Residential child care project addresses emotional pain without causing it

A model of care for children's residential agencies takes children's emotional pain into account and emphasizes the bond between the children and their caregivers.

The model was developed over nearly 15 years by the Residential Child Care Project at Cornell University. In the four-year study at 13 facilities, the Children and Residential Experiences (CARE) model reduced behavioral incidents and improved their relationships with caregivers.

"The ability to deal with children's psycho-emotional pain without inflicting additional painful experiences on them is one of the biggest challenges for caregivers and therapeutic residential care," the authors wrote.

Co-authors Martha Holden, project director of the Residential Child Care Project, and Deborah Sellers, the project's director of research, said most children and young people in residential programs have had traumatic experiences such as severe loss, neglect, rejection and abuse. Unfortunately, many agencies lack a comprehensive vision of how to help the children change and grow.

To develop the CARE model, the team explored existing studies about the effects of trauma on children and strategies that have been proven effective in dealing with it. CARE orients agency practices around six core principles to produce programming that is: based on relationships between children and caregivers, informed by the trauma children have likely endured, targeted at each child's developmental stage and needs, family oriented, focused on allowing children to develop their own competence, and open to adapting their environments to support the children's process.

In the four-year study of the CARE model, 13 agencies in North Carolina showed decreases of 3 to 5 percent per month in incidents of aggression toward staff, property destruction and running away. Children's perceptions of the quality of their relationships with caregivers, according to surveys, improved by 8 to 14 percent.

The paper, "An Evidence-Based Program Model for Facilitating Therapeutic Responses to Pain-Based Behavior in Residential Care," was published in the International Journal of Child, Youth and Family Studies.