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Child-Adult Relationship Enhancement (CARE)

Category

Family Support

Child's Age

2-3 years, 3-4 years, 4-5 years

Participant

Parents/Guardian, ECE Owner/Operator, ECE Teachers, Human Service Professionals, Medical Professionals

Languages

English

Brief Description

Trauma-informed training to develop skills for improving attachment and/or strengthening relationships while reducing mild to moderate behavior concerns, and for increasing compliance.

Expected Impact

  • General increases in positive parenting
  • General decreases in problem behaviors

Core Components for Model Fidelity

  • Training: CARE blends lectures, activities, and live practice with trainer feedback to create a fast-paced, fun-filled training experience. All components are grounded in an understanding of the impact of trauma on relationships and behaviors.

Languages Materials are Available in

English

Delivery Mode

In-person for up to 30 participants or virtually for up to 10 participants. 

Dosage

One 3-6 hour training session.

Consultation follow-up is available, and the training timeline can be modified to suit the organizations’ needs.

Infrastructure for Implementation

Materials: Handouts are provided at training sessions.

Space: In-person training for participants can take place at the Center for Child & Family Health in Durham, NC, and/or in community setting.

Staffing Requirements

CARE training is provided by the Center for Child & Family Health and/or by approved CARE facilitators. CARE facilitators can only be trained by the Center for Child & Family Health. 

For sustainability, CARE Facilitators and CARE Coaches are recommended.

  • CARE Facilitator (train-the-trainer course): CARE Facilitators must be licensed mental health professionals  and complete the CARE Facilitator course (3-6 hours) and are certified in one of the models CARE is based on:
    • Parent-Child Interaction Therapy (PCIT)
    • Incredible Years (IY)
    • Positive Parenting Program (Triple-P)
    • Helping the Noncompliant Child (HNC)
    • Parent Management Training – Oregon Model (PMTO)
  • CARE Coach: Coaches are optional staff members who serve as an extension of the CARE Facilitator and provide one-on-one coaching. All coaches must complete the CARE Coach Course (3-6 hour course).

NCPC strongly recommends staff receive training in the Standards of Quality for Family Support and Strengthening. Contact Prevent Child Abuse North Carolina | PCANC (preventchildabusenc.org) or National Family Support Network for more information, training and certification.

Training for Model Fidelity

Organizations are encouraged to use a cohort approach when sending participants to be trained in CARE. 

Every CARE training participant can train anyone on a 1:1 basis. Only CARE Trainers and CARE Facilitators are eligible to train in a group format.

Contact Information

https://www.ccfhnc.org/programs/pcit-care-training/

Darden White, LCMHCS: Associate Director of PCIT & CARE Training;  darden.white@duke.edu

Cost Estimates

The cost for a CARE Workshop varies. The Center for Child & Family Health offers in-person CARE Workshops in Durham, NC for $100/person (cost is subject to change). The Center for Child & Family Health can also work with organizations to contract trainings in their area upon request. For more information and to contact the CARE training team, please use this link: https://www.ccfhnc.org/programs/pcit-care-training/.

Purpose Service Code (PSC)

5505 – Parent Education

Program Identifier (PID)

Child-Adult Relationship Enhancement (CARE)

Minimal Outputs for NCPC Reporting

FY 23-24:

  • Number of parent/guardians participating†
  • Number of non-parent adults participating

FY 24-25:

  • Number of parent/guardian's participating†
  • Number of professionals participating

†Select Family Support Programs data collection will include basic demographic data for parent/guardian participants including Race, Ethnicity. Data on interpretation and transportation will be collected when appropriate.

Minimal Outcomes for NCPC Reporting

FY 23-24:

  • Increase in provider knowledge

FY 24-25:

  • Increase in parent knowledge                

Minimal Measures for NCPC Reporting

FY 23-24:

  • CARE Evaluation- Smart Start Version (L&E can provide to LPs implementing) 

FY 24-25:

  • CARE Evaluation- Smart Start Version (L&E can provide to LPs implementing) 

NCPC Evidence Categorization

Evidence Based- 2 randomized controlled trials and 1 quasi-experimental study with a historical comparison group.

