child welfare system or at risk of involvement. Additionally, ZERO TO THREE provides TTA to support data collection and use for continuous quality improvement, program evaluation, program sustainability, and policy strategies for systems improvement. In its role as a national resource center, ZERO TO THREE provides a platform to reach all sites and states implementing Safe Babies.

Support is offered through site visits, virtual engagements, email communications, and in-person learning opportunities. The TTA:

• Is designed for different audiences and takes different formats (e.g., universal webinars, constituency-focused Communities of Practice, targeted consultation), and
• Emphasizes role-specific support (e.g., for Community Coordinators, judicial officers, attorneys, child welfare professionals) as well as peer-to-peer sharing. Topics cover a wide range of practice areas including the unique developmental needs of infants and toddlers, strengths-based family engagement, trauma-responsive care, and collaborative teaming. TTA also focuses on early childhood systems change to increase the coordination and integration of care for very young children and their families who are involved with the child welfare system or at risk of involvement. Additionally, ZERO TO THREE provides TTA to support data collection and use for continuous quality improvement, program evaluation, program sustainability, and policy strategies for systems improvement. In its role as a national resource center, ZERO TO THREE provides a platform to reach all sites and states implementing Safe Babies, or related approaches, with implementation support resources that it produces and other relevant resources to inform enhanced practice for infants, toddlers, and their families involved with the child welfare system.

For information, please contact Maria Gehl, Senior Practice and Field Operations Director at mgehl@zerotothree.org.

Fidelity Measures

There are fidelity measures for Safe Babies, a program of ZERO TO THREE™ as listed below:

ZERO TO THREE approaches implementation support using improvement methodology rather than fidelity measurement. This is because Safe Babies is not a circumscribed intervention with discrete practices but, rather, promotes a range of enhanced practices and system change strategies. In this way, Safe Babies is designed to be applicable across the highly variable and dynamic child welfare system landscapes in the U.S. and other countries, which comprise multiple sectors and subsystems (including child protective services, judicial, legal, clinical) and involves an array of multidisciplinary professionals functioning in different organizational structures and cultures. Accordingly, ZERO TO THREE’s implementation support focuses on continuous quality improvement, offering local site implementation teams self-report tools structured to guide individual- or team-based reflection on successes and areas for improvement and growth as pertains to implementation and sustainment of the practices and activities in the approach (referred to as an Implementation Progress Toolkit). A key aspect of implementation support focuses on building data and continuous quality improvement capacity for identifying meaningful metrics, collecting data, and monitoring implementation progress (in fact, CQI is a core component of the approach). While sites (or states, if applicable) may decide to employ these metrics for the purpose of fidelity measurement, and ZERO TO THREE is available to provide support for that purpose, the development and use of a fidelity assessment is not required. All sites implementing Safe Babies are offered free access to a secure, web-based database for case tracking to support implementation monitoring and improvement. The database is protected by an SSI certificate that encrypts all data transmitted from the user’s web browser to the server and is maintained on a secure server managed by ZERO TO THREE.

Implementation Guides or Manuals

There are implementation guides or manuals for Safe Babies, a program of ZERO TO THREE™ as listed below:

Aside from the audiovisual materials and online trainings for Safe Babies, there is a repository of implementation support materials including the following key foundational resources:

• Safe Babies Overview
• Core Components Overview
• Implementation Roadmaps for States and Sites
• Definitional Tools for Key Roles and Teams
• Case Mapping Tool
• Implementation Progress Toolkit
• Family Team Meeting Toolkit

ZERO TO THREE’s implementation support materials are available on ZERO TO THREE’s learning management system: https://elearn.zerotothree.org/itcp

Implementation Cost

There have been studies of the costs of implementing Safe Babies, a program of ZERO TO THREE™ which are listed below:

In 2025, a benefit-cost study was conducted by researchers at the Center for State Child Welfare Data at Chapin Hall. Using an ingredients survey and a prospective approach, the study examines whether foster care plus Safe Babies is a cost advantageous alternative to foster care alone:

• ZERO TO THREE. (2025). Summary of new benefit-cost study of the Safe Babies Approach. https://www.zerotothree.org/wp-content/uploads/2025/03/ZTT-Safe-Babies-Summary-of-Cost-Benefits-Analysis-Final-3-25_508.pdf
• Wulczyn, F., Huhr, S., Van Drunen, M., & McCrae, J. (2025). Safe Babies Court Team: A benefit-cost analysis. Center for State Child Welfare Data. https://fcda.chapinhall.org/publication/safe-babies-court-team-a-benefit-cost-analysis/

In 2012, a cost study was conducted by researchers at the University of North Carolina-Chapel Hill estimating the full costs of the originating ‘Court Teams initiative’ and subsequent taxpayer reduced costs (savings) in the first year of implementation:

• Foster, E. M., McCombs-Thornton, K. (2012). Key findings from investing in our most vulnerable: A cost analysis of the ZERO TO THREE Safe Babies Court Teams Project. https://www.zerotothree.org/wp-content/uploads/2019/12/Investing-in-Our-Most-Vulnerable_-A-Cost-Analysis-of-the-ZERO-TO-THREE-Safe-Babies-Court-Teams-Project-2012..pdf

Research on How to Implement the Program

Research has been conducted on how to implement Safe Babies, a program of ZERO TO THREE™ as listed below:

• Casanueva, C., Harris, S., Adeeb, J., & Kluckman, M. (2023, August). Final evaluation report of the Infant-Toddler Court Program. https://www.zerotothree.org/wp-content/uploads/2024/01/Final-ITCP-Evaluation-Report_8.2023.pdf
• Casanueva, C., Harris, S., Carr, C., Burfeind, C., & Smith, K. (2017, September 30). Final evaluation report of the quality improvement center for research-based Infant-Toddler Court Teams. https://www.zerotothree.org/wp-content/uploads/2019/12/Final-Evaluation-QICCT.pdf

Child Welfare Outcome: Permanency

“What is included in the Relevant Published, Peer-Reviewed Research section?”

