The difficult, and sometimes dangerous, job of caregiving in residential facilities for troubled youth becomes notably more fulfilling when agencies de-emphasize behavior control in favor of creating opportunities for children's success.
And for the children, most of whom are placed in residential care facilities by social service authorities or courts, there are fewer incidents of aggression toward adult staff and other youth, less property destruction and less frequent running away.
These findings come from a recent three-year study on a Cornell-developed program model called CARE: Children and Residential Experiences, a long-term initiative of the Residential Child Care Project (RCCP) in the Bronfenbrenner Center for Translational Research at the College of Human Ecology.
After RCCP staff from Cornell helped caregivers and administrators at 11 residential child care facilities implement CARE principles -- for a "kinder, more supportive environment," as one staffer recounted -- there was less violence during a three-year field study of the intervention protocol. Results are reported online in Prevention Science as "Intervening at the Setting Level to Prevent Behavioral Incidents in Residential Child Care: The Efficacy of the CARE Program Model."
The CARE program at the Waterford Country School in Connecticut reduced the need for physical restraint of unruly children, according to a subsequent report to be published in Child Welfare as "Benefits of Embedding Research into Practice: An Agency-University Collaboration."
Established in 1982 under a grant from the U.S. Department of Health and Human Services, RCCP develops and promotes model techniques and systems to prevent institutional child abuse and neglect, and improve the quality of care for children in out-of-home settings. This includes encouraging child care agencies to create safe environments with treatment programs that are trauma-sensitive and developmentally appropriate for the children and families they serve.
The CARE principles are embraced by many staff at residential child care organizations, according to Charles Izzo, BCTR research associate and lead author of the Prevention Science report.
Izzo said too many staff have "little training in child development, behavior management or dealing with complex trauma. They struggle to help residents manage emotions, and without adequate guidance and support they're more likely to respond to distressed youth in ways that trigger dangerous behavioral incidents -- like aggression and self-harm."
By using an "ecological approach," Izzo said, CARE program advocates mean to help agencies transition from simply maintaining compliance to creating a living environment that offers youth developmentally enriching experiences and a "sense of normality."
Approximately 50,000 youth reside in facilities in the U.S. like the ones where the CARE model was tested. But at the Waterford Country School, which focused on reducing the need to physically restrain disruptive children, results were not instantaneous. Due in part to increasing enrollments and an older child population, physical restraint incidents actually increased during the first full year of the CARE implementation there. Then the professional staff began to notice changes.
As one staff member noted in the forthcoming Child Welfare report, "The agency developed a kinder, more supportive environment where the success of the children was the primary agenda. Rather than 'villainizing' a child's behavior, staff saw behavior as pain- or trauma-based. Staff began to report changes in their perception of the environment (at the school), away from behavioral control strategies and toward creating opportunities for success."
Significant improvements continued over the subsequent two years. But one personal transformation required less than 30 minutes, as recounted by one staff member who watched a student exit class through an unlocked door:
"A student left the school without permission at 12:15 p.m. and went to the cottage area. I went and found him in his room, playing the piano. PLAYING THE PIANO! Before I knew it, both he and I were banging out songs on the piano. We are both fans of each other now and as I left to return to the school, the student asked: 'Can I come back to school now?' By 12:45 the student was back in class."
According to Martha Holden, senior extension associate at the Bronfenbrenner Center, the piano anecdote epitomizes a central CARE goal: increase opportunities for healthy social interaction.
"By intervening 'upstream' at the setting level, we can prevent coercive caregiving patterns," Holden said. "The teachers need not be punitive jailers and misbehaving kids aren't necessarily villains. They can become supportive 'fans' of each other, create a new normal for children and the institution and make some good music along the way."
Besides Izzo and Holden, other Cornell authors of the Prevention Science paper are BCTR staff Elliott Smith, Catherine Norton, Michael Nunno and Deborah Sellers. Smith and Nunno are joined in the Connecticut agency report by William Martin and Sharon Butcher of the Waterford Country School. The research was supported in part by the RCCP, which receives funding from the Duke Foundation, and by the Waterford Country School.
On June 21-24 in Lake George, N.Y., the RCCP will host its fourth international conference, Building a Community of Practice, which will focus on helping professionals who work with vulnerable children and families to improve caregiving methods.
The CARE intervention protocol is based on six core principles. Programming in residential settings needs to be:
1. relationship-based, to help youth form healthy models of adult-child relationships and build their capacity for healthier relationships in the future;
2. trauma-informed, with sensitivity to the child's trauma history;
3. developmentally-focused, providing more opportunity for normative developmental experiences and adapting expectations to meet the unique needs of youth;
4. family-involved, seeking to understand and adapt to families' cultural norms whenever possible;
5. competence-centered, creating opportunities for building the child's self-efficacy and competence for dealing with life circumstances; and
6. ecologically-oriented, enriching the physical and social environment to create a therapeutic setting.
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