Research Summary

Recent publications include two randomized control trials, a within-subjects study, and a comparison study using an historical sample. Overall, the research has shown CARE (Child Adult Relationship Enhancement) to have positive outcomes and to be an appropriate training for various populations. In the foster care community, those trained in CARE showed significant increases in the number of positive parenting statements and decreases in negative parenting statements. Decreases were also found for the number of problem behaviors in young children and less anxiety issues.1,2  In the primary care setting, parents that were involved in PriCARE saw significant decreases in problem behaviors and the use of physical punishment. Parents’ empathy, understanding, and acceptance of children’s independence significantly increased.3 When examining the use of IntegratedCARE in a primary care clinic, results showed results showed that the parents found their children to be less difficult by the end of the intervention and there were significant decreases in both the frequency and irritation from their children’s behaviors.4

  1. ^ See Messer, et al. (2018). This study was conducted to test the feasibility and effectiveness of CARE training in the foster-care community. 31 foster caregivers were randomly assigned to CARE or the standard training. Data collected focused on interactions with foster children and the amount of trauma related behaviors/symptoms noted. The foster children were ages three through twelve in this study. Data was collected using the Dyadic Parent-Child Interaction Coding-IV and the Trauma Symptom Checklist for Young Children. 
  2. ^ See Wood, et al. (2019). This study compares Child-Adult Relationship Enhancement (CARE) training to standard training in a foster care environment through comparing foster caregivers that received CARE training with a historical comparison group. The foster children targeted were ages three to eight and new to foster care. Researchers used structured interviews with the caregivers, the Child Behavior Checklist (CBCL), and agency reports in order to collect data.
  3. ^ See Schilling, et al. (2017). The authors conducted a pilot study on CARE in primary care settings (PriCARE). The study was designed to see differences in parenting attitudes and reported problem behaviors by parents of children 2 to 6 years old. Parents were randomly assigned to either PriCARE or the control group. Researchers used surveys, the Eyberg Child Behavior Inventory (ECBI) and the Adult Adolescent Parenting Inventory 2 (AAPI2) for data collection.
  4. ^ See Scott et al. (2021). This article examines a modified version of the CARE model, known as IntegratedCARE (I-CARE), for use in a primary care clinic. The study used a within subjects, time-series design and I-CARE was provided to parents and their children (ages 2 to 8). The researchers used the Parenting Stress Index 4-Short Form and the Eyberg Child Behavior Inventory to measure the frequency of behaviors and which behaviors were found irritating by the parents.

Researched Population

  • Parents, Foster, and Adoptive parents
  • Medical, Mental Health, and Allied Health professionals

Messer, E.P., Greiner, M., Beal, S., Cassedy, A., Eismann, E., Gurwitch, R.H., Boat, B., Bensman, H., Bemerer, J., Greenwell, S., Eiler-Sims, P. (2018). Child Adult Relationship Enhancement (CARE): A brief, skills-building training for foster caregivers to increase positive parenting practices. Children and Youth Services Review, 90, 74-82. https://www.doi.org/10.1016/j.childyouth.2018.05.017

Schilling, S., French, B., Berkowitz, S. J., Dougherty, S. L., Scribano, P. V., & Wood, J. N. (2017). Child-Adult Relationship Enhancement in Primary Care (PriCARE): A randomized trial of a parent training for child behavior problems. Academic Pediatrics, 17, 53–60.  http://dx.doi.org/10.1016/j.acap.2016.06.009

Scott, B., Gurwitch, R. H., Messer, E. P., Kelley, L. P., Myers, D. R., & Young, J. K. (2021). Integrated CARE: Adaptation of Child-Adult Relationship Enhancement (CARE) Model for use in integrated behavioral pediatric care. Clinical Pediatrics, 60(2), 100-108. https://www.doi.org/10.1177/0009922820959938

Wood, J., Dougherty, S. L., Long, J., Messer, E. P., & Rubin, D. M. (2019). A pilot investigation of a novel intervention to improve behavioral well-being for children in foster care. Journal of Emotional and Behavioral Disorders, 27(1), 3-13. https://doi.org/10.1177/1063426617733715

CARE offers multiple adaptations based on different delivery settings. Only CARE and FosterCARE meet Smart Start criteria for an evidence-based program eligible for Smart Start funding.



Local Partnerships Currently Implementing

Local Partnerships in purple have adopted Child-Adult Relationship Enhancement (CARE). Local Partnership contact information can be found here.