Program Goals

The goals of the CARE: Creating Conditions for Change model are:

For staff:

• Learn how to create a therapeutic environment that is more conducive for children and adolescents who have experienced trauma and their families
• Reduce the risk of retraumatizing the children/adolescents
• Improve relationship quality with children/adolescents
• Increase the use of trauma-informed practices
• Reduce the use of physical restraints and other restrictive practices
• Learn how to collect, analyze, and use data in decision-making
• Reduce likelihood to leave and find employment elsewhere

For children/adolescents:

• Improve relationship quality with staff
• Improve social and emotional functioning
• Decrease likelihood of high-risk behavioral incidents such as aggression, property destruction, and running away
• Improve academic achievement and overall functioning in school or vocational settings
• Increase likelihood of contact with their families while in care

Logic Model

View the Logic Model for CARE: Creating Conditions for Change (CARE).

Essential Components

The essential components of the Children and Residential Experiences (CARE) model include:

• A practice model based on 6 core principles
• Relationship-based: Form healthy models of adult-child relationships and build capacity for future relationships
• Trauma-informed: Use professional practice that is sensitive to the children's trauma history
• Developmentally focused: Provide normative developmental experiences and adapt expectations to meet individual needs
• Competence-centered: Foster self-efficacy and competence for dealing with life circumstances
• Family-involved: Understand and adapt to families' cultural norms and promote active family involvement
• Ecologically oriented: Enrich the physical and social environment to create a therapeutic milieu
• Committed leadership and an implementation team that guide and facilitate agency-wide training and technical assistance to help personnel at all levels of the facility learn to use the 6 principles to enhance interactions with children and staff by focusing on strengthening attachments, building competencies, adjusting expectations to account for children's developmental stage and trauma history, involving families in the child's care and treatment, and enriching dimensions of the environment to create a more therapeutic milieu.
• On-going agency-wide incorporation of the 6 principles in leadership, policies and procedures, training and professional development of staff, supervision, and all interactions with children and families.
• Consistent application of the 6 principles within and across all levels of the agency, including administration, supervision, clinical care, education, and direct care.

Program Delivery

Recommended Intensity:

This is a comprehensive agency-wide program model. The program's core principles are incorporated into the culture of the organization and guide its interventions and treatment philosophy on an ongoing basis.

Recommended Duration:

Implementation of the program typically requires 4 years. Once implemented, the program continues indefinitely as a framework that guides the treatment philosophy of the organization as it provides out-of-home care and treatment to its clients.

Delivery Settings

This program is typically conducted in a(n):

• Foster / Kinship Care
• Group or Residential Care
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

• Commitment of agency leadership to at least a 4-year implementation process
• Funding for 4 years of implementation assistance through training and technical assistance
• Time and resources to provide training for all staff
• Time and resources for regular implementation meetings for key staff
• Staff available to commit the time and effort to lead local implementation and serve as trainers for agency personnel
• No specific concrete resources are viewed as essential, as the program is adaptable to the real-world setting in which it is implemented.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

There are no educational requirements to become a CARE educator. Anyone interested in becoming one must attend a training of educators' course offered at the organization and pass the written test to be certified.

Manual Information

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

Program Manual(s)

Manual Details:

Certified CARE Educators use the CARE Activity Guide to train staff in their organization in CARE. The CARE Activity Guide is available after organizations establish a contractual agreement with Cornell University and complete the 5-day Training of Educators Workshop.

Training Information

There is training available for this program.

Training Contact:

• Martha J. Holden, Director of the Residential Child Care Project
  Cornell University
  dept.: Bronfenbrenner Center for Translational Research
  mjh19@cornell.edu
  phone: (607) 254-5337

Training Type/Location:

Onsite training is provided as part of an implementation agreement and contract with Cornell University. During the implementation period, Cornell consultants collaborate with agency leadership to assist the agency in fully implementing the CARE model. Consultation includes leadership retreats during which agency leaders are trained in the CARE model and principles. In addition, Cornell consultants conduct a 5-day training-of-educators event during which CARE Educators are prepared to train other agency staff in the CARE model.