• McCombs-Thornton, K. L., & Foster, E. M. (2012). The effect of the ZERO TO THREE Court Teams initiative on types of exits from the foster care system — A competing risks analysis. Children and Youth Services Review, 34(1), 169–178. https://doi.org/10.1016/j.childyouth.2011.09.013

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Sample:

  Age — Not specified

  Participants: 809

  Race/Ethnicity — Not specified

  Gender — Not specified

  Status — Participants were children with an out-of-home placement (supervised by child welfare services) before age three.

  Location/Institution: Not specified

  Summary:

  The purpose of the study was to use compared data from children receiving ZERO TO THREE Court Team (ZTT Court Teams) [now called Safe Babies, a program of ZERO to THREE] services to child welfare services as usual, using data from the National Survey of Child and Adolescent Well-Being (NSCAW I) to consider how the ZTT Court Teams children exit the child welfare system. Participants were in ZTT Court Teams from the four initial sites compared to a group of cases from the NSCAW I study. Propensity score weights were combined with a competing risks analysis to isolate program effect on types of foster care exits. Measures utilized include the National Survey of Child and Adolescent Well-Being (NSCAW I), data from child protective services, child welfare documents, and court records. Results indicate that ZTT Court Team cases experience a different pattern of exits from the foster care system. Reunification is the most common type of exit for ZTT Court Team cases (38%) while adoption is the most prevalent for the NSCAW group (41%). Results also suggest that ZTT Court Team children exit the foster care system faster regardless of the type of exit, and that ZTT Court Team children are significantly more likely to exit foster care for reunification, relative custodianship, and non-relative legal guardianship rather than stay in foster care. Limitations include the lack of randomization of subjects to services as usual or ZTT Court Team services, a lack of information on re-reports and re-entry in the ZTT Court Teams sample, lack of control for geographic differences between the two studies, and the multiyear time difference between the studies (the ZTT Court Team children entered between 2004 and 2009, while NSCAW I children entered between 1999 and 2000).

  Length of controlled postintervention follow-up: None.

• Casanueva, C., Williams, J., Kluckman, M., Harris, S., & Fraser, J. G. (2024). The effect of the ZERO TO THREE Infant-Toddler Court Teams on type and time of exits from out-of-home care: A new study ten years after the first competing risks analysis. Children and Youth Services Review, 156, Article 107327. https://doi.org/10.1016/j.childyouth.2023.107327

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Sample:

  Age — ITCT Mean=11.1 months; NSCAW Mean=11.8 months

  Participants: 183

  Race/Ethnicity — ITCT Group: 53% White, 31% Black, and 10% Hispanic; NSCAW Group: 48% White, 32% Black, and 12% Hispanic

  Gender — ITCT Group: 52% Male; NSCAW Group: 55% Male

  Status — Participants were children with an out-of-home placement (supervised by child welfare services) before age three.

  Location/Institution: Not specified

  Summary:

  The purpose of the study was to examine differences in type and time to permanency between Infant-Toddler Court Teams (ITCT) [now called Safe Babies, a program of ZERO to THREE] children in out-of-home care and a comparison group created using propensity score matching from a sample of children in the National Survey of Child and Adolescent Well-Being (NSCAW II). Participants in the ITCT group were matched and compared to children in the NSCAW II group. Measures utilized include the National Survey of Child and Adolescent Well-Being (NSCAW II), data from child protective services, child welfare documents, and court records. Results indicate that reunification was the most common type of permanency for ITCT children and was significantly higher among ITCT children compared to the NSCAW II sample. In addition, ITCT children were significantly less likely to remain in foster care by the end of the study period. ITCT children also had a shorter mean time to permanency at 450.6 days compared to 654.9 days for those in the NSCAW II group. In both unadjusted and adjusted survival models, the main effect of ITCT was significant, with children in the ITCT group being 1.6 times as likely to exit foster care to permanency compared to NSCAW II group. Limitations include potential non-identified confounders such as state-level child welfare policies, the extent of time available to study each group, and non-randomization.

  Length of controlled postintervention follow-up: Not specified.

• Casanueva, C., Harris, S., Carr, C., Burfeind, C., & Smith, K. (2017). The final evaluation report of the Quality Improvement Center for Research-Based Infant-toddler Court Teams. Available here.

• Hudson, L., Beilke, S., Norris, J., Parker, K., & Williams, R. (2017). Safe Babies Court Teams: Collaborative journeys of healing and hope. Zero To Three Journal, 38(2), 12-19.

• Ryznar, T. (2018). Understanding interdisciplinary collaboration within ZERO TO THREE Safe Babies Court Teams (Doctoral dissertation). Retrieved from https://digitalcommons.wayne.edu/oa_dissertations/1957/