Number of days/hours:

Leadership and Implementation Team members are trained in the CARE principles and develop an agency-specific implementation plan through a 3- to 4-day  manualized program. CARE educators are trained in CARE principles and training methods through a 5-day manualized program. Agency staff members are trained in CARE principles through a 5-day training program. CARE educators must be certified.

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for CARE: Creating Conditions for Change (CARE) as listed below:

As part of the implementation process, baseline surveys are administered to assess organizational culture, perceptions of safety, current status of the organization's crisis management system, and alignment of staff knowledge, beliefs and practice with the CARE principles. The CARE consultants present findings from this assessment at an agency leadership retreat, and help participants consider how several aspects of culture (proficiency, resistance, rigidity) and climate (stress, engagement, functionality) may have implications for the upcoming CARE implementation process. The surveys are administered only as part of an agreement with Cornell University.

Formal Support for Implementation

There is formal support available for implementation of CARE: Creating Conditions for Change (CARE) as listed below:

Cornell University supports agencies with Implementation of CARE through a 4-year implementation agreement and contract (see the https://rccp.cornell.edu/downloads/CARE_INFO_BULLETIN_2024.pdf). At the start of the implementation agreement, the agency is assigned a CARE team comprised of 2 to 3 Cornell faculty members specializing in CARE content and organizational implementation strategies. These CARE consultants provide onsite assistance throughout the implementation period. Cornell consultants also provide on-going support through regular email, teleconferencing, and video conferencing.

During the implementation period, agency leaders are trained in the CARE model, the 6 core principles, and organizational change strategies during a 3- to 4-day leadership retreat. In addition, agency personnel are trained as CARE educators and certified to conduct the CARE training curriculum with agency staff.

Technical assistance visits include observation and feedback, training and coaching for frontline supervisors, developing routines for reflective practice, assistance with survey administration and data analysis, and addressing organizational barriers to create a more therapeutic milieu. After implementation is complete, there is a 3-year sustainability agreement that includes an annual onsite visit and continued email communication, teleconferences, videoconferences and access to annual regional, national, and international events. Agencies can apply for CARE Agency Certification once CARE is fully implemented. Support during the sustainability agreement includes continued support through onsite visits, training, on-going data collection and survey analysis, certification (or re-certification) assessment visit, and on-going certification of agency staff to deliver CARE training throughout their organization.

Fidelity Measures

There are fidelity measures for CARE: Creating Conditions for Change (CARE) as listed below:

• The CARE staff surveys (administered at baseline, midway through the implementation period, and during the sustainability agreement) measure staff's knowledge and beliefs about effective childcare practice as well as their actual practices to optimize children's residential experiences in order to track alignment with the 6 CARE principles.
• Given the centrality of high-quality relationships between staff and the children they care for in the CARE program model, children are asked to complete a survey that assesses their perceptions about the relationships they have with staff, thus incorporating the children’s perceptions of their lived experience as a component of assessing the implementation of CARE.
• Essential elements of the CARE program model have been identified and fidelity tools that assess the structures and processes necessary to sustain the CARE model have been developed. These measures are used by the leadership team as a self-assessment process as well as by the Cornell consultants to provide feedback and recommendation for continued improvement and agency CARE certification.

Implementation Guides or Manuals

There are implementation guides or manuals for CARE: Creating Conditions for Change (CARE) as listed below:

The book, CARE: Creating Conditions for Change (3rd edition), provides substantial information about implementing the CARE program model.

Research on How to Implement the Program

Research has been conducted on how to implement CARE: Creating Conditions for Change (CARE) as listed below:

Anglin, J. P. (2011). Translating the CARE program model into practice: Lessons from the pioneer agencies on changing agency cultures and care practices. https://rccp.cornell.edu/downloads/Translating%20the%20CARE%20Program%20Model%20into%20Practice.pdf

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Additional References